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

From a Preexisting or Newly Acquired Illness

Study online at https://quizlet.com/_bof9gq
1. A 15-year-old adolescent arrives at the office with a report of flu
a) Support her by respecting her right to privacy and confidential-
symptoms, including nausea and vomiting and recent weight loss.
ity
A pregnancy test is done and is positive. The client begins crying
and tells the nurse her mother will be furious with her. What can
Pg. 568, 570
the nurse do to assist this adolescent at this point?
The nurse needs to be an advocate for the adolescent and respect
a) Support her by respecting her right to privacy and confidentiality
her privacy and confidentiality. It would be advisable for the nurse
b) Contact the mother of the adolescent to be sure the child gets
to encourage the adolescent to talk to her mother or some other
prenatal care
support person for help. The nurse has no right to contact the
c) Recommend some adoption agencies for her to talk to in the
adolescent's mother or to share any information with her. Also, the
near future
nurse should not mention adoption at this point to the adolescent.
d) Tell the adolescent that this is too big of a problem for her to
That would be a topic for later discussion.
make decisions 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 positive for HIV using an en-
Pg. 1175-1178
zyme-linked immunoassay (ELISA) test. When talking with the
client about the results, she asks, "So what happens next?" Which
The client with a reactive screening test, such as the ELISA test,
response by the nurse would be appropriate as the next step?
needs to be prepared for an additional test, such as the Western
blot or an immunofluorescence assay. The Western blot is the
a) "You will need testing for other infections like gonorrhea or
confirmatory diagnostic test. A positive antibody test confirmed
syphilis"
by a supplemental test indicates that the client has been infected
b) "You will need to have an amniocentesis to check on the baby"
with HIV and can pass it on to others. Antiviral therapy and testing
c) "You will need to have another test to confirm the diagnosis"
for other sexually transmitted infections will be done, but the
d) "First you will get treated with antibiotics and then antiviral
diagnosis must be confirmed first. Antibiotics are not used for HIV.
medicines"
Also, amniocentesis is to be avoided to prevent 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
Pg. 491 come to the clinic for an evaluation. The client has a history of
mitral valve prolapse and is listed as risk class II. During the visit,
Typically, a woman with class I or II cardiac disease can go the woman states, "We want to have a baby, but I know I am at
through a pregnancy without major complications. For class I dis- higher risk. But what is my risk, really?" Which response by the
ease, there is no detectable increased risk of maternal mortality nurse would be appropriate?
and no increase or a mild increase in morbidity. For class II dis-
ease, there is a small increased risk of maternal mortality or mod- a) "Your heart disease would put too much strain on your heart if
erate increase in morbidity and cardiac consultation should occur you were to get pregnant"
every trimester. It is best to have the woman see her cardiologist b) "If you do get pregnant, you will need to be seen by a cardiol-
before becoming pregnant. A woman with class III disease needs ogist every other month for monitoring"
frequent visits with the cardiac care team throughout pregnancy. c) "Your risk during pregnancy is small, but you should see your
There is a significantly increased risk of maternal mortality or se- cardiologist first before getting pregnant"
vere morbidity and cardiologist consult should occur every other d) "Your pregnancy would be uneventful, but you would need
month with prenatal care and delivery occurring at an appropriate specialized care for labor and birth"
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
c) Check her blood sugars frequently and adjust insulin accord- to best control her blood sugar while she is pregnant. The best
ingly reply would be for the woman to:

Pg. 515 a) Begin oral hyperglycemic medications along with the insulin she
is currently taking
The goal for a mother who has type I diabetes mellitus is to keep b) Exercise for 1 to 2 hours each day to keep the blood glucose
tight control over her blood sugars throughout the pregnancy. down
Therefore, she needs to test her blood sugar frequently during the c) Check her blood sugars frequently and adjust insulin accord-
day and make adjustments in the insulin doses she is receiving. ingly
d) Limit weight gain to 15 pounds during the pregnancy
a) Diet
5. A 29-year-old client has gestational diabetes. The nurse is
teaching her about managing her glucose levels. Which therapy
Pg. 515

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 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
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would be most appropriate for this client?
Clients with gestational diabetes are usually managed by diet
alone to control their glucose intolerance. Long-acting insulin
a) Diet
usually is not needed for blood glucose control in the client with
b) Glucagon
gestational diabetes. Oral hypoglycemic drugs are usually not giv-
c) Long-acting insulin
en during pregnancy and would not be the first option. Glucagon
d) Oral hypoglycemic drugs
raises blood glucose and is used to treat hypoglycemic reactions.
a) Avoidance of infection
6. A nurse is teaching a 30-year-old gravida 1 who has sickle cell
Pg. 499-500
anemia. Providing education on which topic is the highest nursing
priority?
Prevention of crises, if possible, is the focus of treatment for the
pregnant woman with sickle cell anemia. Maintaining adequate
a) Avoidance of infection
hydration, avoiding infection, getting adequate rest, and eating a
b) Administration of immunoglobulins
balanced diet are all common-sense strategies that decrease the
c) Consumption of a low-fat diet
risk of a crisis. Fat intake does not need to be decreased and
d) Constipation prevention
immunoglobulins are not normally administered. Constipation is
not usually a result of sickle cell anemia.
b) "Pregnancy affects insulin production, so I will need to make 7. The nurse is teaching a pregnant client with type 2 diabetes
adjustments in my diet" about diet during pregnancy. Which client statement indicates that
the nurse's teaching was successful?
Pg. 513
a) "Because I need extra protein, I will have to increase my intake
In pregnancy, placental hormones cause insulin resistance at a of milk and meat"
level that tends to parallel growth of the fetoplacental unit. Nu- b) "Pregnancy affects insulin production, so I will need to make
tritional management focuses on maintaining balanced glucose adjustments in my diet"
levels. Thus, the client will probably need to make adjustments c) "I'll basically follow the same diet that I was following before I
in the diet. Protein needs increase during pregnancy, but this is became pregnant"
unrelated to diabetes. Blood glucose monitoring results typically d) "I will adjust my diet and insulin based on the results of my urine
guide therapy. tests for glucose"
8. A pregnant client with type 1 diabetes is in labor. The client's
blood glucose levels are being monitored every hour and she has
a prescription for an infusion of regular insulin as needed based
a) 1500
on the client's blood glucose levels. Her levels are as follows:
Pg. 601
1300: 105 mg/dL (5.83 mmol/L)
1400: 100 mg/dL (5.55 mmol/L)
For the laboring woman with diabetes, intravenous (IV) saline or
1500: 120 mg/dL (6.66 mmol/L)
lactated Ringer's is given, and blood glucose levels are monitored
1600: 106 mg/dl (5.88 mmol/L)
every 1 to 2 hours. Glucose levels are maintained below 110
mg/dL (6.11 mmol/L) throughout labor to reduce the likelihood of
Based on the recorded blood glucose levels, at which time would
neonatal hypoglycemia. If necessary, an infusion of regular insulin
the nurse likely administer the regular insulin infusion?
may be given to maintain this level. The insulin infusion would be
given at 1500, based on the blood glucose level being higher than
a) 1500
110 mg/dL (6.11 mmol/L).
b) 1400
c) 1600
d) 1300
b) Check blood sugar levels daily
9. The nurse is assessing a 35-year-old woman at 22 weeks'
Pg. 500
gestation who has had recent laboratory work. The nurse notes
fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13
An elevated blood glucose is concerning for diabetes. A fasting
g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results,
blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or
which instruction should the nurse prioritize?
random level of greater than 200 mg/dl (11.10 mmol/L) is con-
cerning; this must be followed up to ensure the client is not devel-
a) The signs and symptoms of urinary tract infection
oping gestational diabetes. The hemoglobin and hematocrit are
b) Check blood sugar levels daily
within normal limits for this client. The values should be hemoglo-
c) Take daily iron supplements
bin greater than 11 g/dl (110 g/L) and hematocrit greater than 33%
d) Include iron-enriched foods in the diet
(0.33). Values lower than that are possible indications of anemia
and would necessitate further evaluation. An individual with higher

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 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
Study online at https://quizlet.com/_bof9gq
than normal blood glucose levels is at risk for developing urinary
tract infection. This will usually happen after the glucose levels are
elevated. Anemia can be treated by increasing the consumption
of iron-enriched foods and taking a daily iron supplement.
c) Dyspnea, crackles, and irregular weak pulse
10. The nurse is assessing a pregnant client with a known history
of congestive heart failure who is in her third trimester. Which
Pg. 492
assessment findings should the nurse prioritize?
The nurse should be alert for signs of cardiac decompensation
a) Increased urinary output, tachycardia, and dry cough
due to congestive heart failure, which include crackles in the lungs
b) Regular heart rate and hypertension
from fluid, difficulty breathing, and weak pulse from heart exhaus-
c) Dyspnea, crackles, and irregular weak pulse
tion. The heart rate would not be regular, and a cough would not
d) Shortness of breath, bradycardia, and hypertension
be dry. The heart rate would increase rather than decrease.
c) Orange juice
11. The nurse is preparing to teach a pregnant client with iron
Pg. 499
deficiency anemia about the various iron-rich foods to include in
her diet. Which food should the nurse point out will help increase
Anemia is a condition in which the blood is deficient in red blood
the absorption of her iron supplement?
cells, from an underlying cause. The woman needs to take iron
to manufacture enough red blood cells. Taking an iron supple-
a) Dried apples
ment will help improve her iron levels, and taking iron with foods
b) Dried beans
containing ascorbic acid, such as orange juice, improves the
c) Orange juice
absorption of iron. Dried fruit (such as apples), fortified grains,
d) 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 anemia is admitted in crisis.
Pg. 500 Which nursing intervention should the nurse prioritize?

A sickle cell crisis during pregnancy is usually managed by ex- a) IV fluids

change transfusion, oxygen, and IV fluids. Antihypertensive drugs b) Diuretic drugs
usually aren't necessary. Diuretics would not be used unless fluid c) Antihypertensive drugs
overload resulted. The client would be given antibiotics only if d) Antibiotics
there were evidence of an infection.
13.
c) Maintain a daily blood glucose log

Pg. 519
Control of the blood glucose throughout the pregnancy is the
primary goal to help decrease potential complications to both the
mother and fetus. The mother should keep a daily log of her blood
glucose levels and bring this log to each visit for the nurse to
evaluate. The other choices of reporting possible signs of a UTI
and working with a dietitian to plan menus would also be important
but would be secondary to the blood glucose control. It would be
inappropriate to discuss 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 petechiae and premature sepa-
ration of the placenta
Pg. 497
Subclinical bleeding from continuous anticoagulant therapy in
the woman has the potential to cause placental dislodgement.
Observe a woman who is taking an anticoagulant for signs of
petechiae and signs of premature separation of the placenta
during both pregnancy and labor. The nurse should not urge
the client to discontinue the anticoagulant, as this is not within
14. The nurse is preparing information for a client who has
just been diagnosed with gestational diabetes. Which instruction
should the nurse prioritize in this information?
a) Report any signs of possible urinary tract infection
b) Long-term therapy goals
c) Maintain a daily blood glucose log
d) Plan daily menus with dietitian
15. A nurse is assessing a client in her seventh month of pregnan-
cy who has an artificial valve prosthesis. The client is taking an oral
anticoagulant to prevent the formation of clots at the valve site.
Which of the following nursing interventions is most appropriate
in this situation?
a) Put the client on bed rest
b) Urge the client to discontinue the anticoagulant to prevent
pregnancy complications
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 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
Study online at https://quizlet.com/_bof9gq
the nurse's scope of practice and, in any case, the client still
c) Observe the client for signs of petechiae and premature sepa-
needs the anticoagulant to prevent clots. Bed rest is prescribed for
ration of the placenta
clients with a thrombus to prevent it from moving and becoming
d) Instruct the client to avoid wearing constrictive knee-high stock-
a pulmonary embolus. Avoiding the use of constrictive knee-high
ings
stockings is to prevent thrombus formation.
d) "I need to begin taking allergy shots like my friend to prevent
16. A mother is talking to the nurse and is concerned about
me from having an allergic reaction this spring"
managing her asthma while she is pregnant. Which response
to the nurse's teaching indicates that the woman needs further
Pg. 504
instruction?
A pregnant woman with a history of asthma needs to be proactive,
a) "I will monitor my peak expiratory flow rate regularly to help me
taking her inhalers and other asthma medications to prevent
predict when an asthma attack is coming on"
an acute asthma attack. She needs to understand that it is far
b) "I need to be aware of my triggers and avoid them as much as
more dangerous to not take the medications and have an asthma
possible"
attack. She also needs to monitor her peak flow for decreases, be
c) "It is fine for me to use my albuterol inhaler if I begin to feel tight"
aware of triggers, and avoid them if possible. However, a pregnant
d) "I need to begin taking allergy shots like my friend to prevent
woman should never begin allergy shots if she has not been taking
me from having an allergic reaction this spring"
them previously, due to the potential of an adverse reaction.
17. The nurse is teaching a client with gestational diabetes about
a) "If my blood sugars are elevated, my baby's lungs will mature
complications that can occur either following birth or during the
faster, which is good"
birth for the infant. Which statement by the mother indicates that
further teaching is needed by the nurse?
Pg. 513
a) "If my blood sugars are elevated, my baby's lungs will mature
Elevated blood sugars delay the maturation of fetal lungs, not
faster, which is good"
increase maturation time, resulting in potential respiratory dis-
b) "I may need an amniocentesis during the third trimester to see
tress in newborns born to mothers with diabetes. Doing fetal
if my baby's lungs are ready to be born"
movement (kick) counts is standard practice, as is the possibility
c) "My baby may be very large and I may need a cesarean birth
of an amniocentesis to determine lung maturity during the third
to have him"
trimester. Health care personnel should also prepare the mother
d) "Beginning at 28 weeks' gestation, I will start counting with my
for the potential of a cesarean birth if the infant is too large.
baby's movements every day"
c) Jugular distention
18. The nurse is assessing a mother who just delivered a 7 lb
Pg. 493-494
(3136 g) baby via cesarean delivery. Which assessment finding
should the nurse prioritize if the mother has a history of controlled
A woman who has a cardiac condition is at increased risk in the
atrial fibrillation?
postpartum period. The most important nursing action is to moni-
tor for signs of cardiac decompensation. The nurse should monitor
a) Nausea and vomiting
for and report jugular distention, clubbing, and slow capillary refill
b) Urinary retention
time. If an irregular pulse is noted, compare it to the apical pulse.
c) Jugular distention
The abdominal cramps may be related to the uterus involution.
d) Abdominal cramps
The nausea and vomiting and urinary retention may be related to
the surgical procedure and not necessarily the cardiac issue.
c) Iron-deficiency anemia
19. Which condition is the most common cause of anemia in
Pg. 498
pregnancy?
Iron-deficiency anemia accounts for approximately 95% of ane-
a) Sickle cell anemia
mia in pregnancy. Thalassemias are the most common genetic
b) Alpha thalassemia
disorders of the blood. These anemias cause a reduction or ab-
c) Iron-deficiency anemia
sence of the alpha or beta hemoglobin chain. Sickle cell anemia
d) Beta thalassemia
is an inherited chronic disease that results from abnormal hemo-
globin synthesis.
a) "I'll let the doctor know so you can discuss your medications. In
the meantime, I'll give you a list of folate-rich foods you can add
20. A 32-year-old woman with epilepsy mentions to the nurse
to your diet"
during a routine well-visit that she would like to have children and
asks the nurse for advice. Which response is most appropriate
Pg.
from the nurse?
Any woman with epilepsy needs to discuss medication man-

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 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
Study online at https://quizlet.com/_bof9gq
agement with her provider. The current research indicates the
medications used for epileptic management are the major cause
of birth defects for these clients. The nurse should be careful about
mentioning that some epilepsy medications are teratogenic; some a) "I'll let the doctor know so you can discuss your medications. In
women may stop taking their medications in order to get pregnant. the meantime, I'll give you a list of folate-rich foods you can add
Suggesting adoption is inappropriate as the mother has given no to your diet"
indication she is interested in adoption; also, the mother needs b) "Do you want to talk to a counselor who can help you weigh the
to discuss this with the physician so that she can get accurate pros and cons of having your own child rather than adopting?"
information about being on anti-seizure medications and being c) "That's great. I've got a 4-year-old and a 2-year-old myself"
pregnant. The nurse should not share personal information as it d) "You should talk to the doctor about that; the medications you're
does not assist this client in making a serious decision. The client on can damage the fetus"
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 pregnancy has developed a uri-
nary tract infection (UTI). The nurse anticipates which medication
Pg. 502 would be safe and appropriate to use with this client? Select all
that apply.
Amoxicillin, ampicillin, and cephalosporins are effective against
most organisms causing UTIs and are safe antibiotics during a) Tetracyclines
pregnancy. The sulfonamides can be used early in pregnancy but b) Sulfonamides
not near term because they can interfere with protein binding of c) Ampicillin
bilirubin, which then leads to hyperbilirubinemia in the newborn. d) Cephalosporins
Tetracyclines are contraindicated during pregnancy as they cause e) Heparin
retardation of bone growth and staining of the fetal teeth. Heparin f) Amoxicillin
is an anticoagulant and is used to prevent clot formation; it would
not be prescribed for a UTI.
c) Pulmonary hypertension
22. The maternal health nurse is caring for a group of high-risk
pregnant clients. Which client condition will the nurse identify as
Pg. 492
being the highest risk for pregnancy?
Pulmonary hypertension is considered the greatest risk to a
a) Secondary hypertension
pregnancy because of the hypoxia that is associated with the
b) Repaired atrial septal defect
condition. The remaining conditions represent potential cardiac
c) Pulmonary hypertension
complications that may increase the client's risk in pregnancy;
d) Loud systolic murmur
however, these do not present the greatest risk in pregnancy.
23. The maternal health nurse is caring for a pregnant client with
c) Drug metabolism changes during pregnancy
a history of epilepsy. The client's antiepileptic drug (AED) levels
have been in the non-therapeutic range the last two times the
Pg. 510
labs were drawn. Which factor does the nurse associate with this
finding?
Drug metabolism changes during pregnancy which may alter the
therapeutic AED levels in the pregnant client. Some AEDs cannot
a) The action of many medications varies in pregnancy
be given in pregnancy due to risk of harm to the fetus; however,
b) Most maintenance medications cannot be given in pregnancy
there are some that may be given. Pregnant clients do not have
c) Drug metabolism changes during pregnancy
high rates of noncompliance and the action of medications does
d) Pregnant clients have high rates of noncompliance with main-
not change in pregnancy.
tenance medications
d) Congenital anomalies 24. A pregnant woman with diabetes at 10 weeks' gestation has
a glycosylated hemoglobin (HbA1c) level of 13%. At this time
Pg. 490 the nurse should be most concerned about which possible fetal
outcome?
A HbA1c level of 13% indicates poor glucose control. This, in con-
junction with the woman being in the first trimester, increases the a) Placenta previa
risk for congenital anomalies in the fetus. Elevated glucose levels b) Incompetent cervix
are not associated with incompetent cervix, placenta previa, or c) Placental abruption (abruptio placentae)
placental abruption (abruptio placentae). d) Congenital anomalies
c) A diagnostic test such as an abdominal ultrasound

Pg. 507

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 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
Study online at https://quizlet.com/_bof9gq
25. A woman at 38 weeks' gestation arrives at the hospital report-
All of the symptoms point to a diagnosis of acute appendicitis. With
ing a sharp pain between her umbilicus and the iliac crest that
appendicitis, the nausea and vomiting are much more intense
is increasing in intensity in the right lower quadrant. She reports
than with morning sickness and the pain is sharp and localized
having experienced intense nausea and vomiting for the past 3
at McBurney's point (a point halfway between the umbilicus and
hours. The nurse will report which recommendation to the primary
the iliac crest on the lower right abdomen). When identifying, it
health care provider?
is best to recommend a diagnostic test such as an abdominal
ultrasound to confirm the diagnosis. It is important to confirm
a) An abdominal assessment with bowel sounds
the diagnosis as surgery needs to be completed to prevent a
b) A fetal nonstress test and fetal movement (kick) counts
rupture. It is important to do an abdominal assessment but that will
c) A diagnostic test such as an abdominal ultrasound
not confirm a diagnosis. The symptoms do not indicate a urinary
d) A urine culture and broad-spectrum antibiotic
issue. There is no data to indicate an issue with the fetus.
c) Restricted sodium intake

Pg. 495 26. A client is diagnosed with peripartum cardiomyopathy (PPCM).

Which therapy would the nurse expect to administer to the client?
The client with peripartum cardiomyopathy should be prescribed a
restricted sodium intake to control the blood pressure. Monoamine a) Methadone therapy
oxidase inhibitors are given to treat depression in pregnancy, not b) Monoamine oxidase inhibitors (MAOIs)
peripartum cardiomyopathy. Methadone is a drug given for the c) Restricted sodium intake
treatment of a substance use disorder during pregnancy. Com- d) Ginger therapy
plementary therapies like ginger therapy help in the alleviation of
hyperemesis gravidarum, not peripartum cardiomyopathy.
d) 24 to 28 weeks 27. The nurse is caring for a pregnant woman determined to be at
high risk for gestational diabetes. The nurse prepares to rescreen
Pg. 514 this client at which time frame?

A woman identified as high risk for gestational diabetes would a) 20 to 24 weeks

undergo rescreening between 24 and 28 weeks; however, some b) 16 to 20 weeks
health care providers can choose to conduct this screening ear- c) 28 to 32 weeks
lier. d) 24 to 28 weeks
d) Anticoagulant
28. A pregnant woman with a history of mitral valve stenosis is to
Pg, 493
be prescribed medication as treatment. Which medication class
would the nurse expect the client to be prescribed?
In mitral valve stenosis, it is difficult for blood to leave the left
atrium. A secondary problem of thrombus formation may de-
a) Inotropic
velop as a result of noncirculating blood. A woman may need
b) Angiotensin receptor blockers
to be prescribed an anticoagulant to prevent this complication.
c) Vasodilator
Vasodilators are used for peripartum cardiomyopathy. Inotropics
d) Anticoagulant
are used for heart failure. Angiotensin receptor blockers are used
for congestive heart failure.
c) Polyhydramnios
29. The nurse is leading a discussion with a group of pregnant
Pg. 519
women who have diabetes. The nurse should point out which
situation can potentially occur during their pregnancy?
Polyhydramnios is an increase, or excess, in amniotic fluid and
is a pregnancy-related complication associated with diabetes. An
a) Postterm birth
infant who is small-for-gestational-age is not associated with a
b) Hypotension of pregnancy
mother who had diabetes prior to pregnancy. Other pregnancy-re-
c) Polyhydramnios
lated complications associated with pregestational diabetes mel-
d) Small-for-gestational-age (SGA) infant
litus include hypertensive disorders, preterm birth, and shoulder
dystocia.
b) Amoxicillin
30. A woman who is 8 months pregnant comes to the clinic with
urinary frequency and pain on urination. The client is diagnosed
Pg. 502
with a urinary tract infection (UTI). Which medication would the
nurse anticipate the physician will prescribe?
Amoxicillin is a penicillin antibiotic and can be used in the preg-
nant woman to treat a UTI. Tetracycline should never be given
a) Bactrim
to a pregnant woman, because it may cause retardation of bone

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 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
Study online at https://quizlet.com/_bof9gq
growth and staining of the fetal teeth. The sulfonamides (bactrim
and septra) can be used in early pregnancy but not near term,
because they can interfere with protein binding of bilirubin, which
then can lead to hyperbilirubinemia in the newborn.
b) Maintain glycemic control
Pg. 512
The most important goal when caring for a pregnant client with
pregestational diabetes is to maintain glycemic control. The sce-
nario does not give enough information on the client's weight
to determine if the client should gain only minimal weight dur-
ing pregnancy. Ensuring compliance of glucose monitoring and
monitoring for associated complications are appropriate nursing
interventions; however, these do not take priority.
c) Fetal malnutrition
Pg. 507
SLE is an autoimmune disorder in which there is a deposition
of immune complexes in the capillaries and visceral structures.
Clients with SLE who become pregnant are at an increased
risk of fetal malnutrition due to decreased placental circulation.
Pregnancy-related problems in SLE include prematurity, stillbirth,
decreased placental weight, and thinner placental villi. In clients
with SLE, there is preterm birth and decreased placental weight.
Fetal macrosomia is seen in clients having gestational diabetes,
not SLE.
b) An insulin pump
Pg. 518
Because a pregnant client will have some periods of relative
hyperglycemia and hypoglycemia no matter how carefully the
client maintains diet and balances exercise levels, an effective
method to keep serum glucose levels constant is to administer
insulin with a continuous pump during pregnancy.
d) Antiepileptic therapy can lead to vitamin K-deficient hemor-
rhage of the newborn
Pg. 510
Antiepileptic therapy may cause vitamin K-deficient hemorrhage
of the newborn. The vitamin K injection the newborn receives
following birth can't fully correct this, so some physicians recom-
mend a vitamin K supplement for their pregnant clients beginning
at 36 weeks' gestation. If the mother should go into preterm labor,
the newborn will have received the vitamin K prior to delivery.
However, many physicians now question the usefulness of the
prophylaxis.
d) Iron-deficiency anemia
Pg. 498
Iron-deficiency anemia is the most common type in pregnancy.
Many woman enter pregnancy with a low iron count because of
poor diet, heavy menstrual periods, unwise weight-loss programs,
or a combination of these.
c) Lie in a semi-recumbent position
7/8
b) Amoxicillin
c) Tetracycline
d) Septra
31. The nurse is caring for a pregnant client with pregestational
diabetes. Which goal does the nurse identify as priority during the
client's pregnancy?
a) Monitor for associated complications
b) Maintain glycemic control
c) Ensure compliance of glucose monitoring
d) Encourage minimal weight gain
32. A pregnant client with deep vein thrombosis has been diag-
nosed as having systemic lupus erythematosus (SLE). The nurse
would monitor the client closely for the development of which
complication?
a) Fetal macrosomia
b) Increased placental weight
c) Fetal malnutrition
d) Postterm birth of infant
33. The clinic nurse teaches a client with pregestational type 1
diabetes that maintaining a constant insulin level is very important
during pregnancy. The nurse tells the client that the best way to
maintain a constant insulin level is to use:
a) An insulin pen
b) An insulin pump
c) Regular insulin twice a day
d) An insulin drip
34. A woman's obstetrician prescribes vitamin K supplements
for a client who is on antiepileptic medications beginning at 36
weeks' gestation. The mother asks the nurse why she is taking
this medication. The nurse's best response would be:
a) The antiepileptic medications can cause the mother's platelets
to drop
b) Administration of vitamin K aids in lung maturity of the fetus
c) Vitamin K helps in keeping the placenta healthy
d) Antiepileptic therapy can lead to vitamin K-deficient hemor-
rhage of the newborn
35. A nursing instructor is teaching students about anemia during
pregnancy. Which type of anemia does the instructor teach stu-
dents is most prevalent during pregnancy?
a) Sickle-cell anemia
b) Folic acid anemia
c) Pernicious anemia
d) Iron-deficiency anemia
 Ch 20: Nursing Care of a Family Experiencing a Pregnancy Complication
From a Preexisting or Newly Acquired Illness
Study online at https://quizlet.com/_bof9gq
36. A woman with class II heart disease is experiencing an un-
Pg. 495
eventful pregnancy and is now prescribed bed rest at 36 weeks'
gestation by her health care provider. The nurse should point out
Semi-recumbent position is the best position for circulation of
that this is best accomplished with which position?
the mother and fetus. Lying flat on the back can induce supine
hypotensive syndrome and fully recumbent impedes other cir-
a) Lie flat on her back
culation. The high Fowler position would not be comfortable for
b) Stay in high Fowler position
sleeping, as well as possibly impede the blood flow through the
c) Lie in a semi-recumbent position
hips and lower abdomen.
d) Use pillows and wedges to stay in a fully recumbent position
37. A 38-year-old client comes into the office for prenatal care,
stating that she is about 12 weeks' pregnant with her first child.
d) Be nonjudgmental in your history gathering and offer her preg-
What action will the nurse take, considering the client's age and
nancy resources to read and explore
potential sensitivity to being labeled an "older" primipara?
Pg. 520
a) Ask about chronic illnesses that the health care provider should
know about due to the client being older
This client is pregnant for the first time later in life. The nurse must
b) Inquire about any family history of chromosomal abnormalities
be supportive of this choice. Most women realize the increased
since older women are more likely to have infants with a chromo-
risks for having giving birth after 35 years of age and do not
somal defect
need constant reminding of the potentially poor outcomes that
c) Offer genetic counseling and an early amniocentesis to deter-
can occur. The majority of pregnancies to women older than 35
mine if termination is needed
years of age end with healthy newborns and mothers.
d) Be nonjudgmental in your history gathering and offer her preg-
nancy resources to read and explore
d) A newborn who was a vaginal delivery to a mother who had her 38. Which neonate is at highest risk for developing neonatal
initial outbreak during the third trimester of pregnancy and has herpes following birth?
active lesions
a) A newborn who was delivered by cesarean section following
Pg. 272 prolonged rupture of membranes to a herpes positive mother with
no active lesions
The newborn most likely to develop a herpetic infection is the b) A newborn who was delivered by cesarean section to a mother
one delivered vaginally to a mother who is experiencing her first with genital herpes
outbreak, may or may not know she has herpes, and has active c) A newborn who was a vaginal delivery to a mother with no active
lesions. Delivery by cesarean section reduces the chance of the lesions but a history of herpes
newborn developing herpes, even if there is premature rupture of d) A newborn who was a vaginal delivery to a mother who had her
membranes prior to delivery. Vaginal deliveries are recommended initial outbreak during the third trimester of pregnancy and has
for mothers with a history of herpes but no current active lesions. active lesions
39. The nurse is assessing a pregnant client who has a long his-
tory of asthma. The client states, "I'm trying not to use my asthma
c) "Actually, having uncontrolled asthma is much riskier for your medications because I certainly don't want my baby exposed to
baby than the medication" them." What is the nurse's best response?

Pg. 504 a) "Your health care provider will likely agree with your decision"
b) "In fact, most modern asthma medications are categorized as
It is important for pregnant clients with asthma to keep taking their safe for use in pregnancy"
medications because the risks of exacerbations exceed the risks c) "Actually, having uncontrolled asthma is much riskier for your
of the medications. baby than the 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 weeks' gestation reports
Pg. 495
she has been having spells of light-headedness and dizziness
every few days. Which instruction should the nurse prioritize?
If the client is developing symptoms associated with her heart
condition, the first intervention is to monitor activity levels, de-
a) Discuss induction of labor with the health care provider
crease activity, and treat the symptoms. At 32 weeks' gestation,
b) Increase fluids and take more vitamins
the suggestion to induce labor is not appropriate, and without
c) Bed rest and bathroom privileges only until birth
knowledge of the type of heart condition one would not recom-
d) Decrease activity and rest more often
mend an increase of fluids or vitamins. Total bed rest may be
required if the symptoms do not resolve with decreased activity.

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