Question 1

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:

Accepted Answer

The fetus of a woman with GDM is at greatest risk for macrosomia, or excessive fetal growth, which increases the risk of birth injury, shoulder dystocia, and neonatal hypoglycemia. While preterm birth and low birth weight can occur in GDM pregnancies, they are not the greatest risks. Congenital anomalies of the central nervous system are not typically associated with GDM.

Question 2

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time?

Accepted Answer

The woman's weight loss and hyperthyroidism indicate that she may be experiencing an imbalance in nutrition, specifically less than body requirements. This nursing diagnosis would involve developing a plan to monitor and promote adequate nutritional intake, as well as assessing for any underlying factors contributing to the imbalance. The other options, deficient fluid volume, disturbed sleep pattern, and imbalanced nutrition more than body requirements, do not appear to be as relevant based on the information provided.

Question 3

In caring for a pregnant woman with sickle cell crisis, the nurse understands that management of this patient includes all except:

Accepted Answer

Antibiotics are not routinely used in the management of sickle cell crisis unless there is an associated infection. Analgesia is important for pain control, oxygen is given to prevent hypoxia, and hydration is important to prevent sickling and promote good circulation.

Question 4

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:

Accepted Answer

Poor glycemic control before and during early pregnancy is associated with Congenital anomalies in the fetus.

Question 5

Systemic lupus erythematosus is a chronic multisystem inflammatory disease that affects skin, joints, kidney, lungs, CNS, liver, and other organs. A lupus flare up during pregnancy or early postpartum occurs in 15% to 60% of women with this disorder. Maternal risks include (choose all that apply):

Accepted Answer

The answer of Systemic lupus erythematosus is a chronic multisystem...

Question 6

In teaching the woman with pregestational diabetes about desired glucose levels, the nurse explains that a normal fasting glucose level, such as before breakfast, is in the range of:

Accepted Answer

A normal fasting glucose level is generally considered to be between 65 and 95 mg/dl. However, the target range for a woman with pregestational diabetes may be more specific and individualized based on her medical history and glucose control goals.

Question 7

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:

Accepted Answer

Prompt treatment of DKA is necessary to save the fetus and the mother.Hydramnios occurs 10 times more often in diabetic pregnancies.Infections are more common and more serious in pregnant women with diabetes.Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

Question 8

Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has:

Accepted Answer

Prophylaxis of subacute bacterial endocarditis is recommended for pregnant women with valvular disease to prevent the risk of bacterial infection during childbirth.

Question 9

Methamphetamine use during pregnancy is a growing problem that the nurse working with obstetric patients must be cognizant of. When caring for the patient who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance?

Accepted Answer

Methamphetamine is a stimulant, not a depressant. While some forms of methamphetamines may have vasodilator effects, this is not true for all types. Methamphetamine users are known to have a high risk of psychological addiction and rehabilitation can be challenging and often not successful.

Question 10

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which are:

Accepted Answer

The signs and symptoms of cardiac decompensation include dyspnea, crackles, and an irregular, weak pulse. The presence of these symptoms requires immediate action and medication to prevent further decompensation or harm to the mother and fetus. Options A, B, and C are incorrect because they do not correspond with the typical signs and symptoms of cardiac decompensation.

Question 11

Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. The 4 Ps include all except:

Accepted Answer

The 4 Ps Plus screening tool includes Partner, Past, and Pregnancy, but not Present.

Question 12

Nurses caring for antepartum women with cardiac conditions should be aware that:

Accepted Answer

Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. This is because they are at a higher risk for complications due to their cardiac condition during pregnancy. The stress on the heart is not necessarily greatest in the first trimester or the last 2 weeks before labor, and bed rest is not typically recommended for women with class I cardiac disease. Women with class III cardiac disease may need to limit their activity level, but the specific recommendation is not to get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.

Question 13

With what heart condition is pregnancy not usually contraindicated?

Accepted Answer

A heart transplant, if successful and stable, does not usually contraindicate pregnancy, unlike peripartum cardiomyopathy and Eisenmenger syndrome, which pose significant risks.

Question 14

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the woman states:

Accepted Answer

Insulin needs typically decrease during the first trimester due to increased insulin sensitivity and lower levels of counter-regulatory hormones. Therefore, stating that insulin dosage needs to increase during the first trimester indicates a misunderstanding.

Question 15

In terms of the incidence and classification of diabetes, maternity nurses should know that:

Accepted Answer

Type 2 diabetes often goes undiagnosed and may be present in a pregnant woman without her knowledge. Type 1 diabetes is less common than type 2, and gestational diabetes usually only requires insulin treatment during pregnancy and not necessarily up to 6 weeks after birth. Type 1 diabetes does not become type 2 during pregnancy.

Question 16

Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (choose all that apply):

Accepted Answer

Congenital anomalies that can occur with AEDs include cleft lip or palate,congenital heart disease,urogenital defects,and neural tube defects.Congenital anomalies of gastroschisis and diaphragmatic hernia are not associated with the use of AEDs.

Question 17

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that:

Accepted Answer

During the second and third trimesters, hormones produced by the placenta (human placental lactogen, estrogen, and progesterone) have a diabetogenic effect, increasing insulin resistance in the mother and ensuring an abundant supply of glucose for the fetus. Insulin requirements in the mother usually increase during this time. Insulin does not cross the placenta to the fetus, but glucose does. Women with insulin-dependent diabetes are not prone to hyperglycemia because they are consuming more sugar, but because the hormonal changes in pregnancy can make it difficult for them to control their blood glucose levels. Maternal insulin requirements do not steadily decline during pregnancy, but may decrease during the first trimester before increasing again in the later stages.

Question 18

Maternal phenylketonuria (PKU) is an important health concern during pregnancy because:

Accepted Answer

Maternal PKU can lead to high levels of phenylalanine in the mother's blood, which can cross the placenta and affect fetal development. This can result in neurologic problems, intellectual disability, low birth weight, and other complications for the fetus. It is important for women with PKU to maintain strict dietary control before and during pregnancy to minimize these risks. Preterm labor and maternal mortality are not commonly associated with maternal PKU, and the notion that women with PKU should not reproduce is outdated and stigmatizing.

Question 19

Since the gene for cystic fibrosis was identified in 1989, it has been possible to collect data for the purposes of genetic counseling for couples in regard to carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births?

Accepted Answer

Cystic fibrosis occurs in 1 in 3200 Caucasian live births.

Question 20

The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc:

Accepted Answer

Glycosylated hemoglobin Alc is a laboratory test that gives an overall picture of blood glucose control over the past 2-3 months. A result of 2.5% to 5.9% is considered evidence of good diabetes control.

Quiz 20: Pregnancy at Risk: Preexisting Conditions