Question 1

Glucose metabolism is profoundly affected during pregnancy because:

Accepted Answer

Placental hormones,estrogen,progesterone,and human placental lactogen (HPL)create insulin resistance.Insulin is also broken down more quickly by the enzyme placental insulinase.Pancreatic functioning is not affected by pregnancy.The glucose requirements differ because of the growing fetus.The pregnant woman should increase her intake by 200 calories a day.

Question 2

With one exception,the safest pregnancy is one in which the woman is drug and alcohol free.For women addicted to opioids,________________________ treatment is the current standard of care during pregnancy.

Accepted Answer

Methadone maintenance treatment (MMT)is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics.Buprenorphine is another medication approved for opioid addiction treatment that is increasingly being used during pregnancy.Opioid replacement therapy has been shown to decrease opioid and other drug use,reduce criminal activity,improve individual functioning,and decrease rates of infections such as hepatitis B and C,HIV,and other sexually transmitted infections.Detoxification is the treatment used for alcohol addiction.Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management.Women are more likely to stop smoking during pregnancy than at any other time in their lives.A smoking cessation program can assist in achieving this goal.The 4 Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment related to substance abuse.

Question 3

In caring for a pregnant woman with sickle cell anemia,the nurse is aware that signs and symptoms of sickle cell crisis include:

Accepted Answer

Women with sickle cell anemia have recurrent attacks (crisis)of fever and pain,most often in the abdomen,joints,and extremities.These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape.Crises are usually triggered by dehydration,hypoxia,or acidosis.Women with sickle cell anemia are not iron deficient.Therefore,routine iron supplementation,even that found in prenatal vitamins,should be avoided in order to prevent iron overload.Women with sickle cell trait usually are at greater risk for after birth endometritis (uterine wall infection); however,this is not likely to occur in pregnancy and is not a sign of crisis.These women are at an increased risk for UTIs; however,this is not an indication of sickle cell crisis.

Question 4

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action,insulin secretion,or both.Over time,diabetes causes significant changes in the microvascular and macrovascular circulations.These complications include: (Select all that apply.)

Accepted Answer

These structural changes are most likely to affect a variety of systems,including the heart,eyes,kidneys,and nerves.Intrauterine fetal death (stillbirth)remains a major complication of diabetes in pregnancy; however,this is a fetal complication.

Question 5

As related to the care of the patient with anemia,the nurse should be aware that:

Accepted Answer

Combined with any other complication,anemia can result in congestive heart failure.Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth.The most common form of anemia is iron deficiency anemia.Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.

Question 6

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

Accepted Answer

The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother.At birth,the maternal glucose supply stops and the neonatal insulin exceeds the available glucose,thus leading to hypoglycemia.Hypocalcemia is associated with preterm birth,birth trauma,and asphyxia,all common problems of the infant of a diabetic mother.Excess erythrocytes are broken down after birth and release large amounts of bilirubin into the neonate's circulation,with resulting hyperbilirubinemia.Because fetal insulin production is accelerated during pregnancy,the neonate presents with hyperinsulinemia.

Question 7

MATCHING
You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

-Step 6

Accepted Answer

The answer of MATCHING
You are preparing to teach an antepartum...

Question 8

MATCHING
You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

-Step 3

Accepted Answer

The answer of MATCHING
You are preparing to teach an antepartum...

Question 9

When the pregnant diabetic woman experiences hypoglycemia while hospitalized,the nurse should intervene by having the patient:

Accepted Answer

Crackers provide carbohydrates in the form of polysaccharides.Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar.Milk is a disaccharide and orange juice is a monosaccharide.They will provide an increase in blood sugar but will not sustain the level.Hard candy or commercial glucose wafers provide only monosaccharides.

Question 10

Achieving and maintaining euglycemia comprise the primary goals of medical therapy for the pregnant woman with diabetes.These goals are achieved through a combination of diet,insulin,exercise,and blood glucose monitoring.The target blood glucose levels 1 hour after a meal should be _________________.

Accepted Answer

The answer of Achieving and maintaining euglycemia comprise the primary...

Question 11

Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin:

Accepted Answer

Insulin needs decrease during the first trimester,when nausea,vomiting,and anorexia are a factor.They increase during the second and third trimesters,when the hormones of pregnancy create insulin resistance in maternal cells.Insulin needs increase during the second and third trimesters,when the hormones of pregnancy create insulin resistance in maternal cells.The insulin needs change throughout the different stages of pregnancy.

Question 12

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

Accepted Answer

Congenital anomalies that can occur with AEDs include cleft lip or palate,congenital heart disease,urogenital defects,and neural tube defects.Gastroschisis and diaphragmatic hernia are not associated with the use of AEDs.

Question 13

The most common neurologic disorder accompanying pregnancy is:

Accepted Answer

The effects of pregnancy on epilepsy are unpredictable.Eclampsia sometimes may be confused with epilepsy,which is the most common neurologic disorder accompanying pregnancy.Bell's palsy is a form of facial paralysis.Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth.

Question 14

MATCHING
You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

-Step 1

Accepted Answer

The answer of MATCHING
You are preparing to teach an antepartum...

Question 15

MATCHING
You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

-Step 2

Accepted Answer

The answer of MATCHING
You are preparing to teach an antepartum...

Question 16

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age.Identify all disorders that fall into the category of collagen vascular disease.

Accepted Answer

Multiple sclerosis is not an autoimmune disorder.This patchy demyelinization of the spinal cord may be a viral disorder.Autoimmune disorders (collagen vascular disease)make up a large group of conditions that disrupt the function of the immune system of the body.They include those listed,as well as systemic sclerosis.

Question 17

To manage her diabetes appropriately and ensure a good fetal outcome,the pregnant woman with diabetes will need to alter her diet by:

Accepted Answer

Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level,provide better balance with insulin administration,and help prevent complications.It is more important to have a fixed meal schedule than equal division of food intake.Approximately 45% of the food eaten should be in the form of carbohydrates.

Question 18

MATCHING
You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

-Step 4

Accepted Answer

Injecting air equal to the dose of NPH insulin into the vial and then removing the syringe without withdrawing any insulin yet is a step that helps prevent creating a vacuum within the vial, which can make withdrawing the correct dose more difficult later. This step comes before withdrawing any insulin to ensure accuracy and ease of withdrawal.

Question 19

Which factor is known to increase the risk of gestational diabetes mellitus?

Accepted Answer

Previous birth of a large infant suggests gestational diabetes mellitus.Obesity (BMI of 30 or greater)creates a higher risk for gestational diabetes.A woman younger than 25 years generally is not at risk for gestational diabetes mellitus.The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy.Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

Question 20

MATCHING
You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

-Step 5

Accepted Answer

The answer of MATCHING
You are preparing to teach an antepartum...

Quiz 11: High-Risk Perinatal Care: Preexisting Conditions

Glucose metabolism is profoundly affected during pregnancy because:

With one exception,the safest pregnancy is one in which the woman is drug and alcohol free.For women addicted to opioids,________________________ treatment is the current standard of care during pregnancy.

In caring for a pregnant woman with sickle cell anemia,the nurse is aware that signs and symptoms of sickle cell crisis include:

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action,insulin secretion,or both.Over time,diabetes causes significant changes in the microvascular and macrovascular circulations.These complications include: (Select all that apply.)

As related to the care of the patient with anemia,the nurse should be aware that:

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

When the pregnant diabetic woman experiences hypoglycemia while hospitalized,the nurse should intervene by having the patient:

Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin:

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

The most common neurologic disorder accompanying pregnancy is:

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age.Identify all disorders that fall into the category of collagen vascular disease.

To manage her diabetes appropriately and ensure a good fetal outcome,the pregnant woman with diabetes will need to alter her diet by:

Which factor is known to increase the risk of gestational diabetes mellitus?