Deck 14: Pregnancy at Risk: Pregestational Problems

Question 1

A client who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which client statement indicates teaching has been effective?
1) "My body makes red blood cells that are smaller than they should be."
2) "Megaloblastic anemia is not known to cause any serious risks to my baby."
3) "Whenever possible, I should boil my vegetables in at least 2 quarts of water."
4) "I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet."

Answer 1

4

Question 2

A woman at 30 weeks' gestation and a history of sickle cell anemia is experiencing fever, chills, and diarrhea for 3 days. What are the most serious potential complications that this client faces?
1) Severe lethargy
2) Sickle cell crisis
3) Electrolyte imbalance
4) Fetal neural tube defects

Answer 2

2

Question 3

A client is identified as having hepatitis B surface antigen (HBsAG) early in her pregnancy. Which client statement about the labor and birth process and having hepatitis B infection indicates the need for additional teaching?
1) "Breastfeeding is a good feeding method for my baby."
2) "My baby will get a bath as soon as its temperature is stable."
3) "An internal fetal monitor will be applied as soon as possible during labor."
4) "Two shots will be given to my baby to prevent transmission of hepatitis B."

Answer 3

3

Question 4

A pregnant client at 23 weeks' gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective?
1) Broiled fish, lettuce salad, grapefruit half, carrot sticks
2) Pork chop, mashed potatoes and gravy, cauliflower, tea
3) Roast beef, steamed spinach, tomato soup, orange juice
4) Tofu with mixed vegetables in curry, milk, whole-wheat bun

Question 5

A client at 9 weeks' gestation learns about being HIV positive. Which client statement indicates teaching about the effects on the baby has been effective?
1) "The pregnancy will increase the progression of my disease and will reduce my CD4 counts."
2) "The HIV will not affect my baby, and I will have a low-risk pregnancy without additional testing."
3) "My baby will probably be born with anti-HIV antibodies, but that does not mean the baby is infected."
4) "I cannot take the medications that control HIV during my pregnancy because they will harm the baby."

Question 6

A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What should the nurse expect to see in the medical record?
1) Dyspnea and chest pain with mild exertion
2) Elective cesarean birth scheduled for 37 weeks
3) Discussed need for labor epidural and vacuum extraction
4) Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally

Question 7

A pregnant woman married to an intravenous drug user had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV?
1) Elevated blood pressure and ankle edema
2) Shortness of breath and frequent urination
3) Hemoglobin of 11 g/dL and a rapid weight gain
4) Unusual fatigue and recurring Candida vaginitis

Question 8

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which client statement indicates that teaching has been effective?
1) "A beer once a week will not damage the fetus."
2) "I can continue to drink alcohol until I am diagnosed as being pregnant."
3) "I can drink alcohol while breastfeeding since it does not pass into breast milk."
4) "I need to stop drinking alcohol completely when I start trying to get pregnant."

Question 9

A 26-year-old multigravida who is 28 weeks pregnant and follows a program of regular exercise develops gestational diabetes. What instructions should be included in a teaching plan for this client?
1) "Carry hard candy (or other simple sugar) when exercising."
2) "If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate."
3) "Exercise either just before meals or wait until 2 hours after a meal."
4) "If your blood sugar is more than 120 mg/dL, drink a glass of whole milk."

Question 10

A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control at 20 weeks' gestation asks how the diabetes will affect the baby. How should the nurse respond?
1) "Your baby may be smaller than average at birth."
2) "Your baby will probably be larger than average at birth." 3 "Your baby might have high blood sugar for several days."
4) "As long as you control your blood sugar, your baby will not be affected at all."

Question 11

A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit, which is the accurate approach to evaluate the client for diabetes?
1) Conduct screening for type 2 diabetes mellitus as soon as possible.
2) Begin serial testing of the client's serum glucose and HA_1c at 24 weeks' gestation.
3) If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM).
4) Recognize HA_1c equal to or greater than
4)5% or a fasting plasma glucose level equal to or greater than 90 mg/dL as being diagnostic of diabetes.

Question 12

The nurse suspects that a pregnant client is a substance user. Which approach should the nurse take during the health history?
1) Explaining how harmful drugs can be for her baby.
2) Asking the woman directly, "Do you use any street drugs?"
3) Asking the woman if she would like to talk to a counselor.
4) Asking some questions about over-the-counter medications and avoiding the mention of illicit drugs.

Question 13

A 20-year-old woman at 28 weeks' gestation has a history of past drug abuse and her urine screening indicates recent heroin use. What should the nurse recognize this client is at risk for developing?
1) Diabetes mellitus
2) Abruptio placentae
3) Erythroblastosis fetalis
4) Pregnancy-induced hypertension

Question 14

A pregnant client who uses cocaine and ecstasy on a regular basis asks why ecstasy should not be used during pregnancy. What should the nurse explain about this drug?
1) "It produces intrauterine growth restriction and meconium aspiration."
2) "It leads to deficiencies of thiamine and folic acid, which help the baby develop."
3) "It produces babies with small heads and short bodies with brain function alterations."
4) "It can cause a high fever in you if high doses are taken and therefore cause the baby harm."

Question 15

During the first antepartal visit, a client who is at 10 weeks' gestation learns of being HIV positive. Which client statement indicates an understanding of the plan of care both during the pregnancy and postpartally?
1) "I should not breastfeed my baby."
2) "When my baby is 2 months old, he or she will be tested for HIV."
3) "If I have a cesarean section, there is an increased risk that my HIV will be passed to my baby."
4) "I am supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."

Question 16

The prenatal clinic nurse has received four phone calls. Which client should be called back first?
1) Multipara at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding
2) Multipara at 6 weeks with a seizure disorder inquiring what foods are good sources of folic acid
3) Primipara at 28 weeks with a history of asthma reporting difficulty breathing and shortness of breath
4) Primipara at 35 weeks with a positive hepatitis B surface antigen (HBsAG) wondering what treatment her baby will receive after birth

Question 17

After completing a physical assessment the nurse determines that a laboring client is experiencing a panic attack. What findings did the nurse use to make this clinical determination? Select all that apply.
1) Flat affect
2) Monotone replies
3) Heart rate 120 bpm
4) Respiratory rate 28/minute
5) Disoriented to place and time

Question 18

The client with insulin-dependent type 2 diabetes and an HbA_1c of 5% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client?
1) Vascular disease that accompanies diabetes slows progression.
2) The risk of ketoacidosis decreases during the length of the pregnancy.
3) The baby is likely to have a congenital abnormality because of the diabetes.
4) Insulin needs decrease in the first trimester and increase during the third trimester.

Question 19

The nurse is concerned that a pregnant client is experiencing depression. Which potential health issues should the nurse include when planning care for this client? Select all that apply.
1) Alcohol use
2) Preterm birth
3) Poor appetite
4) Poor weight gain
5) Antenatal hemorrhage

Question 20

A client who is 32 weeks pregnant is HIV positive, but asymptomatic. What would be important in managing her pregnancy and delivery?
1) An amniocentesis at 30 and 36 weeks
2) Weekly non-stress testing beginning at 32 weeks' gestation
3) Administration of intravenous antibiotics during labor and delivery
4) Application of a fetal scalp electrode as soon as her membranes rupture in labor

Question 21

A pregnant client is diagnosed with a cardiac problem. What should the nurse prepare to instruct this client to do, to ensure a safe pregnancy? Select all that apply.
1) Restrict activities.
2) Follow a diet high in iron and protein.
3) Restrict the intake of sodium.
4) Obtain 8 to 10 hours of sleep.
5) Obtain pneumococcal vaccination.

Question 22

A client in labor is demonstrating acute manifestations of schizophrenia. What should the nurse identify as a priority for this client? Select all that apply.
1) Ensuring fetal well-being
2) Ensuring maternal well-being
3) Maintaining a safe environment
4) Medicating for pain as necessary
5) Considering pharmacologic intervention

Question 23

A 32-year-old pregnant client is diagnosed with active tuberculosis (TB). What fetal health issues is this client at risk for developing? Select all that apply.
1) Cleft palate
2) Preterm labor
3) Microcephaly
4) Spontaneous abortion
5) Suboptimal weight gain