Chapter 26: Concurrent Disorders During Pregnancy My Nursing Test Banks

Chapter 26: Concurrent Disorders During Pregnancy

MULTIPLE CHOICE

1. Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant client with diabetes?

a.

Evaluation of retinopathy by an ophthalmologist

b.

The clients stable emotional and psychological status

c.

Degree of glycemic control before and during the pregnancy

d.

Total protein excretion and creatinine clearance within normal limits

ANS: C

The occurrence of complications can be greatly diminished by maintaining normal blood glucose levels before and during the pregnancy. Even nonpregnant diabetics should have an annual eye examination. Assessing a clients emotional status is helpful. Coping with a pregnancy superimposed on preexisting diabetes can be very difficult for the whole family. However, it is not the top priority. Baseline renal function is assessed with a 24-hour urine collection and does not diminish the clients risk for complications.

PTS: 1 DIF: Cognitive Level: Understanding REF: 539

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

a.

Hypoglycemia

b.

Hypercalcemia

c.

Hypoinsulinemia

d.

Hypobilirubinemia

ANS: A

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

PTS: 1 DIF: Cognitive Level: Understanding REF: 539

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

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

a.

Previous birth of large infant

b.

Maternal age younger than 25 years

c.

Underweight prior to pregnancy

d.

Previous diagnosis of type 2 diabetes mellitus

ANS: A

Prior birth of a large infant suggests gestational diabetes mellitus. A client younger than 25 is not at risk for gestational diabetes mellitus. Obesity (>90 kg [198 lb]) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

PTS: 1 DIF: Cognitive Level: Understanding REF: 541

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. Which disease process improves during pregnancy?

a.

Epilepsy

b.

Bells palsy

c.

Rheumatoid arthritis

d.

Systemic lupus erythematosus (SLE)

ANS: C

Although the reason is unclear, marked improvement is seen with rheumatoid arthritis in pregnancy. Most women relapse 6 weeks to 6 months postpartum. With epilepsy, the effect of pregnancy is variable and unpredictable. Seizures may increase, decrease, or remain the same. Bells palsy was thought to be caused by a virus three times more common during pregnancy and generally occurring in the third trimester. The client with SLE can have a normal pregnancy but must be treated as high risk because 50% of all births will be premature. Pregnancy can exacerbate SLE.

PTS: 1 DIF: Cognitive Level: Understanding REF: 555

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. When a pregnant client with diabetes experiences hypoglycemia while hospitalized, which should the nurse have the client do?

a.

Eat a candy bar.

b.

Eat six saltine crackers or drink 8 oz of milk.

c.

Drink 4 oz of orange juice followed by 8 oz of milk.

d.

Drink 8 oz of orange juice with 2 teaspoons of sugar added.

ANS: B

Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will help increase the blood sugar level but will not sustain it. Orange juice and sugar will increase the blood sugar level but will not provide a slow-burning carbohydrate to sustain it.

PTS: 1 DIF: Cognitive Level: Application REF: 545

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

6. Nursing intervention for pregnant clients with diabetes is based on the knowledge that the need for insulin is:

a.

varied depending on the stage of gestation.

b.

increased throughout pregnancy and the postpartum period.

c.

decreased throughout pregnancy and the postpartum period.

d.

should not change because the fetus produces its own insulin.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Understanding REF: 540

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

7. Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy?

a.

Cardiomyopathy

b.

Mitral valve prolapse

c.

Rheumatic heart disease

d.

Congenital heart disease

ANS: B

Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases will produce pulmonary hypertension or endocarditis during pregnancy.

PTS: 1 DIF: Cognitive Level: Understanding REF: 548

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

8. Which instructions should the nurse include when teaching a pregnant client with Class II heart disease?

a.

Advise her to gain at least 30 pounds.

b.

Instruct her to avoid strenuous activity.

c.

Inform her of the need to limit fluid intake.

d.

Explain the importance of a diet high in calcium.

ANS: B

Activity may need to be limited so that cardiac demand does not exceed cardiac capacity. Weight gain should be kept at a minimum with heart disease. Iron and folic acid are important to prevent anemia. Fluid intake is necessary to prevent fluid deficits. Fluid intake should not be limited during pregnancy. The client may also be put on a diuretic.

PTS: 1 DIF: Cognitive Level: Understanding REF: 548

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

9. The most important instruction to include in a teaching plan for a client in early pregnancy who has Class I heart disease is she:

a.

must report any nausea or vomiting.

b.

may experience mild fatigue in early pregnancy.

c.

must report any chest discomfort or productive cough.

d.

should plan to increase her daily exercise gradually throughout pregnancy.

ANS: C

Angina or a productive cough may signal congestive heart failure or pulmonary edema. Nausea and vomiting are expected in early pregnancy. Mild fatigue is expected in early pregnancy. Depending on the severity of the heart disease, the client may need to limit physical activity.

PTS: 1 DIF: Cognitive Level: Understanding REF: 548

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

10. Antiinfective prophylaxis is indicated for a pregnant client with a history of mitral valve stenosis related to rheumatic heart disease because the client is at risk of developing:

a.

hypertension.

b.

postpartum infection.

c.

bacterial endocarditis.

d.

upper respiratory infections.

ANS: C

Because of vegetations on the leaflets of the mitral valve and the increased demands of pregnancy, the client is at greater risk of bacterial endocarditis. Pulmonary hypertension may occur with mitral valve stenosis, but antiinfective medications will not prevent it from occurring. Women with cardiac problems must be observed for possible infections during the postpartum period but are not given prophylactic antibiotics to prevent them. Women are not put on prophylactic antibiotics to prevent upper respiratory infections.

PTS: 1 DIF: Cognitive Level: Understanding REF: 549

OBJ: Nursing Process Step: Planning MSC: Client Needs: Physiologic Integrity

11. When planning intrapartum care for a client with heart disease, the nurse should include:

a.

taking vital signs according to standard protocols.

b.

continuously monitoring cardiac rhythm with telemetry.

c.

massaging the uterus to hasten birth of the placenta.

d.

maintaining the infusion of intravenous fluids to avoid dehydration.

ANS: B

A client with heart disease should have a cardiac monitor and possibly an arterial line for continuous blood pressure monitoring, as well as hemodynamic monitoring. Vital signs may need to be taken more frequently because of the extra workload on the heart. The uterus should not be massaged to hasten the birth of the placenta because this could cause undue overload on the heart. Circulatory overload can occur, so IV fluids may not be used or may be used minimally.

PTS: 1 DIF: Cognitive Level: Application REF: 549

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

12. For which of the following infectious diseases can a woman be immunized?

a.

Rubella

b.

Toxoplasmosis

c.

Cytomegalovirus

d.

Herpesvirus type 2

ANS: A

Rubella is the only infectious disease for which a vaccine is available. There are no vaccines available for toxoplasmosis, cytomegalovirus, or herpesvirus type 2.

PTS: 1 DIF: Cognitive Level: Understanding REF: 556

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. A client, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?

a.

Her two children should be treated with acyclovir before she goes home from the hospital.

b.

The baby will acquire immunity from her and will not be susceptible to chickenpox.

c.

The children can visit their mother and baby in the hospital as planned but must wear gowns and masks.

d.

She must make arrangements to stay somewhere other than her home until the children are no longer contagious.

ANS: D

Varicella (chickenpox) is highly contagious. Although the baby inherits immunity from the mother, it would not be safe to expose either the mother or the baby. Acyclovir is used to treat varicella pneumonia. The baby is already born and has received the immunity. If the mother never had chickenpox, she cannot transmit the immunity to the baby. Varicella infection occurring in a newborn may be life threatening.

PTS: 1 DIF: Cognitive Level: Application REF: 557

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Safe and Effective Care Environment

14. A client has a history of drug use and is screened for hepatitis B during the first trimester. Which action is appropriate?

a.

Practice respiratory isolation.

b.

Plan for retesting during the third trimester.

c.

Discuss the recommendation to bottle feed her baby.

d.

Anticipate administering the vaccination for hepatitis B as soon as possible.

ANS: B

A person who has a history of high-risk behaviors should be rescreened during the third trimester. Hepatitis B is transmitted through blood. The first trimester is too early to discuss feeding methods with a woman in the high-risk category. The vaccine may not have time to affect a person with high-risk behaviors.

PTS: 1 DIF: Cognitive Level: Application REF: 560

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

15. A client has tested HIV-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?

a.

I know I will need to have an abortion as soon as possible.

b.

Even though my test is positive, my baby might not be affected.

c.

My baby is certain to have AIDS and die within the first year of life.

d.

This pregnancy will probably decrease the chance that I will develop AIDS.

ANS: B

The fetus is likely to test positive for HIV in the first 6 months, until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status. With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased. The pregnancy will increase the chance of converting.

PTS: 1 DIF: Cognitive Level: Analysis REF: 562

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Physiologic Integrity

16. A client who has type 2 diabetes is pregnant with her second child. She was not diagnosed with diabetes until after her first pregnancy. Past obstetric history is unremarkablespontaneous vaginal birth of a male weighing 7 pounds, 15 ounces. The client is now concerned over what will happen during this subsequent pregnancy as a result of her disease process. What impact could the disease process have on her upcoming birth?

a.

Client will not be able to receive an epidural for pain management.

b.

Client will not be able to have a vaginal birth.

c.

A planned birth will be instituted by her health care provider.

d.

It is likely that she will deliver a fetus who is small for gestational age (SGA).

ANS: C

Because of the presence of diabetes as a concurrent disease, the client will be closely monitored and a planned birth will be instituted to improve health outcomes for mother and fetus. Epidurals can be administered to obstetric clients who are diabetics. Although there is an increased risk for macrosomia and dystocia, the client will be prospectively managed and may still be able to have a vaginal birth. Because of the presence of diabetes as a concurrent disease, it is more likely that she will deliver a macrosomic infant who would be large for gestational age (LGA).

PTS: 1 DIF: Cognitive Level: Analysis REF: 541

OBJ: Nursing Process Step: Evaluation

MSC: Client Needs: Physiologic Integrity/Physiologic Adaptation

17. Which client teaching instructions are necessary for a pregnant client who is to undergo a glucose challenge test (GCT) as part of a routine pregnancy treatment plan?

a.

Consume a low-fat diet for 48 hours prior to testing.

b.

Fast for 12 hours prior to testing.

c.

There are no dietary restrictions prior to testing.

d.

Consume a consistent carbohydrate diet (60 g) prior to testing.

ANS: C

For a GCT, there are no dietary restrictions and fasting is not required. Testing is done from 24 to 28 weeks for the general pregnant population.

PTS: 1 DIF: Cognitive Level: Application REF: 541

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity/Reduction of Risk Potential

18. Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?

a.

Rubella

b.

Cytomegalovirus (CMV)

c.

Syphilis

d.

HIV

ANS: A

Transmission of congenital rubella causes serious complications in the fetus that may manifest as cataracts, cardiac defects, microcephaly, deafness, intrauterine growth restriction (IUGR), and developmental delays.

PTS: 1 DIF: Cognitive Level: Application REF: 556

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity/Physiologic Adaptation

19. Which postpartum client requires further assessment?

a.

G4 P4 who has had four saturated pads during the last 12 hours

b.

G1 P1 with Class II heart disease who complains of frequent coughing

c.

G2 P2 with gestational diabetes whose fasting blood sugar level is 100 mg/dL

d.

G3 P2 postcesarean client who has active herpes lesions on the labia

ANS: B

Frequent coughing may be a sign of congestive heart failure in the postpartum client with heart disease. Four saturated pads in a 4-hour period is acceptable postpartum blood loss, a fasting blood sugar is a normal value, and the client with identified active herpes does not require further assessment.

PTS: 1 DIF: Cognitive Level: Analysis REF: 550

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

20. The labor nurse is providing care to a patient at 37 weeks gestation who is an insulin-dependent diabetic. The health care provider prescribes an infusion of insulin throughout her induction to be titrated to keep her blood glucose levels below 110 mg/dL. What type of insulin will the nurse select to prepare the infusion?

a.

NPH insulin

b.

Regular insulin

c.

Lispro (Humalog)

d.

Aspart (Novolog)

ANS: B

Continuous infusion of a regular insulin solution combined with a separate intravenous solution containing glucose, such as 5% dextrose in Ringers lactate, allows titration to maintain blood glucose levels between 80 and 110 mg/dL, or as designated by facility policy. The insulin solution is raised, lowered, or discontinued to maintain euglycemia based on hourly capillary blood glucose levels.

PTS: 1 DIF: Cognitive Level: Understanding REF: 540

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

21. The nurse is reviewing the instructions given to a patient at 24 weeks gestation for a glucose tolerance test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?

a.

I have to fast the night before the test.

b.

I will drink a sugary solution containing 100 grams of glucose.

c.

I will have blood drawn at 1 hour after I drink the glucose solution.

d.

I should keep track of my babys movements between now and the test.

ANS: C

A GCT is administered between 24 and 28 weeks of gestation, often to low- and high-risk antepartum patients. Fasting is not necessary for a GCT, and the woman is not required to follow any pretest dietary instructions. The woman should ingest 50 g of oral glucose solution, and 1 hour later a blood sample is taken. Fetal surveillance with kick counts is an ongoing evaluation for pregnant women; they should contact their health care provider if there is a noticeable decrease in fetal movement.

PTS: 1 DIF: Cognitive Level: Application REF: 541

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

22. The results of a pregnant patients glucose tolerance test (GTT) were 158 mg/dL. What is the next test that the nurse will include in the patients teaching plan?

a.

Urinalysis

b.

Amniocentesis

c.

Nonstress test

d.

Oral glucose tolerance test (OGTT)

ANS: D

If the blood glucose concentration for a GTT is 140 mg/dL or greater, a 3-hour oral glucose tolerance test is recommended. The woman must fast from midnight on the day of the test. After a fasting plasma glucose level is determined, the woman should ingest 100 g of oral glucose solution. Plasma glucose levels are then determined at 1, 2, and 3 hours. Gestational diabetes is the diagnosis if the fasting blood glucose level is abnormal.

PTS: 1 DIF: Cognitive Level: Understanding REF: 541

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

23. The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurses next action?

a.

Ask the patient when she last had anything to eat or drink.

b.

Take a culture of the lesions to verify the involved organism.

c.

Ask the patient if she has had unprotected sex since her outbreak.

d.

Use electronic fetal surveillance to determine a baseline fetal heart rate.

ANS: A

A cesarean birth is recommended for women with active lesions in the genital area, whether recurrent or primary, at the time of labor. The patients dietary intake is needed to prepare for surgery. This patient is in active labor and the fetus is at risk for infection if the membranes rupture. The health care provider needs to be notified, and a cesarean section needs to be performed as soon as possible. There is no need to validate the infection because the patient is well aware of the symptoms of an active infection. Although transmission to sexual partners is valid information, it is not necessary information in an urgent situation such as depicted in this scenario. Electronic fetal surveillance is the standard of care.

PTS: 1 DIF: Cognitive Level: Synthesis REF: 557

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

24. A pregnant patient with acquired immunodeficiency syndrome (AIDS) is reviewing infant care instructions with the prenatal nurse. Which patient statement indicates to the nurse that the teaching was effective?

a.

I will bathe my baby twice a day.

b.

I will use premixed formula to feed my baby.

c.

I will use gloves to change my babys diapers.

d.

I will use alcohol wipes six times a day on the babys cord until it falls off.

ANS: B

Breast milk or prechewed food from an infected person can cause infant infection, so the patient with AIDS should bottle feed her baby. The infant does not require additional bathing. The patient has AIDS and transmission from the infants urine or stool is not an issue. Alcohol can be drying and irritating to the skin.

PTS: 1 DIF: Cognitive Level: Application REF: 561

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

25. An infant of a diabetic mom arrives in the nursery unit for observation. The infant is term at 38 weeks gestation and weighs 10 pounds. The maternal hemoglobin A1c level is noted at 10%. Which findings would the nurse suspect as being present? (Select all that apply.)

a.

Fetus is jittery, temperature is decreased

b.

Nasal flaring and retractions

c.

Slight jaundice noted on blanching of nose

d.

Calcium level of 10 mg/dL

ANS: A, B, C

The most common complications with regard to fetal presentation in the context of maternal preexisting diabetes are hypoglycemia, hypokalemia, hyperbilirubinemia, and respiratory distress syndrome. Maternal hemoglobin A1c levels indicate that glycemic control has not been maintained, so the fetus is at risk to develop complications.

PTS: 1 DIF: Cognitive Level: Analysis REF: 538, 539

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity/Physiologic Adaptation

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