NURS 4403 Chapter 11: Pregnancy at Risk: Preexisting Conditions MULTIPLE CHOICE 1. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs d... uring pregnancy, the nurse recognizes that further teaching is warranted when the client states: a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.” b. “Insulin dosage will likely need to be increased during the second and third trimesters.” c. “Episodes of hypoglycemia are more likely to occur during the first 3 months.” d. “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle- feeding.” 2. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with: a. Frequent episodes of maternal hypoglycemia. b. Congenital anomalies in the fetus. c. Polyhydramnios. d. Hyperemesis gravidarum. 3. 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: a. Mother’s age. b. Number of years since diabetes was diagnosed. c. Amount of insulin required prenatally. d. Degree of glycemic control during pregnancy. 4. Concerning the use and abuse of legal drugs or substances, nurses should be aware that: a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health. b. Caucasian women are more likely to experience alcohol-related problems. c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects. d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed. 5. 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: a. Macrosomia. b. Congenital anomalies of the central nervous system. c. Preterm birth. d. Low birth weight. 6. 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? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern 7. Maternal phenylketonuria (PKU) is an important health concern during pregnancy because: a. It is a recognized cause of preterm labor. b. The fetus may develop neurologic problems. c. A pregnant woman is more likely to die without dietary control. d. Women with PKU are usually retarded and should not reproduce. 8. In terms of the incidence and classification of diabetes, maternity nurses should know that: a. Type 1 diabetes is most common. b. Type 2 diabetes often goes undiagnosed. c. Gestational diabetes mellitus (GDM) means that the woman will be receiving insulin treatment until 6 weeks after birth. d. Type 1 diabetes may become type 2 during pregnancy. 9. 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: a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. Maternal insulin requirements steadily decline during pregnancy. 10. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that: a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. Hydramnios occurs approximately twice as often in diabetic pregnancies. c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being. 11. Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: a. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. d. At birth the neonate of a diabetic mother is no longer in any risk. 12. The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc: a. Is now done for all pregnant women, not just those with or likely to have diabetes. b. Is a snapshot of glucose control at the moment. c. Would be considered evidence of good diabetes control with a result of 5% to 6%. d. Is done on the patient’s urine, not her blood. 13. 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)? a. 75 mg/dL before lunch. This is low; better eat now. b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin. d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. 14. A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding? a. Hyperthyroidism c. Hypothyroidism b. Phenylketonuria (PKU) d. Thyroid storm 15. 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: a. Risk for injury to the fetus related to birth trauma. b. Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan. c. Deficient knowledge related to insulin administration. d. Risk for injury to the mother related to hypoglycemia or hyperglycemia. 16. When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include: a. A regular heart rate and hypertension. b. An increased urinary output, tachycardia, and dry cough. c. Shortness of breath, bradycardia, and hypertension. d. Dyspnea; crackles; and an irregular, weak pulse. 17. Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has: a. Valvular disease. c. Arrhythmias. b. Congestive heart disease. d. Postmyocardial infarction. 18. While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease: a. Is the same as that for any pregnant woman. b. Includes rest, stool softeners, and monitoring of the effect of activity. c. Includes ambulating frequently, alternating with active range of motion. d. Includes limiting visits with the infant to once per day. 19. 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? a. Pitocin b. Nonsteroidal antiinflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl 20. 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: a. Is similar to opiates. b. Is a stimulant with vasoconstrictive characteristics. c. Should not be discontinued during pregnancy. d. Is associated with a low rate of relapse. 21. Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births? a. 1 in 100 c. 1 in 2500 b. 1 in 1200 d. 1 in 3000 22. Which heart condition is not a contraindication for pregnancy? a. Peripartum cardiomyopathy c. Heart transplant b. Eisenmenger syndrome d. All of these contraindicate pregnancy. 23. During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: a. Euglycemia. c. Pneumonia. b. Rheumatic fever. d. Cardiac decompensation. 24. Nurses caring for antepartum women with cardiac conditions should be aware that: a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor. b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. c. Women with class III cardiac disease should have 8 to 10 hours of sleep every day and limit housework, shopping, and exercise. d. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term. 25. As related to the care of the patient with anemia, the nurse should be aware that: a. It is the most common medical disorder of pregnancy. b. It can trigger reflex brachycardia. c. The most common form of anemia is caused by folate deficiency. d. Thalassemia is a European version of sickle cell anemia. 26. The most common neurologic disorder accompanying pregnancy is: a. Eclampsia. c. Epilepsy. b. Bell’s palsy. d. Multiple sclerosis. 27. Marfan syndrome is an autosomal dominant genetic disorder that displays as weakness of the connective tissue, joint deformities, ocular dislocation, and weakness to the aortic wall and root. While providing care to a client with Marfan syndrome during labor, which intervention should the nurse complete first? a. Antibiotic prophylaxis c. Surgery b. -Blockers d. Regional anesthesia 28. 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. a. Methadone maintenance c. Smoking cessation b. Detoxification d. 4 Ps Plus 29. use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications. a. Alcohol c. Tobacco b. Caffeine d. Chocolate 30. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia c. Hypobilirubinemia b. Hypercalcemia d. Hypoinsulinemia 31. Which factor is known to increase the risk of gestational diabetes mellitus? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus 32. Glucose metabolism is profoundly affected during pregnancy because: a. Pancreatic function in the islets of Langerhans is affected by pregnancy. b. The pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. The pregnant woman increases her dietary intake significantly. d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance. 33. To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by: a. Eating six small equal meals per day. b. Reducing carbohydrates in her diet. c. Eating her meals and snacks on a fixed schedule. d. Increasing her consumption of protein. 34. When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient: a. Eat six saltine crackers. b. Drink 8 oz of orange juice with 2 tsp of sugar added. c. Drink 4 oz of orange juice followed by 8 oz of milk. d. Eat hard candy or commercial glucose wafers. 35. Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin: a. Increases throughout pregnancy and the postpartum period. b. Decreases throughout pregnancy and the postpartum period. c. Varies depending on the stage of gestation. d. Should not change because the fetus produces its own insulin. 36. What form of heart disease in women of childbearing years usually has a benign effect on pregnancy? a. Cardiomyopathy c. Congenital heart disease b. Rheumatic heart disease d. Mitral valve prolapse 37. In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include: a. Anemia. c. Fever and pain. b. Endometritis. d. Urinary tract infection. 38. A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? a. Provide a low-protein diet. b. Offer the vaccine. c. Discuss the recommendation to bottle-feed her baby. d. Practice respiratory isolation. A person who has a history of high risk behaviors should be offered the hepatitis B vaccine. Care is supportive and includes bed rest and a high-protein, low-fat diet. The first trimester is too early to discuss feeding methods with a woman in the high risk category. Hepatitis B is transmitted through blood. MULTIPLE RESPONSE 39. Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (Select all that apply): a. Cleft lip. b. Congenital heart disease. c. Neural tube defects. d. Gastroschisis. e. Diaphragmatic hernia. 40. 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: a. Atherosclerosis. b. Retinopathy. c. IUFD. d. Nephropathy. e. Neuropathy. Autonomcs neuropathy. 41. 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. a. Multiple sclerosis b. Systemic lupus erythematosus c. Antiphospholipid syndrome d. Rheumatoid arthritis e. Myasthenia gravis COMPLETION 42. 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: 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. a. Without adding air, withdraw the correct dose of NPH insulin. b. Gently rotate the insulin to mix it, and wipe the stopper. c. Inject air equal to the dose of NPH insulin into the vial, and remove the syringe. d. Inject air equal to the dose of regular insulin into the vial, and withdraw the medication. e. Check the insulin bottles for the expiration date. f. Wash hands. 43. Step 1 44. Step 2 45. Step 3 46. Step 4 47. Step 5 48. Step 6 43. ANS: B PTS: 1 DIF: Cognitive Level: Application REF: 275 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that you are using. The bottle should be checked before withdrawing the medication, to be certain that it is the appropriate type. 44. ANS: C PTS: 1 DIF: Cognitive Level: Application REF: 275 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that you are using. The bottle should be checked before withdrawing the medication, to be certain that it is the appropriate type. 45. ANS: D PTS: 1 DIF: Cognitive Level: Application REF: 275 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that you are using. The bottle should be checked before withdrawing the medication, to be certain that it is the appropriate type. 46. ANS: A PTS: 1 DIF: Cognitive Level: Application REF: 275 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that you are using. The bottle should be checked before withdrawing the medication, to be certain that it is the appropriate type. [Show More]
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