CVD and pregnancy

Question 1

The nurse is providing anticipatory guidance to a gravid patient with cardiomyopathy. Which assessment finding by the nurse indicates deteriorating cardiac function?

1. Shortness of breath while climbing stairs
2. Feeling tired at the end of the day
3. Edema in ankles that improves when putting feet up
4. Syncope during or after exertion

Answer 1

ANS: 4

Option 1: Mild dyspnea is common during pregnancy.
Option 2: Fatigue is common during pregnancy.
Option 3: Dependent edema is common during pregnancy.
Option 4: Syncope is abnormal, and may indicate worsening of the condition.

Question 2

The nurse is teaching a group of pregnant women about the risks of venous thromboembolism (VTE). Which statements would the nurse include in the education? Select all that apply.

1. All pregnant women are at an increased risk because pregnancy is a state of hypercoagulability.
2. Women should report any abrupt unilateral leg pain right away.
3. Heparin is not considered safe during pregnancy, so it should be avoided.
4. Pregnant women should avoid sitting for long periods of time to avoid venous stasis in the lower extremities.
5. A prior history of having a blood clot is not significant and does not put a patient at higher risk during pregnancy.

Answer 2

ANS: 1,2,4

Option 1: Increased fibrin, increased coagulation factors, and venous stasis contribute to hypercoagulability during pregnancy.
Option 2: Classic signs of a deep vein thrombosis (DVT) are acute unilateral leg pain, erythema, edema, and low-grade fever.
Option 3: Low molecular weight heparin is considered safe in pregnancy and is the recommended treatment for VTE in pregnancy.
Option 4: It is important to educate about prevention strategies.
Option 5: A prior history of VTE increases a woman’s risk of recurrence during pregnancy.

Question 3

The nurse is caring for a gravid patient with iron-deficiency anemia. Which assessment findings are associated with this diagnosis? Select all that apply.

1. Pallor
   2.Fatigue
   3.Rales heard on auscultation
   4.Hemoglobin below 10 to 11 g/dL
   5.Bruising easily

Answer 3

ANS: 1,2,4

Option 1: Pallor is a sign of anemia.
Option 2: Fatigue is a symptom of anemia.
Option 3: Rales is not a typical finding associated with anemia and could indicate a more severe complication.
Option 4: Hemoglobin below 10 to 11 g/dL is diagnostic of anemia.
Option 5: Bruising easily is a sign of a clotting disorder.

Question 4

The nurse is caring for a patient with congenital heart disease who is beginning her prenatal care. Which normal cardiac changes during pregnancy can exacerbate cardiac disease during pregnancy? Select all that apply.

1. Increase in total blood volume from 30 to 50%
2. Decrease in heart rate by 10 to 20 beats per minute
3. The weight of the gravid uterus can lie on the inferior vena cava
4. Increased peripheral vascular resistance
5. Increased cardiac output

Answer 4

ANS: 1,3,5

Rationales
Option 1: This may exceed the functional capacity of a diseased heart.
Option 2: This is incorrect, as heart rate typically increases by 15%.
Option 3: This can cause hypotension and decreased cardiac output.
Option 4: This is when decreased vascular resistance occurs.
Option 5: Peaks in cardiac output at 28 to 32 weeks’ gestation may result in exceeding functional capacity of a diseased heart.

Question 5

A patient with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She has dyspnea with exertion and is very tired. Her vital signs are oxygen sat 98, HR 80, RR 20, BP 116/72. She has +2 pedal edema and clear breath sounds. The nurse determines the patient’s symptoms indicate which cardiac functional classification?

1. class I
2. class II
3. class III
4. class IV

Answer 5

ANS: 2

2. Class II means she is symptomatic with increased activity (dyspnea and exertion). Class II patients have cardiac disease and a slight limitation in physical activity. When physical activity occurs, the patient may experience angina, difficulty breathing, palpations, and fatigue.

Question 6

A multigravida patient who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks GA stating, “The varicose veins in my legs have really been bothering me lately.” Which instruction would be most helpful?

1. perform slow contraction and relaxation of the feet and ankles twice daily
2. take frequent rest periods with the legs elevated above the hips
3. avoid support hose that reach above the leg varicosities
4. take a leave of absence from your job to avoid prolonged standing

Answer 6

ANS: 2

1. Doenst promote circulation
2. Frequent rest periods with the legs elevated above the hips promotes venous circulation.
3. The patient should avoid restrictive clothing, but support hose that reach above the varicosities may help alleviate the pain.
4. Not realistic financially

Question 7

While caring for a 24 yr old primigravid patient scheduled for an emergency surgery bc of probable ectopic pregnancy, the nurse should:

1. prepare to witness an informed consent for surgery
2. assess the patient for massive external bleeding
3. explain that the fallopian tube can be saved
4. monitor the patient for uterine contractions

Answer 7

ANS: 1

1. The nurse is usually responsible for witnessing the consent for surgery
2. Typically, if bleeding is occurring, it is internal and there is only scant vaginal bleeding
3. The nurse can’t determine this. If the tube has ruptured, it must be removed. If the tube hasn’t ruptured, a linear salpingostomy may be done to salvage the tube for future pregnancies
4. Although the patient is experiencing abdominal pain, she isn’t having uterine contractions

Question 8

A patient in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the patient needs further teaching when she makes which statement?

1. “I will need more frequent appointments during the remainder of the pregnancy.”
2. “Signs of any type of infection must be reported immediately”
3. “At the earliest signs of a crisis, I need to seek treatment”
4. “I will need to take an iron supplement even if my lab values are normal.”

Answer 8

ANS: 4

Sickle cell diseases is an autosomal recessive disorder requiring both parents to have a sickle cell trait to pass the disease to a child. Deoxygenated hemoglobin cells assume a sickle shape and obstruct tissues. Tissue obstruction causes hypoxia to the area (vasoocclusion) and results in pain, called sickle cell crisis. This type of anemia is an inherited disorder; its not caused by lack of iron in the diet. Iron supplements are only needed if there is lab evidence of iron deficiency anemia.

Question 9

A gravid patient in her third trimester has iron-deficiency anemia. Which instruction by the nurse is correct regarding iron supplementation?

1. Iron should be taken with food to increase absorption.
2. Iron should be taken on an empty stomach to increase absorption.
3. If stools turn black, discontinue the use of iron supplementation.
4. The correct dose of ferrous sulfate is 20 mg once daily.

Answer 9

ANS: 2

Option 1: Taking iron with food decreases absorption.
Option 2: The best absorption is on an empty stomach.
Option 3: This is a normal side effect of iron.
Option 4: An intake of at least 200 mg of elemental iron daily is necessary.

Question 10

A 39 yr old multigravida patient at 39 weeks gestation admitted to the hospital in active labor has been diagnosed with class II heart disease. To ensure cardiac emptying and adequate oxygenation during labor, the nurse plans to encourage the patient to:

1. breathe slowly after each contraction
2. avoid the use of analgesics for the labor pain
3. remain in a side lying position with the head elevated
4. request local anesthesia for vaginal birth

Answer 10

ANS: 3

1. Breathing slowly has no effect on cardiac emptying
2. The patient should be relieved of pain and anxiety if she desires analgesic medication.
3. Class II heart disease means the patient has slight limitation of physical activity and may become fatigued with ordinary physical activity. This position ensures cardiac emptying and oxygenation.
4. Local anesthesia is only effective during the 2nd stage of labor. The patient should receive an epidural or analgesia instead.

Question 11

When developing the plan of care for a multigravida patient with class III heart disease, the nurse should expect to assess the patient frequently for which problem?

1. dehydration
2. nausea and vomiting
3. iron deficiency anemia
4. tachycardia

Answer 11

ANS: 4

4. Patients with class III heart disease have limited physical activity ability. They frequently experience fatigue, dyspnea, palpitations, or anginal pain. A pulse rate > 100 or a respiratory rate > 25 could result in cardiac arrest. They may also experience peripheral edema, orthopnea, tachypnea, rales, and hemoptysis.