Deck 15: Pregnancy at Risk: Pregestational Problems

Question 1

A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit, which is the accurate approach to evaluating the patient for diabetes?

A)Begin serial testing of the patient's serum glucose and HA1c at 24 weeks' gestation.
B)If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM).
C)Recognize HA1c equal to or greater than 4.5% or a fasting plasma glucose level equal to or greater than 90 mg/dl as being diagnostic of diabetes.
D)Conduct screening for type 2 diabetes mellitus as soon as possible.

Answer 1

Conduct screening for type 2 diabetes mellitus as soon as possible.

Question 2

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which of the following statements made by the patient indicates to the nurse that the patient has understood the teaching?

A)"I can continue to drink alcohol until I am diagnosed as pregnant."
B)"I need to stop drinking alcohol completely when I start trying to get pregnant."
C)"A beer once a week will not damage the fetus."
D)"I can drink alcohol while breastfeeding since it doesn't pass into breast milk."

Answer 2

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

Question 3

During her first antepartal visit, a patient who is at 10 weeks' gestation reports that she is HIV-positive. Which statement made by the patient indicates an understanding of the plan of care both during the pregnancy and postpartally?

A)"I'm supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."
B)"I should not breastfeed my baby."
C)"If I have a cesarean section, there's an increased risk that my HIV will be passed to my baby."
D)"When my baby is 2 months old, he or she will be tested for HIV."

Answer 3

"I should not breastfeed my baby."

Question 4

The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The patient states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" The best response by the nurse is: "Ecstasy:

A)"Can cause a high fever in you and therefore cause the baby harm."
B)"Leads to deficiencies of thiamine and folic acid, which help the baby develop."
C)"Produces babies with small heads and short bodies with brain function alterations."
D)"Produces intrauterine growth restriction and meconium aspiration."

Question 5

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 patient needs to be retested for HIV?

A)Hemoglobin of 11 g/dL and a rapid weight gain
B)Elevated blood pressure and ankle edema
C)Shortness of breath and frequent urination
D)Unusual fatigue and recurring Candida vaginitis

Question 6

A 26-year-old multigravida 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 patient?

A)"Exercise either just before meals or wait until two hours after a meal."
B)"Carry hard candy (or other simple sugar) when exercising."
C)"If your blood sugar is 120 mg/dl, eat 20 g of carbohydrate."
D)"If your blood sugar is more than 120 mg/dl, drink a glass of whole milk."

Question 7

A woman is 32 weeks pregnant. She is HIV-positive, but asymptomatic. What would be important in managing her pregnancy and delivery?

A)An amniocentesis at 30 and 36 weeks
B)Weekly nonstress testing beginning at 32 weeks' gestation
C)Application of a fetal scalp electrode as soon as her membranes rupture in labor
D)Administration of intravenous antibiotics during labor and delivery

Question 8

The nurse is reviewing prenatal charts. A patient at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What would the nurse expect to see in the chart?

A)Dyspnea and chest pain with mild exertion
B)Elective cesarean birth scheduled for 37 weeks
C)Discussed need for labor epidural and vacuum extraction
D)Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally

Question 9

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

A)"Your baby may be smaller than average at birth."
B)"Your baby will probably be larger than average at birth."
C)"As long as you control your blood sugar, your baby will not be affected at all."
D)"Your baby might have high blood sugar for several days."

Question 10

The patient with insulin-dependent type 2 diabetes and an HbA_1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this patient?

A)Insulin needs decrease in the first trimester and increase during the third trimester.
B)The risk of ketoacidosis decreases during the length of the pregnancy.
C)Vascular disease that accompanies diabetes slows progression.
D)The baby is likely to have a congenital abnormality because of the diabetes.

Question 11

A patient who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which statement by the patient indicates that she understands the teaching?

A)"I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet."
B)"Whenever possible, I should boil my vegetables in at least 2 quarts of water."
C)"Megaloblastic anemia is not known to cause any serious risks to my baby."
D)"My body makes red blood cells that are smaller than they should be."

Question 12

A woman's history and appearance suggest drug abuse. The nurse's best approach would be to:

A)Ask the woman directly, "Do you use any street drugs?"
B)Ask the woman if she would like to talk to a counselor.
C)Ask some questions about over-the-counter medications and avoid the mention of illicit drugs.
D)Explain how harmful drugs can be for her baby.

Question 13

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:

A)Erythroblastosis fetalis.
B)Diabetes mellitus.
C)Abruptio placentae.
D)Pregnancy-induced hypertension.

Question 14

The patient at 9 weeks' gestation has been told that her HIV test was positive. The patient is very upset and tells the nurse, "I didn't know I had HIV! What will this do to my baby?" The nurse knows teaching has been effective when the patient states:

A)"I cannot take the medications that control HIV during my pregnancy because they will harm the baby."
B)"My baby will probably be born with anti-HIV antibodies, but that doesn't mean it is infected."
C)"The pregnancy will increase the progression of my disease and will reduce my CD4 counts."
D)"The HIV won't affect my baby, and I will have a low-risk pregnancy without additional testing."

Question 15

A woman at 30 weeks' gestation and a history including sickle cell anemia presents to the clinic complaining of fever, chills, and diarrhea for three days. What are the most serious potential complications faced by this patient?

A)Electrolyte imbalance
B)Sickle cell crisis
C)Fetal neural tube defects
D)Severe lethargy