Question 1

A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding?

Accepted Answer

PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine.A woman with hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed.A thyroid storm is a complication of hyperthyroidism.

Question 2

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

Accepted Answer

Children born to women with untreated PKU are more likely to be born with mental retardation,microcephaly,congenital heart disease,and low birth weight.Maternal PKU has no effect on labor.Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies.Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted,especially in individuals with a family history of the disorder,with low intelligence of uncertain etiology,or who have given birth to microcephalic infants.

Question 3

Concerning the use and abuse of legal drugs or substances,nurses should be aware that:

Accepted Answer

African-American and poor women are more likely to use illicit substances,particularly cocaine,whereas Caucasian and educated women are more likely to use alcohol.
Cigarette smoking impairs fertility and is a cause of low birth weight.Caffeine consumption has not been related to birth defects.Psychotherapeutic drugs have some effect on the fetus,and that risk must be weighed against their benefit to the mother.

Question 4

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 client states:

Accepted Answer

Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin."Insulin dosage will likely need to be increased during the second and third trimesters," "Episodes of hypoglycemia are more likely to occur during the first 3 months," and "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding" are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.

Question 5

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

Accepted Answer

A score of 5% to 6% indicates good control.This is an extra test for diabetic women,not one done for all pregnant women.This test defines glycemic control over the previous 4 to 6 weeks.Glycosylated hemoglobin level tests are done on the blood.

Question 6

A woman with asthma is experiencing a postpartum hemorrhage.Which drug would not be used to treat her bleeding because it may exacerbate her asthma?

Accepted Answer

Prostaglandin derivatives should not be used to treat women with asthma,because they may exacerbate symptoms.Pitocin would be the drug of choice to treat this woman's bleeding because it would not exacerbate her asthma.NSAIDs are not used to treat bleeding.Fentanyl is used to treat pain,not bleeding.

Question 7

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 one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

Accepted Answer

60 mg/dL after waking from a nap is too low.During hours of sleep glucose levels should not be less than 70 mg/dL.Snacks before sleeping can be helpful.The premeal acceptable range is 65 to 95 mg/dL.The readings 1 hour after a meal should be less than 140 mg/dL.Two hours after eating,the readings should be less than 120 mg/dL.

Question 8

While providing care in an obstetric setting,the nurse should understand that postpartum care of the woman with cardiac disease:

Accepted Answer

Bed rest may be ordered,with or without bathroom privileges.Bowel movements without stress or strain for the woman are promoted with stool softeners,diet,and fluid.Care of the woman with cardiac disease in the postpartum period is tailored to the woman's functional capacity.The woman will be on bed rest to conserve energy and reduce the strain on the heart.Although the woman may need help caring for the infant,breastfeeding and infant visits are not contraindicated.

Question 9

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

This client's clinical cues include weight loss,which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements.No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume.This client reports weight loss,not weight gain.Imbalanced nutrition: more than body requirements is not an appropriate nursing diagnosis.Although the client reports nervousness,based on the client's other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements.

Question 10

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

Poor glycemic control later in pregnancy increases the rate of fetal macrosomia.Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies.Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes.Increased weight,or macrosomia,is the greatest risk factor for this woman.

Question 11

Diabetes in pregnancy puts the fetus at risk in several ways.Nurses should be aware that:

Accepted Answer

Congenital malformations account for 30% to 50% of perinatal deaths.Even with good control,sudden and unexplained stillbirth remains a major concern.Infants of diabetic mothers are at increased risk for respiratory distress syndrome.The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

Question 12

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

Accepted Answer

Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis.Prophylaxis for intrapartum endocarditis is not indicated for congestive heart disease,arrhythmias,or after myocardial infarction.

Question 13

In planning for the care of a 30-year-old woman with pregestational diabetes,the nurse recognizes that the most important factor affecting pregnancy outcome is the:

Accepted Answer

Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

Question 14

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

Accepted Answer

Type 2 diabetes often goes undiagnosed because hyperglycemia develops gradually and often is not severe.Type 2 diabetes,sometimes called adult onset diabetes,is the most common.GDM refers to any degree of glucose intolerance first recognized during pregnancy.Insulin may or may not be needed.People do not go back and forth between types 1 and 2 diabetes.

Question 15

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

Accepted Answer

Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies.Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception)as a result of hormone changes and the effects on insulin production and usage.Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies.Typically it is seen in the third trimester of pregnancy.Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

Question 16

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes.She attends her centering appointment accompanied by one of her girlfriends.This young woman appears more concerned about how her pregnancy will affect her social life than about her recent diagnosis of diabetes.Several nursing diagnoses are applicable to assist in planning adequate care.The most appropriate diagnosis at this time is:

Accepted Answer

Before a treatment plan is developed or goals for the outcome of care are outlined,this client must come to an understanding of diabetes and the potential effects on her pregnancy.She appears to have greater concern for changes to her social life than adoption of a new self-care regimen.Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy.At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy.The client may not yet be on insulin.Insulin requirements increase with gestation.The importance of glycemic control must be part of health teaching for this client.However,she has not yet acknowledged that changes to her lifestyle need to be made,and she may not participate in the plan of care until understanding takes place.

Question 17

The use of methamphetamine (meth)has been described as a significant drug problem in the United States.In order to provide adequate nursing care to this client population the nurse must be cognizant that methamphetamine:

Accepted Answer

Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly.As is the case with cocaine users,methamphetamine users are urged to immediately stop all use during pregnancy.Unfortunately,because methamphetamine users are extremely psychologically addicted,the rate of relapse is very high.

Question 18

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

Accepted Answer

Pregnant women develop increased insulin resistance during the second and third trimesters.Insulin never crosses the placenta; the fetus starts making its own insulin around the tenth week.As a result of normal metabolic changes during pregnancy,insulin-dependent women are prone to hypoglycemia (low levels).Maternal insulin requirements may double or quadruple by the end of pregnancy.

Question 19

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

Accepted Answer

Signs of cardiac decompensation include dyspnea; crackles; an irregular,weak,rapid pulse; rapid respirations; a moist,frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds.A regular heart rate and hypertension are not generally associated with cardiac decompensation.Tachycardia would indicate cardiac decompensation,but increased urinary output and a dry cough would not.Shortness of breath would indicate cardiac decompensation,but bradycardia and hypertension would not.

Question 20

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.

Quiz 11: Pregnancy at Risk: Preexisting Conditions