Question 1

A patient 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 2

Which disease process improves during pregnancy?

Accepted Answer

Although the reason is unclear, marked improvement is seen with rheumatoid arthritis in pregnancy. Unfortunately relapse occurs within 36 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 the result of infection by a virus three times more common during pregnancy and generally occurring in the third trimester. The patient 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 3

Anti-infective prophylaxis is indicated for a pregnant patient with a history of mitral valve stenosis related to rheumatic heart disease because the patient is at risk of developing

Accepted Answer

Because of vegetations on the leaflets of the mitral valve and the increased demands of pregnancy, the patient is at greater risk of bacterial endocarditis. Pulmonary hypertension may occur with mitral valve stenosis, but anti-infective 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 4

A patient has a history of drug use and is screened for hepatitis B during the first trimester. Which action is most 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 5

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 6

What is the value of the main line fluid rate for your patient, whose total fluid intake is ordered at 150 mL/hour and who is also being given magnesium sulfate at 1 g/hour (1 g = 25 mL/hour) IV piggyback and pitocin at 15 mU/minute (l mU/minute = 1 mL/hour) IV piggyback. ______

Accepted Answer

The answer of What is the value of the main...

Question 7

The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.)

Accepted Answer

Signs of magnesium toxicity include the following:
· Respiratory rate of less than 12 breaths per minute (hospitals may specify a rate <14 breaths per minute)
· Maternal pulse oximeter reading lower than 95%
· Absence of deep tendon reflexes
· Sweating, flushing
· Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
· Hypotension
· Serum magnesium value above the therapeutic range of 4 to 8 mg/dL
Cold, clammy skin and a pulse oximeter reading of 95% would not be signs of toxicity.

Question 8

Which postpartum patient requires further assessment?

Accepted Answer

Frequent coughing may be a sign of congestive heart failure in the postpartum patient 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 patient with identified active herpes does not require further assessment.

Question 9

Which instructions should the nurse include when teaching a pregnant patient 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 patient may also be put on a diuretic.

Question 10

The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse's next action?

Accepted Answer

A cesarean birth is recommended for women with active lesions in the genital area, whether recurrent or primary, at the time of labor. The patient's dietary intake is needed to prepare for surgery. This patient is in active labor and the fetus is at risk for infection if the membranes rupture. The health care provider needs to be notified, and a cesarean birth needs to be performed as soon as possible. There is no need to validate the infection because the patient is well aware of the symptoms of an active infection. Although transmission to sexual partners is valid information, it is not necessary information in an urgent situation such as depicted in this scenario. Electronic fetal surveillance is the standard of care.

Question 11

The rate of obesity in the United States has reached epidemic proportions. Morbidity and mortality for both the mother and baby are increased in these circumstances. The nurse caring for the patient with an elevated BMI should be cognizant of these potential complications and plan care accordingly. Significant risks include (Select all that apply.)

Accepted Answer

Maternal complications associated with pregnancy include: Gestational diabetes, preeclampsia, venous thromboembolism, Caesarean delivery, wound infection, respiratory complications, preterm birth, birth trauma and postpartum anemia. Obese women also have an increased risk of spontaneous abortions and stillbirth. Complications for infants of obese mothers have an increased risk of neural tube defects, hydrocephaly, cardiovascular defects, macrosomia, hypoglycemia, and birth injuries from shoulder dystocia.

Question 12

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 13

The nurse is reviewing the instructions given to a patient at 24 weeks' gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?

Accepted Answer

A GCT is administered between 24 and 28 weeks of gestation, often to low- and high-risk antepartum patients. Fasting is not necessary for a GCT, and the woman is not required to follow any pretest dietary instructions. The woman should ingest 50 g of oral glucose solution, and 1 hour later a blood sample is taken. Fetal surveillance with kick counts is an ongoing evaluation for pregnant women; they should contact their health care provider if there is a noticeable decrease in fetal movement.

Question 14

A patient, 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 15

Nursing intervention for pregnant patients 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.

Quiz 10: Complications of Pregnancy