CH 20 Nursing Care of A Family Experiencing A Pregnancy Complication

Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness

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1. A 15-year-old adolescent arrives at the
office with a report of flu symptoms, in-
a) Support her by respecting her right to
cluding nausea and vomiting and recent
privacy and confidentiality
weight loss. A pregnancy test is done
and is positive. The client begins crying
Pg. 568, 570
and tells the nurse her mother will be
furious with her. What can the nurse do
The nurse needs to be an advocate for
to assist this adolescent at this point?
the adolescent and respect her privacy
and confidentiality. It would be advisable
a) Support her by respecting her right to
for the nurse to encourage the adoles-
privacy and confidentiality
cent to talk to her mother or some oth-
b) Contact the mother of the adolescent
er support person for help. The nurse
to be sure the child gets prenatal care
has no right to contact the adolescent's
c) Recommend some adoption agencies
mother or to share any information with
for her to talk to in the near future
her. Also, the nurse should not mention
d) Tell the adolescent that this is too big
adoption at this point to the adolescent.
of a problem for her to make decisions
That would be a topic for later discussion.
about and she needs to listen to her
mother
c) "You will need to have another test to
confirm the diagnosis"
2. A pregnant client has tested posi-
tive for HIV using an enzyme-linked im-
Pg. 1175-1178
munoassay (ELISA) test. When talking
with the client about the results, she
The client with a reactive screening test,
asks, "So what happens next?" Which
such as the ELISA test, needs to be pre-
response by the nurse would be appro-
pared for an additional test, such as the
priate as the next step?
Western blot or an immunofluorescence
assay. The Western blot is the confirma-
a) "You will need testing for other infec-
tory diagnostic test. A positive antibody
tions like gonorrhea or syphilis"
test confirmed by a supplemental test in-
b) "You will need to have an amniocente-
dicates that the client has been infected
sis to check on the baby"
with HIV and can pass it on to others. An-
c) "You will need to have another test to
tiviral therapy and testing for other sex-
confirm the diagnosis"
ually transmitted infections will be done,
d) "First you will get treated with antibi-
but the diagnosis must be confirmed first.
otics and then antiviral medicines"
Antibiotics are not used for HIV. Also,
amniocentesis is to be avoided to prevent
1 / 18
contamination of the amniotic fluid with
maternal blood.
c) "Your risk during pregnancy is small,
but you should see your cardiologist first
before getting pregnant"
3. The nurse reviews the medical record
of a woman who has come to the clinic Pg. 491
for an evaluation. The client has a history
of mitral valve prolapse and is listed as Typically, a woman with class I or II car-
risk class II. During the visit, the woman diac disease can go through a preg-
states, "We want to have a baby, but I nancy without major complications. For
know I am at higher risk. But what is class I disease, there is no detectable
my risk, really?" Which response by the increased risk of maternal mortality and
nurse would be appropriate? no increase or a mild increase in mor-
bidity. For class II disease, there is a
a) "Your heart disease would put too small increased risk of maternal mor-
much strain on your heart if you were to tality or moderate increase in morbidity
get pregnant" and cardiac consultation should occur
b) "If you do get pregnant, you will need every trimester. It is best to have the
to be seen by a cardiologist every other woman see her cardiologist before be-
month for monitoring" coming pregnant. A woman with class
c) "Your risk during pregnancy is small, III disease needs frequent visits with the
but you should see your cardiologist first cardiac care team throughout pregnan-
before getting pregnant" cy. There is a significantly increased risk
d) "Your pregnancy would be uneventful, of maternal mortality or severe morbidi-
but you would need specialized care for ty and cardiologist consult should occur
labor and birth" every other month with prenatal care and
delivery occurring at an appropriate level
hospital. A woman with class IV disease
is typically advised to avoid pregnancy.
4. A pregnant client with type I diabetes
asks the nurse about how to best control c) Check her blood sugars frequently and
her blood sugar while she is pregnant. adjust insulin accordingly
The best reply would be for the woman
to: Pg. 515
a) Begin oral hyperglycemic medications The goal for a mother who has type I
along with the insulin she is currently
2 / 18
taking
diabetes mellitus is to keep tight con-
b) Exercise for 1 to 2 hours each day to
trol over her blood sugars throughout the
keep the blood glucose down
pregnancy. Therefore, she needs to test
c) Check her blood sugars frequently
her blood sugar frequently during the day
and adjust insulin accordingly
and make adjustments in the insulin dos-
d) Limit weight gain to 15 pounds during
es she is receiving.
the pregnancy
a) Diet
5. A 29-year-old client has gestational di- Pg. 515

abetes. The nurse is teaching her about
managing her glucose levels. Which Clients with gestational diabetes are usu-
therapy would be most appropriate for ally managed by diet alone to control
this client? their glucose intolerance. Long-acting in-
sulin usually is not needed for blood glu-
a) Diet cose control in the client with gestational
b) Glucagon diabetes. Oral hypoglycemic drugs are
c) Long-acting insulin usually not given during pregnancy and
d) Oral hypoglycemic drugs would not be the first option. Glucagon
raises blood glucose and is used to treat
hypoglycemic reactions.
a) Avoidance of infection
Pg. 499-500
6. A nurse is teaching a 30-year-old
gravida 1 who has sickle cell anemia. Prevention of crises, if possible, is the fo-
Providing education on which topic is the cus of treatment for the pregnant woman
highest nursing priority? with sickle cell anemia. Maintaining ade-
quate hydration, avoiding infection, get-
a) Avoidance of infection ting adequate rest, and eating a bal-
b) Administration of immunoglobulins anced diet are all common-sense strate-
c) Consumption of a low-fat diet gies that decrease the risk of a crisis. Fat
d) Constipation prevention intake does not need to be decreased
and immunoglobulins are not normally
administered. Constipation is not usually
a result of sickle cell anemia.
7. The nurse is teaching a pregnant client b) "Pregnancy affects insulin production,
with type 2 diabetes about diet during so I will need to make adjustments in my
3 / 18
pregnancy. Which client statement indi- diet"
cates that the nurse's teaching was suc-
cessful? Pg. 513
a) "Because I need extra protein, I will In pregnancy, placental hormones cause

have to increase my intake of milk and insulin resistance at a level that tends
meat" to parallel growth of the fetoplacen-
b) "Pregnancy affects insulin production, tal unit. Nutritional management focus-
so I will need to make adjustments in my es on maintaining balanced glucose lev-
diet" els. Thus, the client will probably need
c) "I'll basically follow the same diet that I to make adjustments in the diet. Protein
was following before I became pregnant" needs increase during pregnancy, but
d) "I will adjust my diet and insulin based this is unrelated to diabetes. Blood glu-
on the results of my urine tests for glucose monitoring results typically guide
cose" therapy.
8. A pregnant client with type 1 diabetes
is in labor. The client's blood glucose lev-
els are being monitored every hour and a) 1500
she has a prescription for an infusion of
regular insulin as needed based on the Pg. 601
client's blood glucose levels. Her levels
are as follows: For the laboring woman with diabetes, in-
travenous (IV) saline or lactated Ringer's
1300: 105 mg/dL (5.83 mmol/L) is given, and blood glucose levels are
1400: 100 mg/dL (5.55 mmol/L) monitored every 1 to 2 hours. Glucose
1500: 120 mg/dL (6.66 mmol/L) levels are maintained below 110 mg/dL
1600: 106 mg/dl (5.88 mmol/L) (6.11 mmol/L) throughout labor to reduce
the likelihood of neonatal hypoglycemia.
Based on the recorded blood glucose If necessary, an infusion of regular in-
levels, at which time would the nurse like- sulin may be given to maintain this level.
ly administer the regular insulin infusion? The insulin infusion would be given at
1500, based on the blood glucose lev-
a) 1500 el being higher than 110 mg/dL (6.11
b) 1400 mmol/L).
c) 1600
d) 1300
4 / 18
b) Check blood sugar levels daily
Pg. 500
An elevated blood glucose is concerning

for diabetes. A fasting blood glucose level
9. The nurse is assessing a 35-year-old
of greater than 140 mg/dl (7.77 mmol/L)
woman at 22 weeks' gestation who
or random level of greater than 200 mg/dl
has had recent laboratory work. The
(11.10 mmol/L) is concerning; this must
nurse notes fasting blood glucose 146
be followed up to ensure the client is
mg/dl (8.10 mmol/L), hemoglobin 13 g/dl
not developing gestational diabetes. The
(130 g/L), and hematocrit 37% (0.37).
hemoglobin and hematocrit are within
Based on these results, which instruction
normal limits for this client. The values
should the nurse prioritize?
should be hemoglobin greater than 11
g/dl (110 g/L) and hematocrit greater
a) The signs and symptoms of urinary
than 33% (0.33). Values lower than that
tract infection
are possible indications of anemia and
b) Check blood sugar levels daily
would necessitate further evaluation. An
c) Take daily iron supplements
individual with higher than normal blood
d) Include iron-enriched foods in the diet
glucose levels is at risk for developing uri-
nary tract infection. This will usually hap-
pen after the glucose levels are elevated.
Anemia can be treated by increasing the
consumption of iron-enriched foods and
taking a daily iron supplement.
10. The nurse is assessing a pregnant c) Dyspnea, crackles, and irregular weak
client with a known history of congestive pulse
heart failure who is in her third trimester.
Which assessment findings should the Pg. 492
nurse prioritize?
The nurse should be alert for signs of car-
a) Increased urinary output, tachycardia, diac decompensation due to congestive
and dry cough heart failure, which include crackles in
b) Regular heart rate and hypertension the lungs from fluid, difficulty breathing,
c) Dyspnea, crackles, and irregular weak and weak pulse from heart exhaustion.
pulse The heart rate would not be regular, and
d) Shortness of breath, bradycardia, and a cough would not be dry. The heart rate
hypertension would increase rather than decrease.
5 / 18
c) Orange juice
Pg. 499
11. The nurse is preparing to teach a
pregnant client with iron deficiency ane- Anemia is a condition in which the blood
mia about the various iron-rich foods to is deficient in red blood cells, from an
include in her diet. Which food should underlying cause. The woman needs to
the nurse point out will help increase the take iron to manufacture enough red
absorption of her iron supplement? blood cells. Taking an iron supplement
will help improve her iron levels, and tak-
a) Dried apples ing iron with foods containing ascorbic
b) Dried beans acid, such as orange juice, improves the
c) Orange juice absorption of iron. Dried fruit (such as
d) Fortified grains apples), fortified grains, and dried beans
are additional food choices that are rich
in iron and should be included in her daily
diet.
a) IV fluids
12. A pregnant client with sickle cell ane- Pg. 500

mia is admitted in crisis. Which nursing
intervention should the nurse prioritize? A sickle cell crisis during pregnancy is
usually managed by exchange transfu-
a) IV fluids sion, oxygen, and IV fluids. Antihyper-
b) Diuretic drugs tensive drugs usually aren't necessary.
c) Antihypertensive drugs Diuretics would not be used unless fluid
d) Antibiotics overload resulted. The client would be
given antibiotics only if there were evi-
dence of an infection.
13.
c) Maintain a daily blood glucose log
14. The nurse is preparing information Pg. 519

for a client who has just been diagnosed
with gestational diabetes. Which instruc- Control of the blood glucose through-
out the pregnancy is the primary goal to
help decrease potential complications to
6 / 18
both the mother and fetus. The mother
should keep a daily log of her blood glu-
tion should the nurse prioritize in this cose levels and bring this log to each
information? visit for the nurse to evaluate. The oth-
er choices of reporting possible signs
a) Report any signs of possible urinary of a UTI and working with a dietitian to
tract infection plan menus would also be important but
b) Long-term therapy goals would be secondary to the blood glucose
c) Maintain a daily blood glucose log control. It would be inappropriate to dis-
d) Plan daily menus with dietitian cuss long-term goals at this time. This
would be handled at a later time and
would depend on the mother's situation.
c) Observe the client for signs of pe-
techiae and premature separation of the
placenta
15. A nurse is assessing a client in her
seventh month of pregnancy who has
Pg. 497
an artificial valve prosthesis. The client
is taking an oral anticoagulant to prevent
Subclinical bleeding from continuous an-
the formation of clots at the valve site.
ticoagulant therapy in the woman has
Which of the following nursing interven-
the potential to cause placental dislodge-
tions is most appropriate in this situa-
ment. Observe a woman who is taking an
tion?
anticoagulant for signs of petechiae and
signs of premature separation of the pla-
a) Put the client on bed rest
centa during both pregnancy and labor.
b) Urge the client to discontinue the anti-
The nurse should not urge the client to
coagulant to prevent pregnancy compli-
discontinue the anticoagulant, as this is
cations
not within the nurse's scope of practice
c) Observe the client for signs of pe-
and, in any case, the client still needs the
techiae and premature separation of the
anticoagulant to prevent clots. Bed rest
placenta
is prescribed for clients with a thrombus
d) Instruct the client to avoid wearing
to prevent it from moving and becoming
constrictive knee-high stockings
a pulmonary embolus. Avoiding the use
of constrictive knee-high stockings is to
prevent thrombus formation.
d) "I need to begin taking allergy shots
like my friend to prevent me from having
an allergic reaction this spring"
7 / 18
16. A mother is talking to the nurse and is

Pg. 504
concerned about managing her asthma
while she is pregnant. Which response
A pregnant woman with a history of asth-
to the nurse's teaching indicates that the
ma needs to be proactive, taking her
woman needs further instruction?
inhalers and other asthma medications
to prevent an acute asthma attack. She
a) "I will monitor my peak expiratory flow
needs to understand that it is far more
rate regularly to help me predict when an
dangerous to not take the medications
asthma attack is coming on"
and have an asthma attack. She also
b) "I need to be aware of my triggers and
needs to monitor her peak flow for de-
avoid them as much as possible"
creases, be aware of triggers, and avoid
c) "It is fine for me to use my albuterol
them if possible. However, a pregnant
inhaler if I begin to feel tight"
woman should never begin allergy shots
d) "I need to begin taking allergy shots
if she has not been taking them previ-
like my friend to prevent me from having
ously, due to the potential of an adverse
an allergic reaction this spring"
reaction.
17. The nurse is teaching a client with a) "If my blood sugars are elevated, my
gestational diabetes about complica- baby's lungs will mature faster, which is
tions that can occur either following birth good"
or during the birth for the infant. Which
statement by the mother indicates that Pg. 513
further teaching is needed by the nurse?
Elevated blood sugars delay the matu-
a) "If my blood sugars are elevated, my ration of fetal lungs, not increase matu-
baby's lungs will mature faster, which is ration time, resulting in potential respira-
good" tory distress in newborns born to moth-
b) "I may need an amniocentesis during ers with diabetes. Doing fetal movement
the third trimester to see if my baby's (kick) counts is standard practice, as is
lungs are ready to be born" the possibility of an amniocentesis to
c) "My baby may be very large and I may determine lung maturity during the third
need a cesarean birth to have him" trimester. Health care personnel should
d) "Beginning at 28 weeks' gestation, I also prepare the mother for the potential
will start counting with my baby's move- of a cesarean birth if the infant is too
ments every day" large.
c) Jugular distention
Pg. 493-494
8 / 18
A woman who has a cardiac condition is

18. The nurse is assessing a mother who
at increased risk in the postpartum pe-
just delivered a 7 lb (3136 g) baby via ce-
riod. The most important nursing action
sarean delivery. Which assessment find-
is to monitor for signs of cardiac decom-
ing should the nurse prioritize if the moth-
pensation. The nurse should monitor for
er has a history of controlled atrial fibril-
and report jugular distention, clubbing,
lation?
and slow capillary refill time. If an irregu-
lar pulse is noted, compare it to the apical
a) Nausea and vomiting
pulse. The abdominal cramps may be re-
b) Urinary retention
lated to the uterus involution. The nausea
c) Jugular distention
and vomiting and urinary retention may
d) Abdominal cramps
be related to the surgical procedure and
not necessarily the cardiac issue.
c) Iron-deficiency anemia
Pg. 498
19. Which condition is the most common
cause of anemia in pregnancy? Iron-deficiency anemia accounts for ap-
proximately 95% of anemia in pregnancy.
a) Sickle cell anemia Thalassemias are the most common ge-
b) Alpha thalassemia netic disorders of the blood. These ane-
c) Iron-deficiency anemia mias cause a reduction or absence of the
d) Beta thalassemia alpha or beta hemoglobin chain. Sickle
cell anemia is an inherited chronic dis-
ease that results from abnormal hemo-
globin synthesis.
a) "I'll let the doctor know so you can dis-
cuss your medications. In the meantime,
I'll give you a list of folate-rich foods you
20. A 32-year-old woman with epilep-
can add to your diet"
sy mentions to the nurse during a rou-
tine well-visit that she would like to have
Pg.
children and asks the nurse for ad-
vice. Which response is most appropri-
Any woman with epilepsy needs to dis-
ate from the nurse?
cuss medication management with her
provider. The current research indicates
the medications used for epileptic man-
9 / 18
agement are the major cause of birth de-
fects for these clients. The nurse should
be careful about mentioning that some
a) "I'll let the doctor know so you can dis- epilepsy medications are teratogenic;
cuss your medications. In the meantime, some women may stop taking their med-
I'll give you a list of folate-rich foods you ications in order to get pregnant. Sug-
can add to your diet" gesting adoption is inappropriate as the
b) "Do you want to talk to a counselor mother has given no indication she is
who can help you weigh the pros and interested in adoption; also, the mother
cons of having your own child rather than needs to discuss this with the physician
adopting?" so that she can get accurate information
c) "That's great. I've got a 4-year-old and about being on anti-seizure medications
a 2-year-old myself" and being pregnant. The nurse should
d) "You should talk to the doctor about not share personal information as it does
that; the medications you're on can dam- not assist this client in making a serious
age the fetus" decision. The client should be referred to
the health care provider to help the client
make the best decision.
c) Ampicillin
d) Cephalosporins
f) Amoxicillin
21. A woman in week 40 of her pregnan-
Pg. 502
cy has developed a urinary tract infection
(UTI). The nurse anticipates which med-
Amoxicillin, ampicillin, and
ication would be safe and appropriate to
cephalosporins are effective against
use with this client? Select all that apply.
most organisms causing UTIs and are
safe antibiotics during pregnancy. The
a) Tetracyclines
sulfonamides can be used early in preg-
b) Sulfonamides
nancy but not near term because they
c) Ampicillin
can interfere with protein binding of biliru-
d) Cephalosporins
bin, which then leads to hyperbiliru-
e) Heparin
binemia in the newborn. Tetracyclines
f) Amoxicillin
are contraindicated during pregnancy as
they cause retardation of bone growth
and staining of the fetal teeth. Heparin is
an anticoagulant and is used to prevent
10 / 18
clot formation; it would not be prescribed
for a UTI.
c) Pulmonary hypertension
22. The maternal health nurse is car-
ing for a group of high-risk pregnant Pg. 492
clients. Which client condition will the
nurse identify as being the highest risk Pulmonary hypertension is considered
for pregnancy? the greatest risk to a pregnancy be-
cause of the hypoxia that is associated
a) Secondary hypertension with the condition. The remaining con-
b) Repaired atrial septal defect ditions represent potential cardiac com-
c) Pulmonary hypertension plications that may increase the client's
d) Loud systolic murmur risk in pregnancy; however, these do not
present the greatest risk in pregnancy.
23. The maternal health nurse is caring
for a pregnant client with a history of
c) Drug metabolism changes during
epilepsy. The client's antiepileptic drug
pregnancy
(AED) levels have been in the non-ther-
apeutic range the last two times the labs
Pg. 510
were drawn. Which factor does the nurse
associate with this finding?
Drug metabolism changes during preg-
nancy which may alter the therapeutic
a) The action of many medications varies
AED levels in the pregnant client. Some
in pregnancy
AEDs cannot be given in pregnancy due
b) Most maintenance medications can-
to risk of harm to the fetus; however,
not be given in pregnancy
there are some that may be given. Preg-
c) Drug metabolism changes during
nant clients do not have high rates of
pregnancy
noncompliance and the action of medica-
d) Pregnant clients have high rates of
tions does not change in pregnancy.
noncompliance with maintenance med-
ications
24. A pregnant woman with diabetes at d) Congenital anomalies
10 weeks' gestation has a glycosylat-
ed hemoglobin (HbA1c) level of 13%. At Pg. 490
this time the nurse should be most con-
cerned about which possible fetal out- A HbA1c level of 13% indicates poor
come? glucose control. This, in conjunction with
the woman being in the first trimester, in-
11 / 18
a) Placenta previa creases the risk for congenital anomalies
b) Incompetent cervix in the fetus. Elevated glucose levels are
c) Placental abruption (abruptio placen- not associated with incompetent cervix,
tae) placenta previa, or placental abruption
d) Congenital anomalies (abruptio placentae).
c) A diagnostic test such as an abdomi-
nal ultrasound
25. A woman at 38 weeks' gestation ar-
Pg. 507
rives at the hospital reporting a sharp
pain between her umbilicus and the il-
All of the symptoms point to a diagnosis
iac crest that is increasing in intensity
of acute appendicitis. With appendicitis,
in the right lower quadrant. She reports
the nausea and vomiting are much more
having experienced intense nausea and
intense than with morning sickness and
vomiting for the past 3 hours. The nurse
the pain is sharp and localized at McBur-
will report which recommendation to the
ney's point (a point halfway between the
primary health care provider?
umbilicus and the iliac crest on the low-
er right abdomen). When identifying, it
a) An abdominal assessment with bowel
is best to recommend a diagnostic test
sounds
such as an abdominal ultrasound to con-
b) A fetal nonstress test and fetal move-
firm the diagnosis. It is important to con-
ment (kick) counts
firm the diagnosis as surgery needs to
c) A diagnostic test such as an abdomi-
be completed to prevent a rupture. It is
nal ultrasound
important to do an abdominal assess-
d) A urine culture and broad-spectrum
ment but that will not confirm a diagnosis.
antibiotic
The symptoms do not indicate a urinary
issue. There is no data to indicate an
issue with the fetus.
c) Restricted sodium intake
26. A client is diagnosed with peripartum
Pg. 495
cardiomyopathy (PPCM). Which therapy
would the nurse expect to administer to
The client with peripartum cardiomy-
the client?
opathy should be prescribed a restrict-
ed sodium intake to control the blood
a) Methadone therapy
pressure. Monoamine oxidase inhibitors
b) Monoamine oxidase inhibitors
are given to treat depression in preg-
nancy, not peripartum cardiomyopathy.
12 / 18
Methadone is a drug given for the treat-
ment of a substance use disorder dur-
(MAOIs)
ing pregnancy. Complementary thera-
c) Restricted sodium intake
pies like ginger therapy help in the alle-
d) Ginger therapy
viation of hyperemesis gravidarum, not
peripartum cardiomyopathy.
27. The nurse is caring for a pregnant
d) 24 to 28 weeks
woman determined to be at high risk
for gestational diabetes. The nurse pre-
Pg. 514
pares to rescreen this client at which
time frame?
A woman identified as high risk for gesta-
tional diabetes would undergo rescreen-
a) 20 to 24 weeks
ing between 24 and 28 weeks; however,
b) 16 to 20 weeks
some health care providers can choose
c) 28 to 32 weeks
to conduct this screening earlier.
d) 24 to 28 weeks
d) Anticoagulant
Pg, 493
28. A pregnant woman with a history of
mitral valve stenosis is to be prescribed
In mitral valve stenosis, it is difficult for
medication as treatment. Which medica-
blood to leave the left atrium. A sec-
tion class would the nurse expect the
ondary problem of thrombus formation
client to be prescribed?
may develop as a result of noncirculat-
ing blood. A woman may need to be
a) Inotropic
prescribed an anticoagulant to prevent
b) Angiotensin receptor blockers
this complication. Vasodilators are used
c) Vasodilator
for peripartum cardiomyopathy. Inotrop-
d) Anticoagulant
ics are used for heart failure. Angiotensin
receptor blockers are used for conges-
tive heart failure.
c) Polyhydramnios
29. The nurse is leading a discussion
with a group of pregnant women who Pg. 519
have diabetes. The nurse should point
out which situation can potentially occur Polyhydramnios is an increase, or ex-
during their pregnancy? cess, in amniotic fluid and is a pregnan-
cy-related complication associated with
13 / 18
diabetes. An infant who is small-for-ges-
tational-age is not associated with a
a) Postterm birth mother who had diabetes prior to preg-
b) Hypotension of pregnancy nancy. Other pregnancy-related compli-
c) Polyhydramnios cations associated with pregestational
d) Small-for-gestational-age (SGA) in- diabetes mellitus include hypertensive
fant disorders, preterm birth, and shoulder
dystocia.
b) Amoxicillin
30. A woman who is 8 months pregnant Pg. 502

comes to the clinic with urinary frequen-
cy and pain on urination. The client is Amoxicillin is a penicillin antibiotic and
diagnosed with a urinary tract infection can be used in the pregnant woman to
(UTI). Which medication would the nurse treat a UTI. Tetracycline should never be
anticipate the physician will prescribe? given to a pregnant woman, because it
may cause retardation of bone growth
a) Bactrim and staining of the fetal teeth. The sulfon-
b) Amoxicillin amides (bactrim and septra) can be used
c) Tetracycline in early pregnancy but not near term,
d) Septra because they can interfere with protein
binding of bilirubin, which then can lead
to hyperbilirubinemia in the newborn.
b) Maintain glycemic control
Pg. 512
31. The nurse is caring for a preg-
nant client with pregestational diabetes.
The most important goal when caring for
Which goal does the nurse identify as
a pregnant client with pregestational dia-
priority during the client's pregnancy?
betes is to maintain glycemic control. The
scenario does not give enough informa-
a) Monitor for associated complications
tion on the client's weight to determine
b) Maintain glycemic control
if the client should gain only minimal
c) Ensure compliance of glucose moni-
weight during pregnancy. Ensuring com-
toring
pliance of glucose monitoring and mon-
d) Encourage minimal weight gain
itoring for associated complications are
appropriate nursing interventions; how-
ever, these do not take priority.
14 / 18
c) Fetal malnutrition
Pg. 507
32. A pregnant client with deep vein
SLE is an autoimmune disorder in which
thrombosis has been diagnosed as
there is a deposition of immune complex-
having systemic lupus erythematosus
es in the capillaries and visceral struc-
(SLE). The nurse would monitor the
tures. Clients with SLE who become
client closely for the development of
pregnant are at an increased risk of fetal
which complication?
malnutrition due to decreased placental
circulation. Pregnancy-related problems
a) Fetal macrosomia
in SLE include prematurity, stillbirth, de-
b) Increased placental weight
creased placental weight, and thinner
c) Fetal malnutrition
placental villi. In clients with SLE, there
d) Postterm birth of infant
is preterm birth and decreased placen-
tal weight. Fetal macrosomia is seen in
clients having gestational diabetes, not
SLE.
b) An insulin pump
33. The clinic nurse teaches a client with
pregestational type 1 diabetes that main-
Pg. 518
taining a constant insulin level is very im-
portant during pregnancy. The nurse tells
Because a pregnant client will have
the client that the best way to maintain a
some periods of relative hyperglycemia
constant insulin level is to use:
and hypoglycemia no matter how care-
fully the client maintains diet and
a) An insulin pen
balances exercise levels, an effective
b) An insulin pump
method to keep serum glucose levels
c) Regular insulin twice a day
constant is to administer insulin with a
d) An insulin drip
continuous pump during pregnancy.
d) Antiepileptic therapy can lead to vita-
34. A woman's obstetrician prescribes
min K-deficient hemorrhage of the new-
vitamin K supplements for a client who
born
is on antiepileptic medications beginning
at 36 weeks' gestation. The mother asks
Pg. 510
the nurse why she is taking this med-
ication. The nurse's best response would
Antiepileptic therapy may cause vitamin
be:
K-deficient hemorrhage of the newborn.
15 / 18
The vitamin K injection the newborn re-
a) The antiepileptic medications can ceives following birth can't fully correct
cause the mother's platelets to drop this, so some physicians recommend a
b) Administration of vitamin K aids in lung vitamin K supplement for their pregnant
maturity of the fetus clients beginning at 36 weeks' gesta-
c) Vitamin K helps in keeping the placen- tion. If the mother should go into preterm
ta healthy labor, the newborn will have received
d) Antiepileptic therapy can lead to vita- the vitamin K prior to delivery. However,
min K-deficient hemorrhage of the new- many physicians now question the use-
born fulness of the prophylaxis.
35. A nursing instructor is teaching stu- d) Iron-deficiency anemia
dents about anemia during pregnancy.
Which type of anemia does the instructor Pg. 498
teach students is most prevalent during
pregnancy? Iron-deficiency anemia is the most com-
mon type in pregnancy. Many woman
a) Sickle-cell anemia enter pregnancy with a low iron count
b) Folic acid anemia because of poor diet, heavy menstrual
c) Pernicious anemia periods, unwise weight-loss programs,
d) Iron-deficiency anemia or a combination of these.
36. A woman with class II heart disease c) Lie in a semi-recumbent position
is experiencing an uneventful pregnan-
cy and is now prescribed bed rest at Pg. 495
36 weeks' gestation by her health care
provider. The nurse should point out that Semi-recumbent position is the best po-
this is best accomplished with which position for circulation of the mother and
sition? fetus. Lying flat on the back can induce
supine hypotensive syndrome and ful-
a) Lie flat on her back ly recumbent impedes other circulation.
b) Stay in high Fowler position The high Fowler position would not be
c) Lie in a semi-recumbent position comfortable for sleeping, as well as pos-
d) Use pillows and wedges to stay in a sibly impede the blood flow through the
fully recumbent position hips and lower abdomen.
37. A 38-year-old client comes into the
office for prenatal care, stating that she
d) Be nonjudgmental in your history gath-
is about 12 weeks' pregnant with her first
ering and offer her pregnancy resources
child. What action will the nurse take,
considering the client's age and poten-
16 / 18
tial sensitivity to being labeled an "older"
primipara? to read and explore
a) Ask about chronic illnesses that the Pg. 520

health care provider should know about
due to the client being older This client is pregnant for the first time
b) Inquire about any family history of later in life. The nurse must be supportive
chromosomal abnormalities since older of this choice. Most women realize the in-
women are more likely to have infants creased risks for having giving birth after
with a chromosomal defect 35 years of age and do not need con-
c) Offer genetic counseling and an early stant reminding of the potentially poor
amniocentesis to determine if termina- outcomes that can occur. The majority
tion is needed of pregnancies to women older than 35
d) Be nonjudgmental in your history years of age end with healthy newborns
gathering and offer her pregnancy re- and mothers.
sources to read and explore
d) A newborn who was a vaginal delivery
38. Which neonate is at highest risk
to a mother who had her initial outbreak
for developing neonatal herpes following
during the third trimester of pregnancy
birth?
and has active lesions
a) A newborn who was delivered by ce-
Pg. 272
sarean section following prolonged rup-
ture of membranes to a herpes positive
The newborn most likely to develop a
mother with no active lesions
herpetic infection is the one delivered
b) A newborn who was delivered by ce-
vaginally to a mother who is experienc-
sarean section to a mother with genital
ing her first outbreak, may or may not
herpes
know she has herpes, and has active
c) A newborn who was a vaginal delivery
lesions. Delivery by cesarean section re-
to a mother with no active lesions but a
duces the chance of the newborn devel-
history of herpes
oping herpes, even if there is premature
d) A newborn who was a vaginal delivery
rupture of membranes prior to delivery.
to a mother who had her initial outbreak
Vaginal deliveries are recommended for
during the third trimester of pregnancy
mothers with a history of herpes but no
and has active lesions
current active lesions.
39. The nurse is assessing a pregnant
client who has a long history of asth-
ma. The client states, "I'm trying not to
17 / 18
use my asthma medications because I
certainly don't want my baby exposed
to them." What is the nurse's best re-
c) "Actually, having uncontrolled asthma
sponse?
is much riskier for your baby than the
medication"
a) "Your health care provider will likely
agree with your decision"
Pg. 504
b) "In fact, most modern asthma medica-
tions are categorized as safe for use in
It is important for pregnant clients with
pregnancy"
asthma to keep taking their medications
c) "Actually, having uncontrolled asthma
because the risks of exacerbations ex-
is much riskier for your baby than the
ceed the risks of the medications.
medication"
d) "I'm glad to hear that you're focused
on ensuring your baby's health"
d) Decrease activity and rest more often
13. A woman with cardiac disease at 32 Pg. 495

weeks' gestation reports she has been
having spells of light-headedness and If the client is developing symptoms as-
dizziness every few days. Which instruc- sociated with her heart condition, the first
tion should the nurse prioritize? intervention is to monitor activity levels,
decrease activity, and treat the symp-
a) Discuss induction of labor with the toms. At 32 weeks' gestation, the sug-
health care provider gestion to induce labor is not appropri-
b) Increase fluids and take more vitamins ate, and without knowledge of the type
c) Bed rest and bathroom privileges only of heart condition one would not recom-
until birth mend an increase of fluids or vitamins.
d) Decrease activity and rest more often Total bed rest may be required if the
symptoms do not resolve with decreased
activity.
18 / 18

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Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication

From a Preexisting or Newly Acquired Illness

5. A 29-year-old client has gestational di- Pg. 515

a) "Because I need extra protein, I will In pregnancy, placental hormones cause

An elevated blood glucose is concerning

12. A pregnant client with sickle cell ane- Pg. 500

c) Maintain a daily blood glucose log

14. The nurse is preparing information Pg. 519

16. A mother is talking to the nurse and is

A woman who has a cardiac condition is

30. A woman who is 8 months pregnant Pg. 502

a) Ask about chronic illnesses that the Pg. 520

13. A woman with cardiac disease at 32 Pg. 495

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