Question 1

Which postpartum client requires further assessment?

Accepted Answer

Frequent coughing may be a sign of congestive heart failure in the postpartum client with heart disease. Four saturated pads in a 4-hour period is acceptable postpartum blood loss, a fasting blood sugar is a normal value, and the client with identified active herpes does not require further assessment.

Question 2

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy?

Accepted Answer

Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

Question 3

The most important instruction to include in a teaching plan for a client in early pregnancy who has Class I heart disease is she:

Accepted Answer

Angina or a productive cough may signal congestive heart failure or pulmonary edema. Nausea and vomiting are expected in early pregnancy. Mild fatigue is expected in early pregnancy. Depending on the severity of the heart disease, the client may need to limit physical activity.

Question 4

When planning intrapartum care for a client with heart disease, the nurse should include:

Accepted Answer

A client with heart disease should have a cardiac monitor and possibly an arterial line for continuous blood pressure monitoring, as well as hemodynamic monitoring. Vital signs may need to be taken more frequently because of the extra workload on the heart. The uterus should not be massaged to hasten the birth of the placenta because this could cause undue overload on the heart. Circulatory overload can occur, so IV fluids may not be used or may be used minimally.

Question 5

A client has tested HIV-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?

Accepted Answer

The fetus is likely to test positive for HIV in the first 6 months, until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status. With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased. The pregnancy will increase the chance of converting.

Question 6

For which of the following infectious diseases can a woman be immunized?

Accepted Answer

Rubella is the only infectious disease for which a vaccine is available. There are no vaccines available for toxoplasmosis, cytomegalovirus, or herpesvirus type 2.

Question 7

Which client teaching instructions are necessary for a pregnant client who is to undergo a glucose challenge test (GCT) as part of a routine pregnancy treatment plan?

Accepted Answer

For a GCT, there are no dietary restrictions and fasting is not required. Testing is done from 24 to 28 weeks for the general pregnant population.

Question 8

Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant client with diabetes?

Accepted Answer

The occurrence of complications can be greatly diminished by maintaining normal blood glucose levels before and during the pregnancy. Even nonpregnant diabetics should have an annual eye examination. Assessing a client's emotional status is helpful. Coping with a pregnancy superimposed on preexisting diabetes can be very difficult for the whole family. However, it is not the top priority. Baseline renal function is assessed with a 24-hour urine collection and does not diminish the client's risk for complications.

Question 9

When a pregnant client with diabetes experiences hypoglycemia while hospitalized, which should the nurse have the client do?

Accepted Answer

Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will help increase the blood sugar level but will not sustain it. Orange juice and sugar will increase the blood sugar level but will not provide a slow-burning carbohydrate to sustain it.

Question 10

Which factor is known to increase the risk of gestational diabetes mellitus?

Accepted Answer

Prior birth of a large infant suggests gestational diabetes mellitus. A client younger than 25 is not at risk for gestational diabetes mellitus. Obesity (>90 kg [198 lb]) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

Question 11

Nursing intervention for pregnant clients with diabetes is based on the knowledge that the need for insulin is:

Accepted Answer

Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. Insulin needs change during pregnancy.

Question 12

A client, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?

Accepted Answer

Varicella (chickenpox) is highly contagious. Although the baby inherits immunity from the mother, it would not be safe to expose either the mother or the baby. Acyclovir is used to treat varicella pneumonia. The baby is already born and has received the immunity. If the mother never had chickenpox, she cannot transmit the immunity to the baby. Varicella infection occurring in a newborn may be life threatening.

Question 13

The labor nurse is providing care to a patient at 37 weeks' gestation who is an insulin-dependent diabetic. The health care provider prescribes an infusion of insulin throughout her induction to be titrated to keep her blood glucose levels below 110 mg/dL. What type of insulin will the nurse select to prepare the infusion?

Accepted Answer

Continuous infusion of a regular insulin solution combined with a separate intravenous solution containing glucose, such as 5% dextrose in Ringer's lactate, allows titration to maintain blood glucose levels between 80 and 110 mg/dL, or as designated by facility policy. The insulin solution is raised, lowered, or discontinued to maintain euglycemia based on hourly capillary blood glucose levels.

Question 14

A client has a history of drug use and is screened for hepatitis B during the first trimester. Which action is appropriate?

Accepted Answer

A person who has a history of high-risk behaviors should be rescreened during the third trimester. Hepatitis B is transmitted through blood. The first trimester is too early to discuss feeding methods with a woman in the high-risk category. The vaccine may not have time to affect a person with high-risk behaviors.

Question 15

Antiinfective prophylaxis is indicated for a pregnant client with a history of mitral valve stenosis related to rheumatic heart disease because the client is at risk of developing:

Accepted Answer

Because of vegetations on the leaflets of the mitral valve and the increased demands of pregnancy, the client is at greater risk of bacterial endocarditis. Pulmonary hypertension may occur with mitral valve stenosis, but antiinfective medications will not prevent it from occurring. Women with cardiac problems must be observed for possible infections during the postpartum period but are not given prophylactic antibiotics to prevent them. Women are not put on prophylactic antibiotics to prevent upper respiratory infections.

Question 16

Which disease process improves during pregnancy?

Accepted Answer

Although the reason is unclear, marked improvement is seen with rheumatoid arthritis in pregnancy. Most women relapse 6 weeks to 6 months postpartum. With epilepsy, the effect of pregnancy is variable and unpredictable. Seizures may increase, decrease, or remain the same. Bell's palsy was thought to be caused by a virus three times more common during pregnancy and generally occurring in the third trimester. The client with SLE can have a normal pregnancy but must be treated as high risk because 50% of all births will be premature. Pregnancy can exacerbate SLE.

Question 17

Which instructions should the nurse include when teaching a pregnant client with Class II heart disease?

Accepted Answer

Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept at a minimum with heart disease. Iron and folic acid are important to prevent anemia. Fluid intake is necessary to prevent fluid deficits. Fluid intake should not be limited during pregnancy. The client may also be put on a diuretic.

Question 18

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

Accepted Answer

The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops, and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation, which results in hyperbilirubinemia.

Question 19

Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?

Accepted Answer

Transmission of congenital rubella causes serious complications in the fetus that may manifest as cataracts, cardiac defects, microcephaly, deafness, intrauterine growth restriction (IUGR), and developmental delays.

Question 20

A client who has type 2 diabetes is pregnant with her second child. She was not diagnosed with diabetes until after her first pregnancy. Past obstetric history is unremarkable-spontaneous vaginal birth of a male weighing 7 pounds, 15 ounces. The client is now concerned over what will happen during this subsequent pregnancy as a result of her disease process. What impact could the disease process have on her upcoming birth?

Accepted Answer

Because of the presence of diabetes as a concurrent disease, the client will be closely monitored and a planned birth will be instituted to improve health outcomes for mother and fetus. Epidurals can be administered to obstetric clients who are diabetics. Although there is an increased risk for macrosomia and dystocia, the client will be prospectively managed and may still be able to have a vaginal birth. Because of the presence of diabetes as a concurrent disease, it is more likely that she will deliver a macrosomic infant who would be large for gestational age (LGA).

Quiz 26: Concurrent Disorders During Pregnancy