Question 1

A patient with asthma who is 32 weeks pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. What should the nurse respond to this patient's concern?

Accepted Answer

Some asthma maintenance medication such as beta-adrenergic agonists may be taken safely during pregnancy, but they have the potential to reduce labor contractions. The doses of these medications may be reduced as the patient approaches the time of delivery. Not all asthma medication is teratogenic. Asthma can improve during pregnancy because of circulating corticosteroids; however, the doses of the medications should have already been adjusted according to the patient's symptoms. There is no evidence to support that asthma medication is ineffective during pregnancy.

Question 2

A patient with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the patient to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes?

Accepted Answer

To support the 2020 National Health Goals, the nurse should instruct the patient to enter pregnancy without hyperglycemia. This action helps reduce congenital anomalies in newborns. Reducing exercise, limiting carbohydrates and fats, and reducing the use of insulin for blood glucose coverage does not support the 2020 National Health Goals to reduce the complications of pregnancy associated with diabetes.

Question 3

A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. What should the nurse respond to the patient?

Accepted Answer

The first trimester of pregnancy is the most important time for fetal development. If the patient can control hyperglycemia during this time, the chances of a congenital anomaly are greatly reduced. Infants of patients with poorly controlled diabetes tend to be large. At birth, babies born to patients with uncontrolled diabetes are prone to respiratory distress syndrome. Elevated blood glucose levels do not hasten the development of the fetus in utero and can lead to hydramnios.

Question 4

The nurse determines that a pregnant patient is at risk for developing a deep vein thrombosis. What should the nurse instruct the patient to reduce the risk of this potential complication? (Select all that apply.)

Accepted Answer

The risk of thrombus formation can be reduced through measures such as avoiding the use of constrictive knee-high stockings, not sitting with legs crossed at the knee, and avoiding standing in one position for a long period. Calcium restriction does not reduce the risk of thrombus formation and could potentially harm the developing fetus. The nurse cannot prescribe medication, and the patient should not take any medication without direction from the health care provider.

Question 5

A patient with diabetes who is in the second trimester of pregnancy notes that the usual dose of insulin to maintain blood glucose levels has been increasing over the last few weeks. What should the nurse explain to the patient about insulin during pregnancy?

Accepted Answer

Patients with diabetes, who become pregnant, develop insulin resistance as the pregnancy progresses, or insulin does not seem as effective during pregnancy. This phenomenon is believed to be caused by the presence of the hormone human placental lactogen and high levels of cortisol, estrogen, progesterone, and catecholamines. The increased need for insulin is not because of the fetus using insulin to maintain blood glucose level in utero. The patient's increased circulating blood volume is not deactivating insulin. The patient's change in diet might necessitate an adjustment in insulin dosage, but this would vary according to blood glucose level.

Question 6

A patient with heart disease who is 28 weeks pregnant asks the nurse why office appointments have been scheduled every week for the next 4 weeks. What should the nurse respond to the patient?

Accepted Answer

The danger of pregnancy in a patient with heart disease occurs primarily because of this increase in circulatory volume. The most dangerous time for the patient is in weeks 28 to 32, just after the blood volume peaks. Weekly appointments are not routine for all pregnant patients at this part of the pregnancy. This is not the time when most patients have a risk of going into early labor. The extra appointments are not needed to make sure the fetus is developing normally during this time period.

Question 7

The nurse is preparing to instruct a pregnant patient with a history of tuberculosis on care needed while pregnant. What should the nurse include when teaching this patient?

Accepted Answer

A patient who had tuberculosis earlier in life must be especially careful to maintain an adequate level of calcium during pregnancy to ensure the calcium tuberculosis pockets in the lungs are not broken down and the disease reactivated. A high vitamin C intake is not indicated for this patient's health history. Pushing during labor might cause calcified tuberculosis pockets in the lungs to break, but this does not mean that all patients with a history of tuberculosis have to have cesarean deliveries. All pregnant patients should be instructed to avoid upper respiratory infections.

Question 8

The nurse is caring for a patient who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this patient?

Accepted Answer

All patients expecting to become pregnant are advised to begin a supplement of 400 $\mu$g folic acid daily in addition to eating foods rich in folic acid. The folic acid supplement is not needed with each meal. Foods high in folic acid should be consumed in addition to the supplement. The patient should take folic acid supplements before becoming pregnant and not wait until pregnancy is confirmed.

Question 9

A patient who is 36 weeks pregnant has been taking phenytoin (Dilantin) for a seizure disorder. Which supplement should the nurse anticipate being prescribed for this patient?

Accepted Answer

Phenytoin (Dilantin) is believed to cause a fetal syndrome that includes vitamin K deficiency. To counteract the vitamin K deficiency and prevent hemorrhage in the newborn, the patient may be prescribed vitamin K during the last 4 weeks of gestation. Vitamins C, D, or E have no impact on the pregnant patient who is taking phenytoin (Dilantin) for a seizure disorder.

Question 10

The nurse instructs a pregnant patient with sickle-cell anemia on ways to prevent a crisis. Which patient statement indicates that teaching has been effective?

Accepted Answer

The fluid status of a pregnant patient with sickle-cell anemia is important because dehydration can precipitate a crisis. The patient should drink at least eight glasses of fluid each day to prevent dehydration. Patients with sickle-cell anemia should not take an iron supplement because the sickled cells cannot incorporate iron in the same way as nonsickled cells. Standing for long periods of time can cause red cell destruction in the patient with sickle-cell anemia. The patient should sit with the legs elevated to encourage venous return of blood from the lower extremities.

Question 11

The nurse is reviewing medication orders for a pregnant patient diagnosed with a urinary tract infection. Which medication order should the nurse question for this patient?

Accepted Answer

Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. Tetracyclines are contraindicated during pregnancy because they cause retardation of bone growth and staining of the fetal teeth.

Question 12

A postpartum patient with systemic lupus erythematosus asks why symptoms of the disease are worse now that the baby has been born. What should the nurse explain to the patient?

Accepted Answer

During the postpartum period, there may be an acute exacerbation of systemic lupus erythematosus symptoms because corticosteroid levels are returning to normal.
Symptoms are not increased because the fetus was keeping the symptoms in check. The stress of delivery is not causing the symptoms to increase. The symptoms are not because of a spike in maternal hormone levels.

Question 13

A pregnant patient is diagnosed with hyperthyroidism. For which medication should the nurse prepare teaching for this patient?

Accepted Answer

Methimazole is the preferred drug to treat pregnant patients with hyperthyroidism because it appears to cross the placenta less easily. Propylthiouracil crosses the placenta and can lead to congenital hypothyroidism and an enlarged thyroid gland in the fetus.
Cephalosporin is an antibiotic that is not used in the treatment of hyperthyroidism. Levothyroxine is thyroid hormone and is used in the treatment of hypothyroidism.

Question 14

The nurse is designing a plan of care for a pregnant patient with inflammatory bowel disease. What should be included in this patient's plan? (Select all that apply.)

Accepted Answer

Because of the potential difficulty with absorbing nutrients, the pregnant patient with inflammatory bowel disease needs careful monitoring for weight gain during pregnancy. Anti-inflammatory medication may be continued during pregnancy without fetal injury. The patient does not need a cesarean birth for this health problem. Foods and fluids should not be restricted because the patient has difficulty absorbing nutrients anyway.
Gamma globulin injections are not indicated for this disorder

Question 15

A patient in the second trimester of pregnancy is diagnosed with cervical cancer. For which treatment should the nurse instruct the patient as causing the least harm to the developing fetal?

Accepted Answer

As a rule, patients can receive chemotherapy in the second and third trimesters without adverse fetal effects. Radiation therapy puts the fetus at risk throughout pregnancy if the fetus is directly exposed. Chelation and anticoagulants are not therapies associated with cancer treatment.

Quiz 20: Nursing Care of a Family Experiencing a Pregnancy Complication From a Preexisting or Newly Acquired Illness