Ch 20 Nursing Care of a Family Experiencing a Pregnancy Complication

From a Preexisting or Newly Acquired Illness

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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 on
the client's blood glucose levels. Her levels are as follows:
1300: 105 mg/dL (5.83 mmol/L)
1400: 100 mg/dL (5.55 mmol/L)
1500: 120 mg/dL (6.66 mmol/L)
1600: 106 mg/dl (5.88 mmol/L)
Based on the recorded blood glucose levels, at which time would
the nurse likely administer the regular insulin infusion?
1500
For the laboring woman with diabetes, intravenous (IV) saline or
lactated Ringer's is given, and blood glucose levels are monitored
every 1 to 2 hours. Glucose levels are maintained below 110
mg/dL (6.11 mmol/L) throughout labor to reduce the likelihood of
neonatal hypoglycemia. If necessary, an infusion of regular insulin
may be given to maintain this level. The insulin infusion would be
given at 1500, based on the blood glucose level being higher than
110 mg/dL (6.11 mmol/L).
"I will take the iron with milk instead of orange or grapefruit juice."

The pregnant client should take the iron supplement with vita-
min C-containing fluids such as orange juice, which will promote
absorption, rather than milk, which can inhibit iron absorption.
Taking iron on an empty stomach improves its absorption, but
A pregnant client with iron-deficiency anemia is prescribed an iron
many women cannot tolerate the gastrointestinal discomfort it
supplement. After teaching the woman about using the supple-
causes. In such cases, the woman is advised to take it with meals.
ment, the nurse determines that more teaching is needed based
The woman also needs instruction about adverse effects, which
on which client statement?
are predominantly gastrointestinal and include gastric discomfort,
nausea, vomiting, anorexia, diarrhea, metallic taste, and con-
stipation. Taking the iron supplement with meals and increasing
intake of fiber and fluids helps overcome the most common side
effects. If the woman misses a dose, she should take a dose as
soon as she remembers.
Preparing for amniocentesis and fetal lung maturity assessment
A 17-year-old primigravida with type 1 diabetes is at 37 weeks'
If the infant has macrosomia, is large for gestation age, and
gestation comes to the clinic for an evaluation. The nurse notes
the mother has had poor blood-sugar control, the provider will
her blood sugar has been poorly controlled and the health care
want further information on the fetus and readiness for delivery
provider is suspecting the fetus has macrosomia. The nurse pre-
before making any decisions on delivery. After determining the
dicts which step will be completed next?
readiness of the fetus, then plans for delivery can be determined
and scheduled.
dyspnea, crackles, and irregular weak pulse

The nurse is assessing a pregnant client with a known history
of congestive heart failure who is in her third trimester. Which
assessment findings should the nurse prioritize?
The nurse should be alert for signs of cardiac decompensation
due to congestive heart failure, which include crackles in the lungs
from fluid, difficulty breathing, and weak pulse from heart exhaus-
tion. The heart rate would not be regular, and a cough would not
be dry. The heart rate would increase rather than decrease.
Plan periods of rest into the workday.
Receive pneumococcal and influenza vaccines.
Let the physician know if you become short of breath or have a
nighttime cough.

A woman with known cardiac disease from childhood presents at
the obstetrician's office 6 weeks' pregnant. What recommenda-
tions would the nurse make to the client to address the known
cardiac problems for this pregnancy? Select all that apply.
Women with known heart conditions need to be closely followed
by both the obstetrician and a cardiologist. Recommendations
would include rest periods, reduction of stress, getting immuniza-
tions, and monitoring for heart failure as demonstrated by a night-
time cough and shortness of breath. Consuming more sodium in
the diet is not recommended due of the potential of developing
hypertension. Warfarin is contraindicated during pregnancy since
it crosses the placental barrier and can cause spontaneous abor-
tion, stillbirth or preterm birth.
Potential for greater than usual back pain

A young woman with scoliosis has just learned that she is preg- Surgical correction of scoliosis (lateral curvature of the spine)
nant. Several years ago, she had stainless-steel rods surgical- involves implanting stainless-steel rods on both sides of the ver-
tebrae to strengthen and straighten the spine. Such rod implan-
tations do not interfere with pregnancy; a woman may notice
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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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more than usual back pain, however, from increased tension on
back muscles. If a woman's pelvis is distorted due to scoliosis, a
ly implanted on both sides of her vertebrae to strengthen and cesarean birth may be scheduled to ensure a safe birth, but this
straighten her spine. However, her pelvis is unaffected by the is not required in this scenario. Vaginal birth, if permitted, requires
condition. Which of the following does the nurse anticipate in this the same management as for any woman. With the improved
woman's pregnancy? management of scoliosis, the high maternal and perinatal risks
associated with the disorder reported in earlier literature no longer
exist.
Appendicitis

A client in week 38 of her pregnancy arrives at the emergency With appendicitis, the nausea and vomiting is much more intense
room reporting a sharp pain between her umbilicus and the iliac than with morning sickness and the pain is sharp and localized
crest in her lower right abdomen that is increasing. She reports at McBurney's point (a point halfway between the umbilicus and
having experienced intense nausea and vomiting for the past 3 the iliac crest on the lower right abdomen). With a ruptured ec-
hours. Given these symptoms, the nurse suspects which of the topic pregnancy, a woman may experience abdominal pain that
following conditions? is either diffuse or sharp, but it is less likely to occur precisely at
McBurney's point. The symptoms described do not match those
of pulmonary embolism or left-sided heart failure.
low birth weight
In women with cardiac failure, the maternal blood pressure be-
Cardiac failure can affect fetal growth at the point at which mater-
comes insufficient to provide an adequate supply of blood to the
nal blood pressure becomes insufficient to provide an adequate
placenta. The infant will likely experience some undesired effects,
supply of blood and nutrients to the placenta. For this reason,
including which of the following?
the infant may tend to have a low birth weight, be preterm, and
respond poorly to labor.
type 1 diabetes

A woman with a history of diabetes has an increased risk for peri-

Which factor would contribute to a high-risk pregnancy? natal complications, including hypertension, preeclampsia, and
neonatal hypoglycemia. The age of 33 without other risk factors
does not increase risk, nor does type O-positive blood or envi-
ronmental allergens.
She is at increased risk for type 2 diabetes mellitus after her baby
A nurse is providing education to a woman at 28 weeks' gestation
is born.
who has tested positive for gestational diabetes mellitus (GDM).
What would be important for the nurse to include in the client
The woman who develops GDM is at increased risk for developing
teaching?
type 2 diabetes mellitus after pregnancy.
Pulmonary hypertension

The maternal health nurse is caring for a group of high-risk Pulmonary hypertension is considered the greatest risk to a preg-
pregnant clients. Which client condition will the nurse identify as nancy because of the hypoxia that is associated with the condition.
being the highest risk for pregnancy? The remaining conditions represent potential cardiac complica-
tions that may increase the client's risk in pregnancy; however,
these do not present the greatest risk in pregnancy.
IV fluids

A sickle cell crisis during pregnancy is usually managed by ex-

A pregnant client with sickle cell anemia is admitted in crisis.
change transfusion, oxygen, and IV fluids. Antihypertensive drugs
Which nursing intervention should the nurse prioritize?
usually aren't necessary. Diuretics would not be used unless fluid
overload resulted. The client would be given antibiotics only if
there were evidence of an infection.
"I need to begin taking allergy shots like my friend to prevent me
from having an allergic reaction this spring."
A mother is talking to the nurse and is concerned about managing
A pregnant woman with a history of asthma needs to be proactive,
her asthma while she is pregnant. Which response to the nurse's
taking her inhalers and other asthma medications to prevent an
teaching indicates that the woman needs further instruction?
acute asthma attack. She needs to understand that it is far more
dangerous to not take the medications and have an asthma at-
tack. She also needs to monitor her peak flow for decreases, be

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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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aware of triggers, and avoid them if possible. However, a pregnant
woman should never begin allergy shots if she has not been taking
them previously, due to the potential of an adverse reaction.
Maintain a daily blood glucose log

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
The nurse is preparing information for a client who has just been
glucose levels and bring this log to each visit for the nurse to
diagnosed with gestational diabetes. Which instruction should the
evaluate. The other choices of reporting possible signs of a UTI
nurse prioritize in this information?
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.
"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
to your diet."

Any woman with epilepsy needs to discuss the medication man-

A 32-year-old woman with epilepsy mentions to the nurse during of birth defects for these patients. The nurse should be care-
a routine well-visit that she would like to have children and asks ful about mentioning that some epileptics are teratogenic; some
the nurse for advice. Which response is most appropriate from the women may stop taking their medications in order to get pregnant.
nurse?
A pregnant woman with type 2 diabetes is scheduled for a lab-
oratory test of glycosylated hemoglobin (HbA1C). What does the
nurse tell the client is a normal level for this test?
A pregnant woman who has been taking penicillin prophylactically
because she had rheumatic fever as a child tells the nurse that
she wants to stop taking it now that she is pregnant. Which of the
following is the best response by the nurse?
A nursing instructor is teaching students about caring for a preg-
nant patient with a pre-existing disease. Which of the following
does the instructor suggest has added to an increased incidence
of pregnant women with a pre-existing disease?
agement with her provider. The current research indicates the
medications used for epileptic management are the major cause
Suggesting adoption is inappropriate as the mother has given no
indication she is interested in adoption; also, the mother needs
to discuss this with the physician so that she can get accurate
information about being on anti-seizure medications and being
pregnant. The nurse should not share personal information as it
does not assist this client in making a serious decision. The client
should be referred to the health care provider to help the client
make the best decision.
6%
The upper normal level of HbA1C is 6% of total hemoglobin.
"You should continue taking this drug, because penicillin is not
known to be a fetal teratogen."
A woman taking penicillin prophylactically because she had
rheumatic fever as a child and wants to prevent a recurrence
should continue this drug during pregnancy. Penicillin is not known
to be a teratogen.
More women waiting until after age 30 years to get pregnant
As more women wait until they are older than 30 years to have
their first child, more also enter pregnancy with a pre-existing
disorder.
"Pregnancy affects insulin production, so I'll need to make adjust-
ments in my diet."

In pregnancy, placental hormones cause insulin resistance at a

The nurse is teaching a pregnant woman with type 1 diabetes
level that tends to parallel growth of the fetoplacental unit. Nu-
about her diet during pregnancy. Which client statement indicates
tritional management focuses on maintaining balanced glucose
that the nurse's teaching was successful?
levels. Thus, the woman will probably need to make adjustments
in her diet. Protein needs increase during pregnancy, but this is
unrelated to diabetes. Blood glucose monitoring results typically
guide therapy.

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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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Gestational diabetes

Glycosuria, glucose in the urine, may occur normally during preg-

nancy; however, if it appears in the urine, the client should be
The nurse is appraising the laboratory results of a pregnant client sent for testing to rule out gestational diabetes. Preeclampsia,
who is in her second trimester and notes the following: thyroid anemia, and hyperthyroidism are not related to glucose nor to
stimulating hormone (TSH) slightly elevated, glucose in the urine, renal function. A slightly elevated TSH would indicate possible
complete blood count (CBC) low normal, and normal electrolytes. hypothyroidism instead of hyperthyroidism. Anemia would be indi-
The nurse prioritizes further testing to rule out which condition? cated by below normal hematocrit. If the client's CBC is low normal
than the nurse should monitor future results to ensure the client's
counts are not dropping. It would also be appropriate for the nurse
to investigate possible dietary issues. Preeclampsia would be best
monitored by the blood pressure readings.
Drug metabolism changes during pregnancy
The maternal health nurse is caring for a pregnant client with
Drug metabolism changes during pregnancy which may alter the
a history of epilepsy. The client's antiepileptic drug (AED) levels
therapeutic AED levels in the pregnant client. Some AEDs cannot
have been in the non-therapeutic range the last two times the
be given in pregnancy due to risk of harm to the fetus; however,
labs were drawn. Which factor does the nurse associate with this
there are some that may be given. Pregnant clients do not have
finding?
high rates of noncompliance and the action of medications do not
change in pregnancy.
"I sometimes get a bit wheezy."

A pregnant client with a history of asthma since childhood pre- Wheezing is a classic symptom of asthma. This statement should
sents for a prenatal visit. What statement by the client would the alert the nurse to the possibility that the woman's asthma is not
nurse prioritize? being well-controlled and needs further evaluation and possible
intervention. The other statements do not relate to the typical
presentation of this disease in pregnancy.
Be nonjudgmental in your history gathering and offer her preg-
nancy resources to read and explore.
A 38-year-old woman comes into the obstetrician's office for
prenatal care, stating that she is about 12 weeks pregnant with Women are having babies later in life and nurses must be support-
her first child. What questions would the nurse ask this client, ive of their choices to postpone pregnancy. Most women realize
considering her age and potential sensitivity to being labeled an the increased risks for having a baby after 35 years of age and
"older" primipara? don't need constant reminding of all the potentially bad outcomes
that can occur. The majority of pregnancies to women over 35
years of age end up with healthy babies and mothers.
Decrease activity and rest more often.

If the client is developing symptoms associated with her heart

A woman with cardiac disease at 32 weeks' gestation reports she condition, the first intervention is to monitor activity levels, de-
has been having spells of light-headedness and dizziness every crease activity, and treat the symptoms. At 32 weeks' gestation,
few days. Which instruction should the nurse prioritize? the suggestion to induce labor is not appropriate, and without
knowledge of the type of heart condition one would not recom-
mend an increase of fluids or vitamins. Total bed rest may be
required if the symptoms do not resolve with decreased activity.
Orange juice

Anemia is a condition in which the blood is deficient in red blood

The nurse is preparing to teach a pregnant client with iron defi-
ciency anemia about the various iron-rich foods to include in her
diet. Which food should the nurse point out will help increase 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-
ment will help improve her iron levels, and taking iron with foods
containing ascorbic acid, such as orange juice, improves the
absorption of iron. Dried fruit (such as apples), fortified grains, and
dried beans are additional food choices that are rich in iron and
should be included in her daily diet.
diet

Clients with gestational diabetes are usually managed by diet

alone to control their glucose intolerance. Long-acting insulin usu-
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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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ally is not needed for blood glucose control in the client with ges-
A 29-year-old client has gestational diabetes. The nurse is teach-
tational diabetes. Oral hypoglycemic drugs are contraindicated in
ing her about managing her glucose levels. Which therapy would
pregnancy. Glucagon raises blood glucose and is used to treat
be most appropriate for this client?
hypoglycemic reactions.
anticoagulant

In mitral valve stenosis, it is difficult for blood to leave the left

A pregnant woman with a history of mitral valve stenosis is to atrium. A secondary problem of thrombus formation may de-
be prescribed medication as treatment. Which medication class velop as a result of noncirculating blood. A woman may need
would the nurse expect the client to be prescribed? to be prescribed an anticoagulant to prevent this complication.
Vasodilators are used for peripartum cardiomyopathy. Inotropics
are used for heart failure. Angiotensin receptor blockers are used
for congestive heart failure.
congenital malformations
macrosomia
The nurse is caring for a pregnant woman with diabetes mellitus. respiratory disorder
Which potential fetal complications should the nurse monitor the
client for as she presents for her scheduled visits? Select all that Potential problems during pregnancy involving maternal diabetes
apply. mellitus include fetal death, macrosomia (oversized fetus), a fetus
with a respiratory disorder, difficult labor, preeclampsia or eclamp-
sia, polyhydramnios, and congenital malformations.
28 to 32 weeks' gestation

A pregnant woman with heart disease is most vulnerable for

The nurse is assessing a pregnant client who has a history of cardiac decompensation from 28 to 32 weeks' gestation, just after
heart disease. The nurse will prioritize assessments focusing on the blood volume peaks. It would be important to assess the
the heart during which time frame? client's heart at each visit; however, the client's heart would be
more stressed at this time due to the increased blood volume and
identifying a serious situation early provides the best opportunity
for treatment and preventing complications.
avoidance of infection

Prevention of crises, if possible, is the focus of treatment for the

A nurse is teaching a 30-year-old gravida 1 who has sickle cell pregnant woman with sickle cell anemia. Maintaining adequate
anemia. Providing education on which topic is the highest nursing hydration, avoiding infection, getting adequate rest, and eating a
priority? balanced diet are all common-sense strategies that decrease the
risk of a crisis. Fat intake does not need to be decreased and
immunoglobulins are not normally administered. Constipation is
not usually a result of sickle cell anemia.
an insulin pump.
The clinic nurse teaches a pregestational type 1 diabetic client
Because a pregnant client will have some periods of relative
that constant insulin levels are very important during pregnancy.
hyperglycemia and hypoglycemia no matter how carefully she
The nurse tells the client that the best way to maintain a constant
maintains her diet and balances her exercise levels, an effective
insulin level is to use:
method to keep serum glucose levels constant is to administer
insulin with a continuous pump during pregnancy.
restricted sodium intake

The client with peripartum cardiomyopathy should be prescribed a

restricted sodium intake to control the blood pressure. Monoamine
A client is diagnosed with peripartum cardiomyopathy (PPCM).
oxidase inhibitors are given to treat depression in pregnancy, not
Which therapy would the nurse expect to administer to the client?
peripartum cardiomyopathy. Methadone is a drug given for the
treatment of a substance use disorder during pregnancy. Com-
plementary therapies like ginger therapy help in the alleviation of
hyperemesis gravidarum, not peripartum cardiomyopathy.
congenital anomalies
A pregnant woman with diabetes at 10 weeks' gestation has
a glycosylated hemoglobin (HbA1c) level of 13%. At this time A HbA1c level of 13% indicates poor glucose control. This, in
conjunction with the woman being in the first trimester, increases

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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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the risk for congenital anomalies in the fetus. Elevated glucose
the nurse should be most concerned about which possible fetal
levels are not associated with incompetent cervix, placenta previa,
outcome?
or placental abruption (abruptio placentae).
Check blood sugar levels daily.

An elevated blood glucose is concerning for diabetes. A fasting

blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or
random level of greater than 200 mg/dl (11.10 mmol/L) is concern-
The nurse is assessing a 35-year-old woman at 22 weeks' gesta- ing; this must be followed up to ensure the client is not developing
tion who has had recent laboratory work. The nurse notes fasting gestational diabetes. The hemoglobin and hematocrit are within
blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 normal limits for this client. The values should be hemoglobin
g/L), and hematocrit 37% (0.37). Based on these results, which greater than 11 g/dl (110 g/L) and hematocrit greater than 33%
instruction should the nurse prioritize? (0.33). Values lower than that are possible indications of anemia
and would necessitate further evaluation. An individual with higher
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.
heparin
The health care provider of a newly pregnant client determines the
This client has an increased risk for developing blood clots. If an
woman also has mitral stenosis and will need appropriate therapy.
anticoagulant is required, heparin is the drug of choice as it does
Which medication should the nurse prepare to teach this client to
not cross the placenta barrier. Warfarin crosses the placenta and
provide her with the best possible care?
may have teratogenic effects. Aspirin is not recommended in this
situation. Digoxin is not used to prevent blood clots.
24 to 28 weeks
The nurse is caring for a pregnant woman determined to be at
high risk for gestational diabetes. The nurse prepares to rescreen A woman identified as high risk for gestational diabetes would
this client at which time frame? undergo rescreening between 24 and 28 weeks; however, some
health care providers can choose to conduct this screening earlier.
Observe the client for signs of petechiae and premature separa-
tion of the placenta

Subclinical bleeding from continuous anticoagulant therapy in

the woman has the potential to cause placental dislodgement.
A nurse is assessing a client in her seventh month of pregnancy
Observe a woman who is taking an anticoagulant for signs of
who has an artificial valve prosthesis. The client is taking an oral
petechiae and signs of premature separation of the placenta,
anticoagulant to prevent the formation of clots at the valve site.
therefore, during both pregnancy and labor. The nurse should not
Which of the following nursing interventions is most appropriate
urge the client to discontinue the anticoagulant, as this is not
in this situation?
within the nurse's scope of practice and, in any case, the client still
needs the anticoagulant to prevent clots. Bed rest is prescribed for
clients with a thrombus, to prevent it from moving and becoming
a pulmonary embolus. Avoiding the use of constrictive knee-high
stockings is to prevent thrombus formation.
hypercoagulable state

The nurse should identify that the increased risk of arterial throm-
bosis in atrial fibrillation is due to the hypercoagulable state of
Which changes in pregnancy would the nurse identify as a con-
pregnancy. During pregnancy, there is a state of hypercoagulation.
tributing factor for arterial thrombosis, especially for the woman
This increases the risk of arterial thrombosis in clients having
with atrial fibrillation?
atrial fibrillation and artificial valves. Increased cardiac output and
blood volume do not cause arterial thrombosis. Elevation of the
diaphragm is due to the uterine distension, and it causes a shift
in the QRS axis and is not associated with arterial thrombosis.
Maintain glycemic control
The nurse is caring for a pregnant client with pregestational
The most important goal when caring for a pregnant client with
diabetes. Which goal does the nurse identify as priority during the
pregestational diabetes is to maintain glycemic control. The sce-
client's pregnancy?
nario does not give enough information on the client's weight
to determine if the client should gain only minimal weight dur-
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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/_96cfln
ing pregnancy. Ensuring compliance of glucose monitoring and
monitoring for associated complications are appropriate nursing
interventions; however, these do not take priority.
"Breast-feeding is not a good idea. Because your breast milk is
high in sodium due to CF, there is a risk of the infant receiving too
much sodium."
A pregnant client with cystic fibrosis (CF) comes to the office for a
prenatal visit. She asks the nurse for information on breast-feed- The milk of a nursing mother with cystic fibrosis is high in sodium.
ing. The best response by the nurse is: This potentially places the infant at risk for hypernatremia, that
is, too much sodium. Provide the client with as much correct
information as possible, and explain medical terms in layperson's
language.
complex carbohydrates

The pregnant woman with diabetes is encouraged to eat three

When providing nutritional counseling to a pregnant woman with
meals a day plus three snacks, with 40% of calories derived from
diabetes, the nurse would urge the client to obtain most of her
good-quality complex carbohydrates, 35% of calories from protein
calories from which source?
sources, and 35% of calories from unsaturated fats. The intake
of saturated fats should be limited during pregnancy, just as they
should be for any person to reduce the risk of heart disease.
"Actually, having uncontrolled asthma is much riskier for your baby
The nurse is assessing a pregnant client who has a long history of than the medication."
asthma. She states, "I'm trying not to use my asthma medications
because I certainly don't want my baby exposed to them." What It is important for pregnant clients with asthma to keep taking their
is the nurse's best response? medications because the risks of exacerbations exceed the risks
of the medications.
Prepare for assessment of fetal lung maturity.

If the infant has macrosomia, is large for gestational age, and the
mother has had poor blood sugar control, the provider will want
A 17-year-old primigravida at 37 weeks' gestation has been un-
further information on the fetus and readiness for delivery before
able to maintain adequate control of her blood glucose throughout
making any decisions on delivery. This will best be accomplished
her pregnancy. The nurse should prioritize which action after the
by an amniocentesis to assess the fetal lung maturity. Scheduling
health care provider suspects the infant has macrosomia based
an induction of labor, allowing the patient to continue without plans
on the recent ultrasound?
for delivery, or scheduling a cesarean delivery at 39 weeks would
not be appropriate nursing actions. Scheduling an induction or
a cesarean section is not in the province of a nurse without a
physician's order.
left lateral recumbent
A nurse informs a pregnant woman with cardiac disease that she
will need two rest periods each day and a full night's sleep. The
The pregnant woman should rest in the left lateral recumbent
nurse further instructs the client that which position for this rest is
position to prevent supine hypotension syndrome and increased
best?
heart effort.
Fetal malnutrition

SLE is an autoimmune disorder in which there is deposition

of immune complexes in the capillaries and visceral structures.
A pregnant client with deep vein thrombosis has been diagnosed
Clients with SLE who become pregnant are at an increased
as having systemic lupus erythematosus (SLE). The nurse would
risk of fetal malnutrition due to decreased placental circulation.
monitor the client closely for the development of which complica-
Pregnancy-related problems in SLE include prematurity, stillbirth,
tion?
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.

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