Deck 20: Pregnancy at Risk: Preexisting Conditions

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:

A) Macrosomia.
B) Congenital anomalies of the central nervous system.
C) Preterm birth.
D) Low birth weight.

Answer 1

Macrosomia.

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?

A) Deficient fluid volume
B) Imbalanced nutrition: less than body requirements
C) Imbalanced nutrition: more than body requirements
D) Disturbed sleep pattern

Answer 2

Imbalanced nutrition: less than body requirements

Question 3

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

A) Analgesia.
B) Oxygen.
C) Hydration.
D) Antibiotics.

Answer 3

Antibiotics.

Question 4

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

A) Frequent episodes of maternal hypoglycemia.
B) Congenital anomalies in the fetus.
C) Polyhydramnios.
D) Hyperemesis gravidarum.

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):

A) Miscarriage.
B) Intrauterine growth restriction (IUGR).
C) Nephritis.
D) Preeclampsia.
E) Caesarean birth.

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:

A) 65 to 95 mg/dl.
B) 130 to 140 mg/dl.
C) 200 mg/dl.
D) 55 mg/dl.

Question 7

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

A) Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
B) Hydramnios occurs approximately twice as often in diabetic pregnancies.
C) Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
D) Even mild-to-moderate hypoglycemic episodes can 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:

A) Valvular disease.
B) Congestive heart disease.
C) Arrhythmias.
D) Postmyocardial infarction.

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?

A) Methamphetamine is a depressant.
B) All methamphetamines are vasodilators.
C) Methamphetamine users are extremely psychologically addicted.
D) Rehabilitation is usually 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:

A) A regular heart rate and hypertension.
B) An increased urinary output, tachycardia, and dry cough.
C) Shortness of breath, bradycardia, and hypertension.
D) Dyspnea; crackles; and an irregular, weak pulse.

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:

A) Present
B) Partner
C) Past
D) Pregnancy

Question 12

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

A) Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
B) Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
C) Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
D) Women with class I cardiac disease need bed rest throughout most of the pregnancy and face the possibility of hospitalization near term.

Question 13

With what heart condition is pregnancy not usually contraindicated?

A) Peripartum cardiomyopathy
B) Eisenmenger syndrome
C) Heart transplant
D) All of these contraindicate pregnancy.

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:

A) "I will need to increase my insulin dosage during the first 3 months of pregnancy."
B) "Insulin dosage will likely need to be increased during the second and third trimesters."
C) "Episodes of hypoglycemia are more likely to occur during the first 3 months."
D) "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding."

Question 15

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

A) Type 1 diabetes is most common.
B) Type 2 diabetes often goes undiagnosed.
C) Gestational diabetes mellitus (GDM) means that the woman will be receiving insulin treatment until 6 weeks after birth.
D) Type 1 diabetes may become type 2 during pregnancy.

Question 16

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

A) Cleft lip.
B) Congenital heart disease.
C) Neural tube defects.
D) Gastroschisis.
E) Diaphragmatic hernia.

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:

A) Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own.
B) Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar.
C) During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
D) Maternal insulin requirements steadily decline during pregnancy.

Question 18

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

A) It is a recognized cause of preterm labor.
B) The fetus may develop neurologic problems.
C) A pregnant woman is more likely to die without dietary control.
D) Women with PKU are usually retarded and should not reproduce.

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?

A) 1 in 100
B) 1 in 1200
C) 1 in 2500
D) 1 in 3200

Question 20

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

A) Is now done for all pregnant women, not just those with or likely to have diabetes.
B) Is a snapshot of glucose control at the moment.
C) Would be considered evidence of good diabetes control with a result of 2.5% to 5.9%.
D) Is done on the patient's urine, not her blood.

Question 21

The standard of care for women who are dependent on heroin or other narcotics is ____________________ maintenance treatment (MMT).