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?
A) "My body makes red blood cells that are smaller than they should be."
B) "Megaloblastic anemia is not known to cause any serious risks to my baby."
C) "Whenever possible, I should boil my vegetables in at least 2 quarts of water."
D) "I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet."

Accepted Answer

The client correctly identifies the nutritional sources that can help treat megaloblastic anemia. Fresh leafy green vegetables, red meat, fish, poultry, and legumes are rich in vitamin B12 and folic acid, which are essential for the production of healthy red blood cells. Option A describes microcytic anemia, which is not indicative of megaloblastic anemia. Option B is incorrect because megaloblastic anemia can lead to fetal developmental problems. Option C is not relevant to the management of megaloblastic anemia.

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?
A) Severe lethargy
B) Sickle cell crisis
C) Electrolyte imbalance
D) Fetal neural tube defects

Accepted Answer

The most serious potential complication for this client with sickle cell anemia experiencing fever, chills, and diarrhea is a sickle cell crisis. This involves a sudden and severe pain episode caused by sickle-shaped red blood cells that obstruct blood flow to organs and tissues. Infections can trigger a sickle cell crisis, and this client's symptoms indicate an infection. Severe lethargy, electrolyte imbalances, and fetal neural tube defects are not the most serious potential complications for this client.

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?
A) "Breastfeeding is a good feeding method for my baby."
B) "My baby will get a bath as soon as its temperature is stable."
C) "An internal fetal monitor will be applied as soon as possible during labor."
D) "Two shots will be given to my baby to prevent transmission of hepatitis B."

Accepted Answer

The use of an internal fetal monitor during labor is not recommended for mothers with hepatitis B infection due to the increased risk of transmitting the virus to the baby. The other options (A, B, D) do not indicate a misunderstanding of the care and precautions necessary for a mother with hepatitis B.

Question 4

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

Accepted Answer

Roast beef and steamed spinach are high in iron, which is important for increasing hemoglobin levels. Orange juice is rich in vitamin C, which enhances iron absorption.

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?
A) "The pregnancy will increase the progression of my disease and will reduce my CD4 counts."
B) "The HIV will not affect my baby, and I will have a low-risk pregnancy without additional testing."
C) "My baby will probably be born with anti-HIV antibodies, but that does not mean the baby is infected."
D) "I cannot take the medications that control HIV during my pregnancy because they will harm the baby."

Accepted Answer

This statement indicates that the client understands that the baby may have anti-HIV antibodies but may not be infected. This shows that the client has been taught about the potential effects of HIV on the baby and the need for further testing and evaluation.

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?
A) Dyspnea and chest pain with mild exertion
B) Elective cesarean birth scheduled for 37 weeks
C) Discussed need for labor epidural and vacuum extraction
D) Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally

Accepted Answer

The answer of A client at 24 weeks has a...

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?
A) Elevated blood pressure and ankle edema
B) Shortness of breath and frequent urination
C) Hemoglobin of 11 g/dL and a rapid weight gain
D) Unusual fatigue and recurring Candida vaginitis

Accepted Answer

Unusual fatigue and recurring Candida vaginitis are indicators of a possible HIV infection and therefore warrant retesting. Elevated blood pressure and ankle edema could be signs of preeclampsia, while shortness of breath and frequent urination could be related to normal pregnancy symptoms or other medical conditions. Hemoglobin of 11 g/dL and rapid weight gain may be related to normal pregnancy changes.

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?
A) "A beer once a week will not damage the fetus."
B) "I can continue to drink alcohol until I am diagnosed as being pregnant."
C) "I can drink alcohol while breastfeeding since it does not pass into breast milk."
D) "I need to stop drinking alcohol completely when I start trying to get pregnant."

Accepted Answer

The correct statement indicating teaching effectiveness is "I need to stop drinking alcohol completely when I start trying to get pregnant." This demonstrates understanding of the importance of reducing alcohol consumption before conception to decrease the risk of harm to the developing fetus. Options A, B, and C are incorrect as they all involve alcohol consumption during pregnancy or breastfeeding, which can be harmful to the fetus or infant.

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?
A) "Carry hard candy (or other simple sugar) when exercising."
B) "If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate."
C) "Exercise either just before meals or wait until 2 hours after a meal."
D) "If your blood sugar is more than 120 mg/dL, drink a glass of whole milk."

Accepted Answer

Carrying a simple sugar source like hard candy during exercise is important for individuals with gestational diabetes to quickly address hypoglycemia if it occurs. Exercise can lower blood sugar levels, and having a quick source of sugar available helps manage sudden drops in blood glucose.

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?
A) "Your baby may be smaller than average at birth."
B) "Your baby will probably be larger than average at birth." 3 "Your baby might have high blood sugar for several days."
C) "As long as you control your blood sugar, your baby will not be affected at all."

Accepted Answer

Babies born to mothers with well-controlled type 1 diabetes may be larger than average at birth due to the increased blood sugar levels in the mother, which leads to increased insulin and growth in the fetus.

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? A) Conduct screening for type 2 diabetes mellitus as soon as possible. B) Begin serial testing of the client's serum glucose and HA_1c at 24 weeks' gestation. C) If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM). D) Recognize HA_1c equal to or greater than4.5% or a fasting plasma glucose level equal to or greater than 90 mg/dL as being diagnostic of diabetes.

Accepted Answer

Current guidelines recommend screening for type 2 diabetes mellitus at the first antenatal visit for women at high risk of developing diabetes, including those with a previous history of gestational diabetes, overweight, obese, older than 25 years or have a family history of diabetes, among others. Early screening and detection of diabetes can improve pregnancy outcomes for both the mother and fetus. Serial testing of serum glucose and HbA1c can be done during subsequent visits, but screening should be done as early as possible. If diabetes is diagnosed, the type of diabetes should be determined based on the diagnostic criteria, which can help inform treatment decisions.

Question 12

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

Accepted Answer

Asking the woman directly if she uses street drugs is the most straightforward approach and allows for open communication between the nurse and patient to address any potential substance use during pregnancy.

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?
A) Diabetes mellitus
B) Abruptio placentae
C) Erythroblastosis fetalis
D) Pregnancy-induced hypertension

Accepted Answer

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

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?
A) "It produces intrauterine growth restriction and meconium aspiration."
B) "It leads to deficiencies of thiamine and folic acid, which help the baby develop."
C) "It produces babies with small heads and short bodies with brain function alterations."
D) "It can cause a high fever in you if high doses are taken and therefore cause the baby harm."

Accepted Answer

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

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?
A) "I should not breastfeed my baby."
B) "When my baby is 2 months old, he or she will be tested for HIV."
C) "If I have a cesarean section, there is an increased risk that my HIV will be passed to my baby."
D) "I am supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."

Accepted Answer

The answer of During the first antepartal visit, a client...

Question 16

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

Accepted Answer

The primipara at 28 weeks reporting difficulty breathing and shortness of breath should be called back first due to the immediate risk to both the mother and fetus. Difficulty breathing can indicate a serious condition requiring urgent attention.

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.
A) Flat affect
B) Monotone replies
C) Heart rate 120 bpm
D) Respiratory rate 28/minute
E) Disoriented to place and time

Accepted Answer

The increased heart rate and respiratory rate are both physiological symptoms of a panic attack. Flat affect, monotone replies, and disorientation are not necessarily indicative of a panic attack.

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? A) Vascular disease that accompanies diabetes slows progression. B) The risk of ketoacidosis decreases during the length of the pregnancy. C) The baby is likely to have a congenital abnormality because of the diabetes. D) Insulin needs decrease in the first trimester and increase during the third trimester.

Accepted Answer

Insulin needs typically decrease in the first trimester of pregnancy, but increase during the second and third trimesters as insulin resistance increases. The other options are incorrect. While vascular disease may slow progression, it is still a significant concern. The risk of ketoacidosis and hyperglycemia may increase during pregnancy. While the risk of congenital abnormalities may be increased in infants born to mothers with diabetes, it is not a guarantee and can be minimized with meticulous glucose control. Thus, the nurse would provide guidance related to insulin needs during pregnancy and the importance of tight glucose control to decrease risk to the fetus.

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.
A) Alcohol use
B) Preterm birth
C) Poor appetite
D) Poor weight gain
E) Antenatal hemorrhage

Accepted Answer

Depression during pregnancy has been linked to an increased risk of preterm birth, poor appetite, and poor weight gain. Alcohol use and antenatal hemorrhage are not directly associated with depression during pregnancy.

Question 20

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

Accepted Answer

For a pregnant client who is HIV positive, but asymptomatic, weekly non-stress testing beginning at 32 weeks' gestation is important to monitor the fetal well-being. Antiretroviral therapy initiated before 14 weeks' gestation and continued through the delivery and postpartum period has been shown to decrease the vertical transmission of HIV. Intravenous antibiotics may be administered during labor and delivery to reduce the risk of transmission but the choice of antibiotics and the duration of treatment should be determined on a case-by-case basis. An amniocentesis at 30 and 36 weeks and the application of fetal scalp electrode are not routinely indicated for the management of a pregnant client who is HIV positive.

Quiz 14: Pregnancy at Risk: Pregestational Problems

A client who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which client statement indicates teaching has been effective?

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?

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?

A pregnant client at 23 weeks' gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective?

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?

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?

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?

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?

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?

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?

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?

The nurse suspects that a pregnant client is a substance user. Which approach should the nurse take during the health history?

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?

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?

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?

The prenatal clinic nurse has received four phone calls. Which client should be called back first?

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.

The client with insulin-dependent type 2 diabetes and an HbA1c of 5% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client?

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.

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

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?