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

orange or grapefruit juice."
The pregnant client should take the iron

supplement with vitamin C-containing
fluids such as orange juice, which will
promote absorption, rather than milk,
which can inhibit iron absorption. Tak-
A pregnant client with iron-deficiency ing iron on an empty stomach improves
anemia is prescribed an iron supple- its absorption, but many women can-
ment. After teaching the woman about not tolerate the gastrointestinal discom-
using the supplement, the nurse de- fort it causes. In such cases, the woman
termines that more teaching is needed is advised to take it with meals. The
based on which client statement? woman also needs instruction about ad-
verse effects, which are predominantly
gastrointestinal and include gastric dis-
comfort, nausea, vomiting, anorexia, di-
arrhea, metallic taste, and constipation.
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
1 / 17
should take a dose as soon as she re-
members.
Preparing for amniocentesis and fetal
lung maturity assessment
A 17-year-old primigravida with type 1
diabetes is at 37 weeks' gestation comes If the infant has macrosomia, is large for
to the clinic for an evaluation. The nurse gestation age, and the mother has had
notes her blood sugar has been poorly poor blood-sugar control, the provider
controlled and the health care provider will want further information on the fetus
is suspecting the fetus has macrosomia. and readiness for delivery before making
The nurse predicts which step will be any decisions on delivery. After deter-
completed next? mining the 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 The nurse should be alert for signs of car-
with a known history of congestive heart diac decompensation due to congestive
failure who is in her third trimester. Which heart failure, which include crackles in
assessment findings should the nurse the lungs from fluid, difficulty breathing,
prioritize? and weak pulse from heart exhaustion.
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
A woman with known cardiac disease short of breath or have a nighttime
from childhood presents at the obste- cough.
trician's office 6 weeks' pregnant. What
recommendations would the nurse make Women with known heart conditions
to the client to address the known car- need to be closely followed by both the
obstetrician and a cardiologist. Recom-
mendations would include rest periods,
reduction of stress, getting immuniza-
tions, and monitoring for heart failure as
2 / 17
demonstrated by a nighttime cough and
shortness of breath. Consuming more
sodium in the diet is not recommend-
diac problems for this pregnancy? Select ed due of the potential of developing
all that apply. hypertension. Warfarin is contraindicated
during pregnancy since it crosses the
placental barrier and can cause sponta-
neous abortion, stillbirth or preterm birth.
Potential for greater than usual back pain
Surgical correction of scoliosis (lateral

curvature of the spine) involves implant-
ing stainless-steel rods on both sides of
the vertebrae to strengthen and straight-
A young woman with scoliosis has just
en the spine. Such rod implantations do
learned that she is pregnant. Several
not interfere with pregnancy; a woman
years ago, she had stainless-steel rods
may notice more than usual back pain,
surgically implanted on both sides of her
however, from increased tension on back
vertebrae to strengthen and straighten
muscles. If a woman's pelvis is distorted
her spine. However, her pelvis is unaf-
due to scoliosis, a cesarean birth may
fected by the condition. Which of the fol-
be scheduled to ensure a safe birth, but
lowing does the nurse anticipate in this
this is not required in this scenario. Vagi-
woman's pregnancy?
nal birth, if permitted, requires the same
management as for any woman. With the
improved management of scoliosis, the
high maternal and perinatal risks associ-
ated with the disorder reported in earlier
literature no longer exist.
Appendicitis
A client in week 38 of her pregnancy
With appendicitis, the nausea and vomit-
arrives at the emergency room reporting
ing is much more intense than with morn-
a sharp pain between her umbilicus and
ing sickness and the pain is sharp and
the iliac crest in her lower right abdomen
localized at McBurney's point (a point
that is increasing. She reports having ex-
halfway between the umbilicus and the
perienced intense nausea and vomiting
iliac crest on the lower right abdomen).
for the past 3 hours. Given these symp-
With a ruptured ectopic pregnancy, a
woman may experience abdominal pain
3 / 17
that is either diffuse or sharp, but it is less
likely to occur precisely at McBurney's
toms, the nurse suspects which of the
point. The symptoms described do not
following conditions?
match those of pulmonary embolism or
left-sided heart failure.
low birth weight
In women with cardiac failure, the mater-
Cardiac failure can affect fetal growth at
nal blood pressure becomes insufficient
the point at which maternal blood pres-
to provide an adequate supply of blood to
sure becomes insufficient to provide an
the placenta. The infant will likely experi-
adequate supply of blood and nutrients
ence some undesired effects, including
to the placenta. For this reason, the infant
which of the following?
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 perina-
Which factor would contribute to a tal complications, including hyperten-
high-risk pregnancy? sion, preeclampsia, and neonatal hypo-
glycemia. The age of 33 without other
risk factors does not increase risk, nor
does type O-positive blood or environ-
mental allergens.
A nurse is providing education to a She is at increased risk for type 2 dia-
woman at 28 weeks' gestation who has betes mellitus after her baby is born.
tested positive for gestational diabetes
mellitus (GDM). What would be impor- The woman who develops GDM is at
tant for the nurse to include in the client increased risk for developing type 2 dia-
teaching? betes mellitus after pregnancy.
Pulmonary hypertension
The maternal health nurse is caring for
a group of high-risk pregnant clients. Pulmonary hypertension is considered
Which client condition will the nurse the greatest risk to a pregnancy be-
identify as being the highest risk for preg- cause of the hypoxia that is associated
nancy? with the condition. The remaining con-
ditions represent potential cardiac com-
4 / 17
plications 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 exchange transfu-
A pregnant client with sickle cell anemia
sion, oxygen, and IV fluids. Antihyper-
is admitted in crisis. Which nursing inter-
tensive drugs usually aren't necessary.
vention should the nurse prioritize?
Diuretics would not be used unless fluid
overload resulted. The client would be
given antibiotics only if there were evi-
dence of an infection.
"I need to begin taking allergy shots like
my friend to prevent me from having an
allergic reaction this spring."
A pregnant woman with a history of asth-

ma needs to be proactive, taking her
inhalers and other asthma medications
A mother is talking to the nurse and is
to prevent an acute asthma attack. She
concerned about managing her asthma
needs to understand that it is far more
while she is pregnant. Which response
dangerous to not take the medications
to the nurse's teaching indicates that the
and have an asthma attack. She also
woman needs further instruction?
needs to monitor her peak flow for de-
creases, be aware of triggers, and avoid
them if possible. However, a pregnant
woman should never begin allergy shots
if she has not been taking them previ-
ously, due to the potential of an adverse
reaction.
Maintain a daily blood glucose log
Control of the blood glucose through-

out 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 glu-
5 / 17
cose levels and bring this log to each
visit for the nurse to evaluate. The oth-
er choices of reporting possible signs
The nurse is preparing information for a
of a UTI and working with a dietitian to
client who has just been diagnosed with
plan menus would also be important but
gestational diabetes. Which instruction
would be secondary to the blood glucose
should the nurse prioritize in this infor-
control. It would be inappropriate to dis-
mation?
cuss 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 dis-
cuss 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 dis-

cuss the medication management with
her provider. The current research indi-
cates the medications used for epilep-
tic management are the major cause
of birth defects for these patients. The
A 32-year-old woman with epilepsy men-
nurse should be careful about mention-
tions to the nurse during a routine
ing that some epileptics are teratogenic;
well-visit that she would like to have
some women may stop taking their med-
children and asks the nurse for ad-
ications in order to get pregnant. Sug-
vice. Which response is most appropri-
gesting adoption is inappropriate as the
ate from the nurse?
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 / 17
A pregnant woman with type 2 diabetes
6%
is scheduled for a laboratory test of
glycosylated hemoglobin (HbA1C). What
The upper normal level of HbA1C is 6%
does the nurse tell the client is a normal
of total hemoglobin.
level for this test?
"You should continue taking this drug,
because penicillin is not known to be a
A pregnant woman who has been taking fetal teratogen."
penicillin prophylactically because she
had rheumatic fever as a child tells the A woman taking penicillin prophylactical-
nurse that she wants to stop taking it now ly because she had rheumatic fever as
that she is pregnant. Which of the follow- a child and wants to prevent a recur-
ing is the best response by the nurse? rence should continue this drug during
pregnancy. Penicillin is not known to be
a teratogen.
More women waiting until after age 30
A nursing instructor is teaching students
years to get pregnant
about caring for a pregnant patient with
a pre-existing disease. Which of the fol-
As more women wait until they are older
lowing does the instructor suggest has
than 30 years to have their first child,
added to an increased incidence of preg-
more also enter pregnancy with a pre-ex-
nant women with a pre-existing disease?
isting disorder.
"Pregnancy affects insulin production, so
I'll need to make adjustments in my diet."
In pregnancy, placental hormones cause

insulin resistance at a level that tends
The nurse is teaching a pregnant woman
to parallel growth of the fetoplacen-
with type 1 diabetes about her diet during
tal unit. Nutritional management focuses
pregnancy. Which client statement indi-
on maintaining balanced glucose levels.
cates that the nurse's teaching was suc-
Thus, the woman will probably need to
cessful?
make adjustments in her diet. Protein
needs increase during pregnancy, but
this is unrelated to diabetes. Blood glu-
cose monitoring results typically guide
therapy.
7 / 17
Gestational diabetes
Glycosuria, glucose in the urine, may oc-

cur normally during pregnancy; howev-
er, if it appears in the urine, the client
should be sent for testing to rule out ges-
The nurse is appraising the laboratory
tational diabetes. Preeclampsia, anemia,
results of a pregnant client who is in her
and hyperthyroidism are not related to
second trimester and notes the follow-
glucose nor to renal function. A slightly
ing: thyroid stimulating hormone (TSH)
elevated TSH would indicate possible hy-
slightly elevated, glucose in the urine,
pothyroidism instead of hyperthyroidism.
complete blood count (CBC) low normal,
Anemia would be indicated by below nor-
and normal electrolytes. The nurse pri-
mal hematocrit. If the client's CBC is low
oritizes further testing to rule out which
normal than the nurse should monitor fu-
condition?
ture results to ensure the client's counts
are not dropping. It would also be appro-
priate for the nurse to investigate possi-
ble dietary issues. Preeclampsia would
be best monitored by the blood pressure
readings.
Drug metabolism changes during preg-
nancy
The maternal health nurse is caring for a
Drug metabolism changes during preg-
pregnant client with a history of epilep-
nancy which may alter the therapeutic
sy. The client's antiepileptic drug (AED)
AED levels in the pregnant client. Some
levels have been in the non-therapeutic
AEDs cannot be given in pregnancy due
range the last two times the labs were
to risk of harm to the fetus; however,
drawn. Which factor does the nurse as-
there are some that may be given. Preg-
sociate with this finding?
nant clients do not have high rates of
noncompliance and the action of medica-
tions do not change in pregnancy.
"I sometimes get a bit wheezy."
A pregnant client with a history of asthma Wheezing is a classic symptom of asth-

since childhood presents for a prenatal ma. This statement should alert the
nurse to the possibility that the woman's
asthma is not being well-controlled and
8 / 17
needs further evaluation and possible in-
visit. What statement by the client would tervention. The other statements do not
the nurse prioritize? relate to the typical presentation of this
disease in pregnancy.
Be nonjudgmental in your history gather-
ing and offer her pregnancy resources to
read and explore.
A 38-year-old woman comes into the ob-
Women are having babies later in life and
stetrician's office for prenatal care, stat-
nurses must be supportive of their choic-
ing that she is about 12 weeks pregnant
es to postpone pregnancy. Most women
with her first child. What questions would
realize the increased risks for having a
the nurse ask this client, considering her
baby after 35 years of age and don't need
age and potential sensitivity to being la-
constant reminding of all the potentially
beled an "older" primipara?
bad outcomes that can occur. The ma-
jority 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 as-

sociated with her heart condition, the first
intervention is to monitor activity levels,
A woman with cardiac disease at 32
decrease activity, and treat the symp-
weeks' gestation reports she has been
toms. At 32 weeks' gestation, the sug-
having spells of light-headedness and
gestion to induce labor is not appropri-
dizziness every few days. Which instruc-
ate, and without knowledge of the type
tion should the nurse prioritize?
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 cells, from an
underlying cause. The woman needs to
take iron to manufacture enough red
9 / 17
blood cells. Taking an iron supplement
will help improve her iron levels, and tak-
The nurse is preparing to teach a preg-
ing iron with foods containing ascorbic
nant client with iron deficiency anemia
acid, such as orange juice, improves the
about the various iron-rich foods to in-
absorption of iron. Dried fruit (such as
clude in her diet. Which food should the
apples), fortified grains, and dried beans
nurse point out will help increase the ab-
are additional food choices that are rich
sorption of her iron supplement?
in iron and should be included in her daily
diet.
diet
Clients with gestational diabetes are usu-

A 29-year-old client has gestational dia- ally managed by diet alone to control
betes. The nurse is teaching her about their glucose intolerance. Long-acting in-
managing her glucose levels. Which sulin usually is not needed for blood glu-
therapy would be most appropriate for cose control in the client with gestational
this client? diabetes. Oral hypoglycemic drugs are
contraindicated in pregnancy. Glucagon
raises blood glucose and is used to treat
hypoglycemic reactions.
anticoagulant
In mitral valve stenosis, it is difficult for

blood to leave the left atrium. A sec-
A pregnant woman with a history of mi- ondary problem of thrombus formation
tral valve stenosis is to be prescribed may develop as a result of noncirculat-
medication as treatment. Which medica- ing blood. A woman may need to be
tion class would the nurse expect the prescribed an anticoagulant to prevent
client to be prescribed? this complication. Vasodilators are used
for peripartum cardiomyopathy. Inotrop-
ics are used for heart failure. Angiotensin
receptor blockers are used for conges-
tive heart failure.
congenital malformations
macrosomia
The nurse is caring for a pregnant
respiratory disorder
woman with diabetes mellitus. Which
Potential problems during pregnancy in-
10 / 17
volving maternal diabetes mellitus in-
potential fetal complications should the clude fetal death, macrosomia (over-
nurse monitor the client for as she pre- sized fetus), a fetus with a respirato-
sents for her scheduled visits? Select all ry disorder, difficult labor, preeclampsia
that apply. or eclampsia, polyhydramnios, and con-
genital malformations.
28 to 32 weeks' gestation
A pregnant woman with heart disease

is most vulnerable for cardiac decom-
The nurse is assessing a pregnant client pensation from 28 to 32 weeks' gesta-
who has a history of heart disease. tion, just after the blood volume peaks. It
The nurse will prioritize assessments fo- would be important to assess the client's
cusing on the heart during which time heart at each visit; however, the client's
frame? heart would be more stressed at this time
due to the increased blood volume and
identifying a serious situation early pro-
vides the best opportunity for treatment
and preventing complications.
avoidance of infection
Prevention of crises, if possible, is the fo-

cus of treatment for the pregnant woman
with sickle cell anemia. Maintaining ade-
A nurse is teaching a 30-year-old gravida
quate hydration, avoiding infection, get-
1 who has sickle cell anemia. Providing
ting adequate rest, and eating a bal-
education on which topic is the highest
anced diet are all common-sense strate-
nursing priority?
gies 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 pregestation-
al type 1 diabetic client that constant Because a pregnant client will have
insulin levels are very important during some periods of relative hyperglycemia
pregnancy. The nurse tells the client that and hypoglycemia no matter how care-
fully she maintains her diet and balances
11 / 17
her exercise levels, an effective method
the best way to maintain a constant in- to keep serum glucose levels constant
sulin level is to use: is to administer insulin with a continuous
pump during pregnancy.
restricted sodium intake
The client with peripartum cardiomy-

opathy should be prescribed a restrict-
ed sodium intake to control the blood
A client is diagnosed with peripartum pressure. Monoamine oxidase inhibitors
cardiomyopathy (PPCM). Which therapy are given to treat depression in preg-
would the nurse expect to administer to nancy, not peripartum cardiomyopathy.
the client? Methadone is a drug given for the treat-
ment of a substance use disorder dur-
ing pregnancy. Complementary thera-
pies like ginger therapy help in the alle-
viation of hyperemesis gravidarum, not
peripartum cardiomyopathy.
congenital anomalies
A pregnant woman with diabetes at 10 A HbA1c level of 13% indicates poor

weeks' gestation has a glycosylated he- glucose control. This, in conjunction with
moglobin (HbA1c) level of 13%. At this the woman being in the first trimester, in-
time the nurse should be most con- creases the risk for congenital anomalies
cerned about which possible fetal out- in the fetus. Elevated glucose levels are
come? not associated with incompetent cervix,
placenta previa, or placental abruption
(abruptio placentae).
Check blood sugar levels daily.
An elevated blood glucose is concerning

for diabetes. A fasting blood glucose level
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
(11.10 mmol/L) is concerning; this must
be followed up to ensure the client is
not developing gestational diabetes. The
hemoglobin and hematocrit are within
12 / 17
normal limits for this client. The values
should be hemoglobin greater than 11
g/dl (110 g/L) and hematocrit greater
than 33% (0.33). Values lower than that
has had recent laboratory work. The
are possible indications of anemia and
nurse notes fasting blood glucose 146
would necessitate further evaluation. An
mg/dl (8.10 mmol/L), hemoglobin 13 g/dl
individual with higher than normal blood
(130 g/L), and hematocrit 37% (0.37).
glucose levels is at risk for developing uri-
Based on these results, which instruction
nary tract infection. This will usually hap-
should the nurse prioritize?
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.
heparin
The health care provider of a newly preg- This client has an increased risk for de-
nant client determines the woman also veloping blood clots. If an anticoagulant
has mitral stenosis and will need appro- is required, heparin is the drug of choice
priate therapy. Which medication should as it does not cross the placenta barrier.
the nurse prepare to teach this client to Warfarin crosses the placenta and may
provide her with the best possible care? 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 A woman identified as high risk for gesta-
for gestational diabetes. The nurse pre- tional diabetes would undergo rescreen-
pares to rescreen this client at which ing between 24 and 28 weeks; however,
time frame? some health care providers can choose
to conduct this screening earlier.
Observe the client for signs of petechiae
and premature separation of the placen-
ta
Subclinical bleeding from continuous an-

ticoagulant therapy in the woman has
the potential to cause placental dislodge-
ment. Observe a woman who is taking
13 / 17
an anticoagulant for signs of petechi-
ae and signs of premature separation
of the placenta, therefore, during both
pregnancy and labor. The nurse should
A nurse is assessing a client in her sev-
not urge the client to discontinue the
enth month of pregnancy who has an ar-
anticoagulant, as this is not within the
tificial valve prosthesis. The client is tak-
nurse's scope of practice and, in any
ing an oral anticoagulant to prevent the
case, the client still needs the anticoag-
formation of clots at the valve site. Which
ulant to prevent clots. Bed rest is pre-
of the following nursing interventions is
scribed for clients with a thrombus, to
most appropriate in this situation?
prevent it from moving and becoming a
pulmonary embolus. Avoiding the use of
constrictive knee-high stockings is to pre-
vent thrombus formation.
hypercoagulable state
The nurse should identify that the in-

creased risk of arterial thrombosis in atri-
al fibrillation is due to the hypercoagula-
ble state of pregnancy. During pregnan-
Which changes in pregnancy would the cy, there is a state of hypercoagulation.
nurse identify as a contributing factor This increases the risk of arterial throm-
for arterial thrombosis, especially for the bosis in clients having atrial fibrillation
woman with atrial fibrillation? and artificial valves. Increased cardiac
output and blood volume do not cause
arterial thrombosis. Elevation of the di-
aphragm is due to the uterine distension,
and it causes a shift in the QRS axis and
is not associated with arterial thrombo-
sis.
Maintain glycemic control
The most important goal when caring for

The nurse is caring for a pregnant client a pregnant client with pregestational dia-
with pregestational diabetes. Which goal betes is to maintain glycemic control. The
scenario does not give enough informa-
tion on the client's weight to determine
if the client should gain only minimal
14 / 17
weight during pregnancy. Ensuring com-
pliance of glucose monitoring and mon-
does the nurse identify as priority during
itoring for associated complications are
the client's pregnancy?
appropriate nursing interventions; how-
ever, these do not take priority.
"Breast-feeding is not a good idea. Be-
cause 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.
The milk of a nursing mother with cystic
She asks the nurse for information on
fibrosis is high in sodium. This potentially
breast-feeding. The best response by the
places the infant at risk for hypernatrem-
nurse is:
ia, 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 meals a day
When providing nutritional counseling to plus three snacks, with 40% of calories
a pregnant woman with diabetes, the derived from good-quality complex car-
nurse would urge the client to obtain bohydrates, 35% of calories from pro-
most of her calories from which source? tein 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
The nurse is assessing a pregnant client much riskier for your baby than the med-
who has a long history of asthma. She ication."
states, "I'm trying not to use my asth-
ma medications because I certainly don't It is important for pregnant clients with
want my baby exposed to them." What is asthma to keep taking their medications
the nurse's best response? because the risks of exacerbations ex-
ceed the risks of the medications.
15 / 17
Prepare for assessment of fetal lung ma-
turity.
If the infant has macrosomia, is large for

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

there is deposition of immune complexes
A pregnant client with deep vein throm-
in the capillaries and visceral structures.
bosis has been diagnosed as having
Clients with SLE who become pregnant
systemic lupus erythematosus (SLE).
are at an increased risk of fetal malnutri-
The nurse would monitor the client close-
tion due to decreased placental circula-
ly for the development of which compli-
tion. Pregnancy-related problems in SLE
cation?
include prematurity, stillbirth, decreased
placental weight and thinner placental
villi. In clients with SLE there is preterm
birth and decreased placental weight.
16 / 17
Fetal macrosomia is seen in clients hav-
ing gestational diabetes, not SLE.
17 / 17

CH 20, Nursing Care of A Family Experiencing A Pregnancy Complication

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Ch 20 Nursing Care of a Family Experiencing a Pregnancy Complication

From a Preexisting or Newly Acquired Illness

"I will take the iron with milk instead of

The pregnant client should take the iron

Surgical correction of scoliosis (lateral

A woman with a history of diabetes

A sickle cell crisis during pregnancy is

A pregnant woman with a history of asth-

Control of the blood glucose through-

Any woman with epilepsy needs to dis-

In pregnancy, placental hormones cause

Glycosuria, glucose in the urine, may oc-

A pregnant client with a history of asthma Wheezing is a classic symptom of asth-

If the client is developing symptoms as-

Anemia is a condition in which the blood

Clients with gestational diabetes are usu-

In mitral valve stenosis, it is difficult for

A pregnant woman with heart disease

Prevention of crises, if possible, is the fo-

The client with peripartum cardiomy-

A pregnant woman with diabetes at 10 A HbA1c level of 13% indicates poor

An elevated blood glucose is concerning

Subclinical bleeding from continuous an-

The nurse should identify that the in-

The most important goal when caring for

The pregnant woman with diabetes is

If the infant has macrosomia, is large for

SLE is an autoimmune disorder in which

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