Chapter 20: Pregnancy at Risk: Preexisting Conditions My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 20: Pregnancy at Risk: Preexisting Conditions

Test Bank 

MULTIPLE CHOICE

1. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the woman 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.

ANS: A

Feedback
A Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin.
B This statement is accurate and signifies that the woman has understood the teachings regarding control of her diabetes during pregnancy.
C This statement is accurate and signifies that the woman has understood the teachings regarding control of her diabetes during pregnancy.
D This statement is accurate and signifies that the woman has understood the teachings regarding control of her diabetes during pregnancy.

DIF:Cognitive Level: ApplicationREF:584

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation

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.

ANS: B

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

DIF:Cognitive Level: ComprehensionREF:584

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

3. In teaching the woman with pregestational diabetes about desired glucose levels, the nurse explains that a normal fasting glucose level, such as before breakfast, is in the range of:

a. 65 to 95 mg/dl.
b. 130 to 140 mg/dl.
c. 200 mg/dl.
d. 55 mg/dl.

ANS: A

Feedback
A Target glucose levels during a fasting period are 65 to 95 mg/dl.
B This glucose level is consistent with 1 hour postprandial levels.
C A glucose level of 200 mg/dl is an indication of hyperglycemia. The physician should be contacted immediately for further orders.
D This level indicates hypoglycemia. An adjustment will need to be made to both diet and insulin.

DIF:Cognitive Level: KnowledgeREF:589

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

4. 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.

ANS: A

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

DIF:Cognitive Level: ComprehensionREF:586

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

5. 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

ANS: B

Feedback
A No clinical signs or symptoms support this nursing diagnosis.
B This patients clinical cues include weight loss, which would support this nursing diagnosis.
C This patient reports weight loss, not weight gain. This nursing diagnosis is not appropriate.
D Although the patient reports nervousness, based on the patients other clinical symptoms, the most appropriate nursing diagnosis would be imbalanced nutrition: less than body requirements.

DIF:Cognitive Level: AnalysisREF:599

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

6. 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.

ANS: B

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

DIF:Cognitive Level: ComprehensionREF:601

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

7. 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.

ANS: B

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

DIF:Cognitive Level: KnowledgeREF:582

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

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

ANS: C

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

DIF:Cognitive Level: ComprehensionREF:583

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

9. Methamphetamine use during pregnancy is a growing problem that the nurse working with obstetric patients must be cognizant of. When caring for the patient who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance?

a. Methamphetamine is a depressant.
b. All methamphetamines are vasodilators.
c. Methamphetamine users are extremely psychologically addicted.
d. Rehabilitation is usually successful.

ANS: C

Feedback
A This substance is a stimulant.
B Methamphetamines are vasoconstrictors.
C Meth users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain.
D The rate of relapse for methamphetamine users is very high.

DIF:Cognitive Level: KnowledgeREF:620

OBJ: Client Needs: Psychologic Integrity TOP: Nursing Process: Planning

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.

ANS: A

Feedback
A Prompt treatment of DKA is necessary to save the fetus and the mother.
B Hydramnios occurs 10 times more often in diabetic pregnancies.
C Infections are more common and more serious in pregnant women with diabetes.
D Mild-to-moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

DIF:Cognitive Level: ComprehensionREF:586

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

11. 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 2.5% to 5.9%.
d. Is done on the patients urine, not her blood.

ANS: C

Feedback
A This is an extra test for diabetic women.
B This test defines glycemic control over the previous 4 to 6 weeks.
C A score of 2.5% to 5.9% indicates good control; 6% to 8% would be fair; over 8% is poor.
D Glycosylated hemoglobin level tests are done on the blood.

DIF:Cognitive Level: ComprehensionREF:585

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

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

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.

ANS: D

Feedback
A These symptoms are not generally associated with cardiac decompensation.
B Of these symptoms, only tachycardia would indicate cardiac decompensation.
C Of these symptoms, only shortness of breath would indicate cardiac decompensation.
D Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds.

DIF:Cognitive Level: ComprehensionREF:607

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

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

a. Valvular disease.
b. Congestive heart disease.
c. Arrhythmias.
d. Postmyocardial infarction.

ANS: A

Feedback
A Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis.
B Prophylaxis for intrapartum endocarditis is not indicated for this condition.
C Prophylaxis for intrapartum endocarditis is not indicated for this condition.
D Prophylaxis for intrapartum endocarditis is not indicated for this condition.

DIF:Cognitive Level: ComprehensionREF:603

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

14. In caring for a pregnant woman with sickle cell crisis, the nurse understands that management of this patient includes all except:

a. Analgesia.
b. Oxygen.
c. Hydration.
d. Antibiotics.

ANS: D

Feedback
A Analgesia is necessary to address pain in the abdomen, joints, or extremities.
B Oxygen is administered to address the hypoxia that often occurs during a sickle cell crisis.
C Dehydration is a common trigger for sickle cell crisis. IV fluid administration will assist in correcting the dehydration. Fluid overload must be prevented.
D Only infections are treated aggressively with antibiotics, not sickle cell crisis.

DIF:Cognitive Level: ApplicationREF:611, 612

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

15. Since the gene for cystic fibrosis was identified in 1989, it has been possible to collect data for the purposes of genetic counseling for couples in regard to carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births?

a. 1 in 100
b. 1 in 1200
c. 1 in 2500
d. 1 in 3200

ANS: D

Feedback
A Cystic fibrosis occurs in about 1 in 3200 Caucasian live births.
B Cystic fibrosis occurs in about 1 in 3200 Caucasian live births.
C Cystic fibrosis occurs in about 1 in 3200 Caucasian live births.
D Cystic fibrosis occurs in about 1 in 3200 Caucasian live births.

DIF:Cognitive Level: ComprehensionREF:613

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

16. With what heart condition is pregnancy not usually contraindicated?

a. Peripartum cardiomyopathy
b. Eisenmenger syndrome
c. Heart transplant
d. All of these contraindicate pregnancy.

ANS: C

Feedback
A Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation.
B Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation.
C Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation.
D Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation.

DIF:Cognitive Level: ComprehensionREF:605

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

17. 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 get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
d. Women with class I cardiac disease need bed rest throughout most of the pregnancy and face the possibility of hospitalization near term.

ANS: B

Feedback
A Stress is greatest between weeks 28 and 32, when homodynamic changes reach their maximum.
B Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate.
C Class III cardiac disease is symptomatic with less than ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term.
D Class I cardiac disease is asymptomatic at normal levels of activity. These women can carry on limited normal activities with discretion, although they still need a good amount of sleep.

DIF:Cognitive Level: ComprehensionREF:601

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

18. Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. The 4 Ps include all except:

a. Present
b. Partner
c. Past
d. Pregnancy

ANS: A

Feedback
A The first P is Parents. The patient should be asked, Did either of your parents have a problem with alcohol or drugs?
B The second P is Partner. Does your partner have a problem with alcohol or drugs?
C The third P is Past. Have you ever had any beer, wine or liquor?
D The fourth P is Pregnancy. In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?

DIF:Cognitive Level: ApplicationREF:618

OBJ: Client Needs: Psychologic Integrity TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

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

a. Cleft lip.
b. Congenital heart disease.
c. Neural tube defects.
d. Gastroschisis.
e. Diaphragmatic hernia.

ANS: A, B, C

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

DIF:Cognitive Level: ComprehensionREF:615

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

2. Systemic lupus erythematosus is a chronic multisystem inflammatory disease that affects skin, joints, kidney, lungs, CNS, liver, and other organs. A lupus flare up during pregnancy or early postpartum occurs in 15% to 60% of women with this disorder. Maternal risks include (choose all that apply):

a. Miscarriage.
b. Intrauterine growth restriction (IUGR).
c. Nephritis.
d. Preeclampsia.
e. Caesarean birth.

ANS: A, C, D, E

Feedback
Correct These are all maternal risks associated with SLE.
Incorrect IUGR is a fetal risk related to SLE. Other fetal risks include stillbirth and prematurity.

DIF:Cognitive Level: ComprehensionREF:617

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

COMPLETION

1. The standard of care for women who are dependent on heroin or other narcotics is ____________________ maintenance treatment (MMT).

ANS:

Methadone

Methadone maintenance treatment should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the HIV rate.

DIF:Cognitive Level: ApplicationREF:620

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

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