Question 1

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 evaluating the patient for diabetes?

Accepted Answer

The current American Diabetes Association (ADA) guidelines recommend that all pregnant women who are at high risk for diabetes, including those with a history of gestational diabetes, be screened for type 2 diabetes at the first prenatal visit. This should be done with either a fasting plasma glucose level, an HA1c test, or a random plasma glucose test. Serial testing can be considered in those with normal initial testing results, but initial screening should occur as soon as possible. If diabetes is diagnosed, it should not be automatically classified as GDM, as this term refers specifically to diabetes that develops during pregnancy. Treatment and management may differ for pre-existing diabetes versus GDM.

Question 2

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which of the following statements made by the patient indicates to the nurse that the patient has understood the teaching?

Accepted Answer

This statement shows that the patient understands the importance of abstaining from alcohol when trying to conceive. A and C are incorrect because alcohol should be avoided completely during pregnancy. D is incorrect because alcohol does pass into breast milk and can harm the infant.

Question 3

During her first antepartal visit, a patient who is at 10 weeks' gestation reports that she is HIV-positive. Which statement made by the patient indicates an understanding of the plan of care both during the pregnancy and postpartally?

Accepted Answer

B) "I should not breastfeed my baby." is correct because HIV can be transmitted from mother to child through breast milk. Avoiding breastfeeding is a key recommendation for HIV-positive mothers in many settings to prevent postnatal transmission of HIV to the infant.

Question 4

The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The patient states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" The best response by the nurse is: "Ecstasy:

Accepted Answer

Ecstasy can cause hyperthermia (high fever) in the mother, which can be harmful to the developing fetus.

Question 5

A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the patient needs to be retested for HIV?

Accepted Answer

Unusual fatigue and recurring Candida vaginitis are both common symptoms of HIV infection, especially in women. Therefore, if the patient experiences these symptoms, it may be a potential indication for retesting for HIV.

Question 6

A 26-year-old multigravida is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this patient?

Accepted Answer

Carrying hard candy or another form of simple sugar is important for individuals with diabetes (including gestational diabetes) when exercising. This is because physical activity can lower blood sugar levels, potentially leading to hypoglycemia (low blood sugar). Having a quick source of sugar available can help manage sudden drops in blood sugar levels during or after exercise.

Question 7

A woman is 32 weeks pregnant. She is HIV-positive, but asymptomatic. What would be important in managing her pregnancy and delivery?

Accepted Answer

Weekly nonstress testing beginning at 32 weeks' gestation is important in managing the pregnancy and delivery of a woman who is HIV-positive and asymptomatic. This is because nonstress testing can help to identify fetal distress, which can be a sign of HIV infection in the baby.

Question 8

The nurse is reviewing prenatal charts. A patient at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart?

Accepted Answer

The answer of The nurse is reviewing prenatal charts. A...

Question 9

A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include:

Accepted Answer

Babies born to mothers with well-controlled type 1 diabetes tend to be larger than average at birth. This is because the extra glucose in the mother's blood crosses the placenta, leading the baby to produce more insulin, which can make the baby grow larger.

Question 10

The patient with insulin-dependent type 2 diabetes and an HbA_1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this patient?

Accepted Answer

During pregnancy, insulin needs increase as the placenta produces hormones that can impair insulin function. The first trimester may see decreased insulin needs due to nausea and vomiting, but by the third trimester, insulin needs usually increase significantly. The risk of ketoacidosis does not decrease during pregnancy and vascular disease can progress more quickly. While there is an increased risk of congenital abnormalities with uncontrolled diabetes during pregnancy, good blood sugar control can significantly reduce this risk.

Question 11

A patient who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which statement by the patient indicates that she understands the teaching?

Accepted Answer

The patient's statement that she should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in her diet indicates an understanding of the importance of consuming foods rich in folate and vitamin B12 to treat megaloblastic anemia. Option B is incorrect because boiling vegetables in at least 2 quarts of water can lead to the loss of vitamins and minerals, including folate and vitamin B12. Option C is incorrect because megaloblastic anemia can lead to serious risks for both the mother and the developing fetus, including preterm labor, low birth weight, and neural tube defects. Option D is incorrect because megaloblastic anemia results in larger-than-normal red blood cells, not smaller.

Question 12

A woman's history and appearance suggest drug abuse. The nurse's best approach would be to:

Accepted Answer

Directly asking about drug use is the most straightforward and effective way to gather accurate information, allowing the nurse to provide appropriate care and support.

Question 13

A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for:

Accepted Answer

The answer of A 20-year-old woman is at 28 weeks'...

Question 14

The patient at 9 weeks' gestation has been told that her HIV test was positive. The patient is very upset and tells the nurse, "I didn't know I had HIV! What will this do to my baby?" The nurse knows teaching has been effective when the patient states:

Accepted Answer

Option B is correct because it accurately reflects the information. If an HIV-positive pregnant woman receives antiretroviral medications during pregnancy, labor, and delivery, and her newborn baby receives medication for 4-6 weeks after delivery, the risk of passing HIV to her baby can be decreased to as low as 1%. Additionally, while the presence of anti-HIV antibodies in a newborn does not definitively indicate that a baby is infected with HIV, confirmatory testing is necessary to ensure the baby is negative. Option A is wrong because antiretroviral medications can be safely used during pregnancy to decrease the risk of transmitting HIV to the fetus. Option C is wrong because pregnancy itself does not lead to a decrease in CD4 counts and HIV progression. Option D is wrong because HIV can affect the baby and additional testing is necessary to determine the baby's HIV status.

Question 15

A woman at 30 weeks' gestation and a history including sickle cell anemia presents to the clinic complaining of fever, chills, and diarrhea for three days. What are the most serious potential complications faced by this patient?

Accepted Answer

The most serious potential complication faced by this patient is sickle cell crisis, which can be triggered by infection or other stressors. In sickle cell crisis, there is a sudden worsening of sickle cell disease symptoms, including severe pain, organ damage, and potentially life-threatening complications. Fever, chills, and diarrhea are also symptoms of infection, which can further increase the risk of sickle cell crisis. Electrolyte imbalance, fetal neural tube defects, and severe lethargy are not typically associated with this patient's presentation.

Quiz 15: Pregnancy at Risk: Pregestational Problems