Deck 14: Pregnancy at Risk: Pre-Existing Conditions

Question 1

The nurse should be aware of which of the following in relation to diabetes in pregnancy?

A) With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern.
B) The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
C) Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.
D) At birth the neonate of a diabetic mother is no longer at any risk.

Answer 1

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

Question 2

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 which of the following?

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

Answer 2

Macrosomia

Question 3

Preconception counselling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with which of the following?

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

Answer 3

Congenital anomalies in the fetus

Question 4

Which factor increases the risk of mother-to-child perinatal HIV transmission?

A) Treatment with antiretroviral
B) Presence of chorioamnionitis
C) Bottle feeding after delivery
D) Maternal plasma viral level less than 1000 copies per mL

Question 5

While providing care in an obstetrical setting,the nurse should understand that postpartum care of the woman with cardiac disease should include which of the following?

A) It should be the same as that for any pregnant woman.
B) It includes rest, stool softeners, and monitoring of the effect of activity.
C) It includes ambulating frequently, alternating with active range of motion.
D) It includes limiting visits with the infant to once per day.

Question 6

The nurse must be alert for which signs and symptoms of cardiac decompensation when caring for a pregnant woman with cardiac problems?

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

Question 7

Which of the following should the nurse know in terms of the incidence and classification of diabetes?

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 8

In providing nutritional counselling for the pregnant woman experiencing cholecystitis,the nurse should include which of the following?

A) Assess the woman's dietary history for adequate calories and proteins.
B) Instruct the woman that the bulk of calories should come from proteins.
C) Instruct the woman to eat a low-fat diet and avoid fried foods.
D) Instruct the woman to eat a low-cholesterol, low-salt diet.

Question 9

With regard to maternal diabetes and other risk situations affecting the mother and fetus,what should the nurse should be aware of?

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 10

In planning for the care of a 30-year-old woman with pregestational diabetes,what does the nurse recognize as the most important factor affecting pregnancy outcome?

A) Mother's age
B) Number of years since diabetes was diagnosed
C) Amount of insulin required prenatally
D) Degree of glycemic control during pregnancy

Question 11

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand.Which of the following is important for the nurse to know?

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 12

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 2 kilograms 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

Question 13

A woman with asthma is experiencing a postpartum hemorrhage.Which drug would be recommended to treat her bleeding that would not exacerbate her asthma?

A) Oxytocin
B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Hemabate
D) Fentanyl

Question 14

Which of the following statements is accurate in providing perinatal care for women who use substances?

A) A decision to stop using substances must be made by the family.
B) Harm reduction practices are not effective with pregnant women.
C) Effects of perinatal substance use in pregnancy and postpartum must be reviewed.
D) Use of community resources for women to eliminate a social bias for perinatal care must be avoided.

Question 15

A woman has presented at the prenatal clinic with a previous history of rheumatic heart disease.Prophylaxis treatment of subacute bacterial endocarditis is given before and after birth when a pregnant woman has which of the following?

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

Question 16

The nurse providing care for a woman with gestational diabetes understands which of the following about a laboratory test for glycosylated hemoglobin Alc?

A) The test is now done for all pregnant women, not just those with or likely to have diabetes.
B) The test is a snapshot of glucose control at the moment.
C) The test is completed to evaluate glycemic control over time.
D) The test is done on the patient's urine, not her blood.

Question 17

Which of the following should the nurse know about drug testing during pregnancy in Canada?

A) It is required at the first prenatal visit.
B) Only those drugs disclosed by the woman are tested for.
C) There is no legal requirement to test the mother or the newborn child.
D) Testing is required before labour and delivery.

Question 18

In assessing the knowledge of a pregestational woman with type 1 diabetes about changing insulin needs during pregnancy,the nurse recognizes that further teaching is warranted when the patient states which of the following?

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 19

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels.She shows the nurse her readings for the past few days.Which reading should the nurse tell her is not within the normal limits for blood glucose levels?

A) 3.2 mmol/L
B) 3.8 mmol/L
C) 4.2 mmol/L
D) 4.8 mmol/L

Question 20

What normal fasting glucose level should the nurse recommend for a woman with pregestational diabetes?

A) 2.5-3.5 mmol/L
B) 3.8-5.2 mmol/L
C) 5.5-7.7 mmol/L
D) 5.0-6.6 mmol/L

Question 21

During a physical assessment of an at-risk patient,the nurse notes generalized edema,crackles at the base of the lungs,and some pulse irregularity.The nurse knows that these are most likely signs of which of the following conditions?

A) Euglycemia
B) Rheumatic fever
C) Pneumonia
D) Cardiac decompensation

Question 22

Since the gene for cystic fibrosis was identified in 1989,data can be collected for the purposes of genetic counselling for couples regarding carrier status.According to statistics,cystic fibrosis occurs once in how many White live births?

A) 100
B) 1200
C) 2500
D) 3300

Question 23

What should the nurse caring for antepartum women with cardiac conditions be aware of?

A) Stress on the heart is greatest in the first trimester and the last 2 weeks before labour.
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 through most of the pregnancy and face the possibility of hospitalization near term.

Question 24

Marfan syndrome is an autosomal dominant genetic disorder that displays as weakness of the connective tissue,joint deformities,ocular dislocation,and weakness to the aortic wall and root.While providing care to a patient with Marfan syndrome early in her pregnancy,which intervention should the nurse initially anticipate?

A) Antibiotic prophylaxis
B) b-Blockers
C) Surgery
D) Regional anaesthesia

Question 25

What should nurses be aware of with regard to anemia?

A) It is the most common medical disorder of pregnancy.
B) It can trigger reflex brachycardia.
C) The most common form of anemia is caused by folate deficiency.
D) Thalassemia is a European version of sickle cell anemia.

Question 26

Which one of the following congenital anomalies may occur with the use of antiepileptic drugs (AEDs)?

A) Gastroschisis
B) Congenital heart disease
C) Diaphragmatic hernia
D) Intrauterine growth restriction

Question 27

In caring for a pregnant woman with sickle cell anemia with increased blood viscosity,the nurse is concerned about the development of a thromboembolism.Which of the following would be important to include in nursing care?

A) Monitor the patient for loss of deep tendon reflexes.
B) Massage her calves when the woman complains of pain.
C) Apply antiembolic stockings.
D) Maintain a restriction on fluid intake.

Question 28

With which of following heart conditions is pregnancy usually contraindicated?

A) Pre-existing hypertension
B) Eisenmenger syndrome
C) Heart transplant
D) Aortic valve stenosis

Question 29

What is the most common neurological disorder accompanying pregnancy?

A) Eclampsia
B) Bell's palsy
C) Epilepsy
D) Multiple sclerosis