Chapter 17 Pregnancy at Risk: Pregestational Problems My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 17 Pregnancy at Risk: Pregestational Problems

1) The nurse is caring for a pregnant woman who admits to using cocaine and ecstasy on a regular basis. The client states, Everybody knows that alcohol is bad during pregnancy, but whats the big deal about ecstasy? What is the nurses best response?

1. Ecstasy can cause a high fever in you and therefore cause the baby harm.

2. Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop.

3. Ecstasy produces babies with small heads and short bodies with brain function alterations.

4. Ecstasy produces intrauterine growth restriction and meconium aspiration.

Answer: 1

Explanation: 1. Hyperthermia (elevated temperature) is a side effect of MDMA (ecstasy).

Page Ref: 355

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

MNL LO: 2.6.3 Determine strategies for managing the care of the pregnant woman who abuses substances.

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2) The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the client indicates to the nurse that the client has understood the teaching?

1. I can continue to drink alcohol until I am diagnosed as pregnant.

2. I need to stop drinking alcohol completely when I start trying to get pregnant.

3. A beer once a week will not damage the fetus.

4. I can drink alcohol while breastfeeding because it doesnt pass into breast milk.

Answer: 2

Explanation: 2. Women should discontinue drinking alcohol when they start to attempt to become pregnant due to possible effects of alcohol on the fetus.

Page Ref: 354

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

MNL LO: 2.6.3 Determine strategies for managing the care of the pregnant woman who abuses substances.

3) A womans history and appearance suggest drug abuse. What is the nurses best approach?

1. Ask the woman directly, Do you use any street drugs?

2. Ask the woman whether she would like to talk to a counselor.

3. Ask some questions about over-the-counter medications and avoid mention of illicit drugs.

4. Explain how harmful drugs can be for her baby.

Answer: 1

Explanation: 1. If drug abuse is suspected, the nurse should ask direct questions and be matter-of-fact and nonjudgmental to elicit honest responses.

Page Ref: 356

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Lifestyle Choices

Standards: QSEN Competencies: I. C. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

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MNL LO: 2.6.3 Determine strategies for managing the care of the pregnant woman who abuses substances.

4) 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 which condition?

1. Erythroblastosis fetalis

2. Diabetes mellitus

3. Abruptio placentae

4. Pregnancy-induced hypertension

Answer: 4

Explanation: 4. Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or preeclampsia-eclampsia).

Page Ref: 356

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

MNL LO: 2.6.3 Determine strategies for managing the care of the pregnant woman who abuses substances.

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5) The nurse is working with a woman who abuses stimulants. The nurse is aware that the fetus is at risk for which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Withdrawal symptoms

2. Cardiac anomalies

3. Sudden infant death syndrome

4. Being small for gestational age

5. Fetal alcohol syndrome

Answer: 1, 2, 3, 4

Explanation: 1. Infants born to mothers who abuse stimulants such as amphetamines can have withdrawal symptoms.

2. Infants born to mothers who abuse stimulants such as cocaine can be born with cardiac anomalies.

3. Infants born to mothers who abuse stimulants such as cocaine can have sudden infant death syndrome.

4. Infants born to mothers who abuse stimulants such as nicotine can be small for gestational age.

Page Ref: 354

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 4. Communicate observations of concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

MNL LO: 2.6.3 Determine strategies for managing the care of the pregnant woman who abuses substances.

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6) The nurse is assessing a woman at 10 weeks gestation who is addicted to alcohol. The woman asks the nurse, What is the point of stopping drinking now if my baby probably has been hurt by it already? What is the best response by the nurse?

1. It wont help your baby, but you will feel better during your pregnancy if you stop now.

2. If you stop now, you and your baby have less chance of serious complications.

3. If you limit your drinking to once a week, your baby will be okay.

4. You might as well stop it now, because once your baby is born, youll have to give up alcohol if you plan on breastfeeding.

Answer: 2

Explanation: 2. Chronic abuse of alcohol can undermine maternal health by causing malnutrition, bone marrow suppression, increased incidence of infections, and liver disease. The effects of alcohol on the fetus may result in fetal alcohol spectrum disorders (FASD).

Page Ref: 353, 355

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

MNL LO: 2.6.3 Determine strategies for managing the care of the pregnant woman who abuses substances.

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7) The client has just been diagnosed as diabetic. The nurse knows teaching was effective when the client makes which statement?

1. Ketones in my urine mean that my body is using the glucose appropriately.

2. I should be urinating frequently and in large amounts to get rid of the extra sugar.

3. My pancreas is making enough insulin, but my body isnt using it correctly.

4. I might be hungry frequently because the sugar isnt getting into the tissues the way it should.

Answer: 4

Explanation: 4. The client who understands the disease process is aware that if the body is not getting the glucose it needs, the message of hunger will be sent to the brain.

Page Ref: 349

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

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8) The client with insulin-dependent type 2 diabetes and an HbA1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client?

1. Insulin needs decrease in the first trimester and usually begin to rise late in the first trimester as glucose use and glycogen storage by the woman and fetus increase.

2. The risk of ketoacidosis decreases during the length of the pregnancy.

3. Vascular disease that accompanies diabetes slows progression.

4. The baby is likely to have a congenital abnormality because of the diabetes.

Answer: 1

Explanation: 1. Insulin needs decrease in the first trimester and usually begin to rise late in the first trimester as glucose use and glycogen storage by the woman and fetus increase.

Page Ref: 341

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

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

1. Your baby could be smaller than average at birth.

2. Your baby will probably be larger than average at birth.

3. As long as you control your blood sugar, your baby will not be affected at all.

4. Your baby might have high blood sugar for several days.

Answer: 2

Explanation: 2. Characteristically, infants of mothers with diabetes are large for gestational age (LGA) as a result of high levels of fetal insulin production stimulated by the high levels of glucose crossing the placenta from the mother. Sustained fetal hyperinsulinism and hyperglycemia ultimately lead to excessive growth, called macrosomia, and deposition of fat.

Page Ref: 342

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

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10) A 26-year-old client 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 client?

1. Exercise either just before meals or wait until 2 hours after a meal.

2. Carry hard candy (or other simple sugar) when exercising.

3. If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate.

4. If your blood sugar is more than 120 mg/dL, drink a glass of whole milk.

Answer: 2

Explanation: 2. The nurse should advise her to carry a simple sugar such as hard candy because of the possibility of exercise-induced hypoglycemia.

Page Ref: 348

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

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11) A 26-year-old client is 26 weeks pregnant. Her previous births include two large-for-gestational-age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes?

1. A 50g, 1-hour glucose screening test

2. A single fasting glucose level

3. A 100g, 1-hour glucose tolerance test

4. A 100g, 3-hour glucose tolerance test

Answer: 4

Explanation: 4. Gestational diabetes is diagnosed if two or more of the following values are met or exceeded after taking the 100 g, 3-hour OGTT: Fasting: 95 mg/dL; 1 hour: 180 mg/dL; 2 hours: 155 mg/dL; 3 hours: 140 mg/dL.

Page Ref: 343

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

12) A client with diabetes is receiving preconception counseling. The nurse will emphasize that during the first trimester, the woman should be prepared for which of the following?

1. The need for less insulin than she normally uses

2. Blood testing for anemia

3. Assessment for respiratory complications

4. Assessment for contagious conditions

Answer: 1

Explanation: 1. Women with diabetes often require less insulin during the first trimester.

Page Ref: 341

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan and in all healthcare settings. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

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MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

13) The nurse has written the nursing diagnosis Injury, Risk for for a diabetic pregnant client. Interventions for this diagnosis include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Assessment of fetal heart tones

2. Perform oxytocin challenge test, if ordered

3. Refer the client to a diabetes support group

4. Assist with the biophysical profile assessment

5. Develop an appropriate teaching plan

Answer: 1, 2, 4

Explanation: 1. Reassuring fetal heart rate variability and accelerations are interpreted as adequate placental oxygenation.

2. The nurse would perform oxytocin challenge test (OCT)/contraction stress test (CST) and non-stress tests as determined by physician.

4. The nurse assists the physician in performing a biophysical profile assessment.

Page Ref: 347

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

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14) A diabetic client goes into labor at 36 weeks gestation. Provided that tests for fetal lung maturity are successful, the nurse will anticipate which of the following interventions?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Administration of tocolytic therapy

2. Beta-sympathomimetic administration

3. Allowance of labor to progress

4. Hourly blood glucose monitoring

5. Cesarean birth may be indicated if evidence of reassuring fetal status exists

Answer: 3, 4

Explanation: 3. There will be no attempt to stop the labor, as this can compromise the mother and fetus.

4. To reduce incidence of congenital anomalies and other problems in the newborn, the woman should be euglycemic (have normal blood glucose) throughout the pregnancy.

Page Ref: 370

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

MNL LO: 2.6.1 Identify implications for providing nursing care to the pregnant woman with pre-existing diabetes.

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15) A woman asks her nurse what she can do before she begins trying to get pregnant to help her baby, as she is prone to anemia. What would the nurse correctly advise her to do?

1. Get pregnant, then start iron supplementation.

2. Add more carbohydrates to her diet.

3. Begin taking folic acid supplements daily.

4. Have a hemoglobin baseline done now so her progress can be followed.

Answer: 3

Explanation: 3. The common anemias of pregnancy are due either to insufficient hemoglobin production related to nutritional deficiency in iron or folic acid during pregnancy. Folic acid deficiency during pregnancy is prevented by a daily supplement of 0.4 mg (400 micrograms) of folate.

Page Ref: 350, 351

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

MNL LO: 6.11.1 Perform a comprehensive prenatal assessment.

16) Which of the following may be the main presenting symptom of iron deficiency anemia?

1. Frequent urination

2. Fatigue

3. Nausea

4. Headaches

Answer: 2

Explanation: 2. The main presenting symptom of iron deficiency anemia may be fatigue.

Page Ref: 350

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

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17) The client with thalassemia intermedia has a hemoglobin level of 9.0. The nurse is preparing an education session for the client. Which statement should the nurse include?

1. You need to increase your intake of meat and other iron-rich foods.

2. Your low hemoglobin could put you into preterm labor.

3. Increasing your vitamin C intake will help your hemoglobin level.

4. You should not take iron supplements.

Answer: 4

Explanation: 4. Folic acid supplements are indicated for women with thalassemia, but iron supplements are not given.

Page Ref: 353

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

MNL LO: 6.11.2 Assess maternal assessment data for potential risk factors.

18) The client at 20 weeks gestation has had an ultrasound that revealed a neural tube defect in her fetus. The clients hemoglobin level is 8.5. The nurse should include which statement when discussing these findings with the client?

1. Your low iron intake has caused anemia, which leads to the neural tube defect.

2. You should increase your vitamin C intake to improve your anemia.

3. You are too picky about food. Your poor diet caused your babys defect.

4. You havent had enough folic acid in your diet. You should take a supplement.

Answer: 4

Explanation: 4. An inadequate intake of folic acid has been associated with neural tube defects (NTDs) (e.g., spina bifida, anencephaly, meningomyelocele) in the fetus or newborn.

Page Ref: 351

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 10. Value active partnerships with patients or designated surrogates in planning, implementation, and evaluation of care. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

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MNL LO: 6.11.2 Assess maternal assessment data for potential risk factors.

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19) The clinic nurse is teaching a pregnant client about her iron supplement. Which information is included in the teaching?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Iron does not affect the gastrointestinal tract.

2. A stool softener might be needed.

3. Start a low dose, and increase it gradually.

4. Expect the stools to be black and bloody.

5. Iron absorption is poor if taken with meals.

Answer: 2, 3, 5

Explanation: 2. Constipation can be a problem when taking iron, so a stool softener might be needed.

3. To prevent anemia, experts recommend that all pregnant women start on 30 mg/day of iron supplements daily. If anemia is diagnosed, the dosage should be increased to 60 to 120 mg per day of iron.

5. Iron absorption is reduced by 40% to 50% if taken with meals.

Page Ref: 350

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

MNL LO: 6.11.1 Perform a comprehensive prenatal assessment.

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20) The client at 9 weeks gestation has been told that her HIV test was positive. The client is very upset, and tells the nurse, I didnt know I had HIV! What will this do to my baby? The nurse knows teaching has been effective when the client makes which statement?

1. I cannot take the medications that control HIV during my pregnancy, because they will harm the baby.

2. My baby can get HIV during the pregnancy and through my breast milk.

3. The pregnancy will increase the progression of my disease and will reduce my CD4 counts.

4. The HIV wont affect my baby, and I will have a low-risk pregnancy without additional testing.

Answer: 2

Explanation: 2. HIV transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth.

Page Ref: 360

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations. | NLN Competencies: Relationship-Centered Care. Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Discuss AIDS, including care of the pregnant woman with HIV/AIDS, neonatal implications, ramifications for the childbearing family, and nursing care.

MNL LO: 2.6.2 Relate the effects of HIV/AIDS on pregnancy to the associated nursing care.

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21) During the history, the client admits to being HIV-positive and says she knows that she is about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. During labor and delivery, I can expect the zidovudine (ZDV) to be given in my IV.

2. After delivery, the dose of zidovudine (ZDV) will be doubled to prevent further infection.

3. My baby will be started on zidovudine (ZDV) for six weeks following the birth.

4. My babys zidovudine (ZDV) will be given in a cream form.

5. My baby will not need zidovudine (ZDV) if I take it during my pregnancy.

Answer: 1, 3

Explanation: 1. ART therapy generally it includes oral Zidovudine (ZDV) daily, IV ZDV during labor and until birth, and ZDV therapy for the infant for 6 weeks following birth.

3. ART therapy generally it includes oral Zidovudine (ZDV) daily, IV ZDV during labor and until birth, and ZDV therapy for the infant for 6 weeks following birth.

Page Ref: 362

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. | AACN Essentials Competencies: IX. 4. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Discuss AIDS, including care of the pregnant woman with HIV/AIDS, neonatal implications, ramifications for the childbearing family, and nursing care.

MNL LO: 2.6.2 Relate the effects of HIV/AIDS on pregnancy to the associated nursing care.

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22) A woman is 32 weeks pregnant. She is HIV-positive but asymptomatic. The nurse knows what would be important in managing her pregnancy and delivery?

1. An amniocentesis at 30 and 36 weeks

2. Weekly non-stress testing beginning at 32 weeks gestation

3. Application of a fetal scalp electrode as soon as her membranes rupture in labor

4. Administration of intravenous antibiotics during labor and delivery

Answer: 2

Explanation: 2. Weekly non-stress testing (NST) is begun at 32 weeks gestation and serial ultrasounds are done to detect IUGR.

Page Ref: 360

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Discuss AIDS, including care of the pregnant woman with HIV/AIDS, neonatal implications, ramifications for the childbearing family, and nursing care.

MNL LO: 2.6.2 Relate the effects of HIV/AIDS on pregnancy to the associated nursing care.

23) 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 client needs to be retested for HIV?

1. Hemoglobin of 11 g/dL and a rapid weight gain

2. Elevated blood pressure and ankle edema

3. Shortness of breath and frequent urination

4. Persistent candidiasis

Answer: 4

Explanation: 4. Signs and symptoms of infections include fever, weight loss, fatigue, persistent candidiasis, diarrhea, cough, and skin lesions (Kaposis sarcoma and hairy leukoplakia in the mouth).

Page Ref: 362

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5 Discuss AIDS, including care of the pregnant woman with HIV/AIDS, neonatal implications, ramifications for the childbearing family, and nursing care.

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MNL LO: 2.6.2 Relate the effects of HIV/AIDS on pregnancy to the associated nursing care.

24) The nurse is evaluating the goal Client will remain free of opportunistic infections for an HIV-positive pregnant client. The nurse determines the goal was met when the client has which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. An absolute CD4+ T-lymphocyte count below 200

2. No complaint of chills or fever during the pregnancy

3. Weight gain of 30 lbs during the pregnancy

4. ESR above 20 mm/hr

5. Normal erythrocyte sedimentation rate maintained during the pregnancy

Answer: 2, 3, 5

Explanation: 2. Not having chills, fever, or a sore throat throughout the pregnancy is an indication the client did not have an infection.

3. Weight gain of 25 to 35 pounds is normal for a pregnancy. This client met the goal for nutrition and remaining infection-free.

5. Having a normal erythrocyte sedimentation rate during the pregnancy is an expected outcome.

Page Ref: 362

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | NLN Competencies: Quality and Safety: contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Discuss AIDS, including care of the pregnant woman with HIV/AIDS, neonatal implications, ramifications for the childbearing family, and nursing care.

MNL LO: 2.6.2 Relate the effects of HIV/AIDS on pregnancy to the associated nursing care.

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25) Women with HIV should be evaluated and treated for other sexually transmitted infections and for what condition occurring more commonly in women with HIV?

1. Syphilis

2. Toxoplasmosis

3. Gonorrhea

4. Herpes

Answer: 2

Explanation: 2. Women with HIV should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with HIV, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia.

Page Ref: 360

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5 Discuss AIDS, including care of the pregnant woman with HIV/AIDS, neonatal implications, ramifications for the childbearing family, and nursing care.

MNL LO: 2.6.2 Relate the effects of HIV/AIDS on pregnancy to the associated nursing care.

26) A 21-year-old at 12 weeks gestation with her first baby has known cardiac disease, class III, as a result of childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompensation with her. The nurse will know that the client understands these signs and symptoms if she states that she would notify her doctor if she had which symptom?

1. A pulse rate increase of 10 beats per minute

2. Breast tenderness

3. Mild ankle edema

4. A frequent cough

Answer: 4

Explanation: 4. The hearts signal of its decreased ability to meet the demands of pregnancy includes frequent cough (with or without hemoptysis).

Page Ref: 365

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

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MNL LO: 2.6.4 Contrast various cardiac conditions and their effects on pregnancy.

27) A client is at 12 weeks gestation with her first baby. She has cardiac disease, class III. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurses response be?

1. Heparin is used when coagulation problems are resolved.

2. Heparin is safer because it does not cross the placenta.

3. They are the same drug, but heparin is less expensive.

4. Coumadin interferes with iron absorption in the intestines.

Answer: 2

Explanation: 2. Heparin is safest for the client to take because it does not cross the placental barrier.

Page Ref: 364

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

MNL LO: 2.6.4 Contrast various cardiac conditions and their effects on pregnancy.

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28) A 21-year-old woman is at 12 weeks gestation with her first baby. She has cardiac disease, class III, as a result of having had childhood rheumatic fever. Which planned activity would indicate to the nurse that the client needs further teaching?

1. I will be sure to take a rest period every afternoon.

2. I would like to take childbirth education classes in my last trimester.

3. I will have to cancel our trip to Disney World.

4. I am going to start my classes in water aerobics next week.

Answer: 4

Explanation: 4. With the slightest exertion, the clients heart rate will rise, and she will become symptomatic. Therefore, she should not establish a new exercise program.

Page Ref: 364

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

MNL LO: 2.6.4 Contrast various cardiac conditions and their effects on pregnancy.

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29) Which of the following symptoms, if progressive, are indicative of CHF, the hearts signal of its decreased ability to meet the demands of pregnancy?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Palpitations

2. Heart murmurs

3. Dyspnea

4. Frequent urination

5. Rales

Answer: 1, 2, 3, 5

Explanation: 1. Palpitations are indicative of CHF.

2. Heart murmurs are indicative of CHF.

3. Dyspnea is indicative of CHF.

5. Rales are indicative of CHF.

Page Ref: 365

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally, and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

MNL LO: 2.6.4 Contrast various cardiac conditions and their effects on pregnancy.

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30) The nurse is evaluating the plan of care for a pregnant client with a heart disorder. The nurse concludes that the plan was successful when data indicate which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. The client gave birth to a healthy baby.

2. The client did not develop congestive heart failure.

3. The client developed thromboembolism.

4. The client identified manifestations of potential complications.

5. The client can identify her condition and its impact on her pregnancy, labor and birth, and postpartum period.

Answer: 1, 2, 4, 5

Explanation: 1. Giving birth to a healthy baby is an expected outcome of the pregnancy.

2. An expected outcome is that the woman does not develop congestive heart failure, thromboembolism, or infection.

4. An expected outcome is that the woman is able to identify potential complications and notify the healthcare provider.

5. The woman must be able to discuss her condition and its possible impact on her pregnancy, labor and birth, and the postpartum period.

Page Ref: 366

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievements. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

MNL LO: 2.6.4 Contrast various cardiac conditions and their effects on pregnancy.

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31) The prenatal clinic nurse has received four phone calls. Which client should the nurse call back first?

1. Pregnant woman at 28 weeks with history of asthma who is reporting difficulty breathing and shortness of breath

2. Pregnant woman at 6 weeks with a seizure disorder who is inquiring which foods are good folic acid sources for her

3. Pregnant woman at 35 weeks with a positive HBsAG who is wondering what treatment her baby will receive after birth

4. Pregnant woman at 11 weeks with untreated hyperthyroidism who is describing the onset of vaginal bleeding

Answer: 1

Explanation: 1. The goal of therapy is to prevent maternal exacerbations because even a mild exacerbation can cause severe hypoxia-related complications in the fetus.

Page Ref: 367

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Compare the effects of selected gestational medical conditions on pregnancy.

32) The nurse is working with a pregnant woman who has systemic lupus erythematosus (SLE). What does the nurse anticipate the infant might be born with?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. A tendency to bleed excessively

2. An increased chance of developing infections

3. A hemoglobin less than optimal for good health

4. Problems with vision

5. Hearing loss

Answer: 1, 2, 3

Explanation: 1. This is true, as the infant might be born with thrombocytopenia.

2. This is true, as the infant might be born with neutropenia.

3. This is true, as the infant might be born with anemia.

Page Ref: 369

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Compare the effects of selected gestational medical conditions on pregnancy.

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33) A pregnant asthmatic client is being seen for her initial prenatal visit. The nurse knows that the fetal implications of maternal asthma include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Prematurity

2. Low birth weight

3. Hypoxia with maternal exacerbation

4. Congenital anomalies from the medications

5. Perinatal transfer of the asthma

Answer: 1, 2, 3

Explanation: 1. One implication of maternal asthma is that the infant is at risk for prematurity.

2. One implication of maternal asthma is that the infant is at risk for low birth weight.

3. One implication of maternal asthma is that the infant is at risk for hypoxia if the mother has an exacerbation of her asthma.

Page Ref: 367

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Compare the effects of selected gestational medical conditions on pregnancy.

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34) While doing a prenatal assessment on a woman who has hepatitis B and intends to become pregnant, the nurse explains the impact of the hepatitis B on pregnancy and birth. Which statement does the nurse include in the teaching?

1. Your baby contracted hepatitis B from you when she was conceived.

2. Dont worry about your baby during the birth. Youre more likely to be affected then by the hepatitis B.

3. Your baby will be immune to your hepatitis B.

4. Hepatitis B does not usually affect the course of pregnancy.

Answer: 4

Explanation: 4. Hepatitis B does not usually affect the course of pregnancy.

Page Ref: 367

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Compare the effects of selected gestational medical conditions on pregnancy.

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