Exam 3 - Chapter 31 Flashcards
A client with a history of bipolar disorder is called by thepostpartum support nurse for
follow- up. Which symptoms would reassure thenurse that theclient is not experiencing a manic
episode?
a. Psychomotor agitation and lack of sleep
b. Increased appetite and lack of interest in activities
c. Hyperactivity and distractibility
d. Pressured speech and grandiosity
B - An increased appetite and a lack of interest would reassure thenurse that theclient is not
experiencing an episode of mania. Clinical manifestations of a manic episode include at least
three of thefollowing: grandiosity, decreased need for sleep, pressured speech, flight of ideas,
distractibility, psychomotor agitation, and excessive involvement in pleasurable activities.
Thepregnant woman exhibiting symptoms of a manic episode will likely have a decreased
interest in eating and an increased level of interest in pleasurable activities without regard for
negative consequences. Psychomotor agitation and a lack of sleep, hyperactivity and
distractibility, and pressured speech and grandiosity are all clinical manifestations of a manic
episode.
DIF: Cognitiv
When a woman is diagnosed with postpartum depression (PPD) with psychotic features,
what is thenurses primary concern in planning theclients care?
a. Displaying outbursts of anger
b. Neglecting her hygiene
c. Harming her infant
d. Losing interest in her husband
C - Thoughts of harm to herself or to theinfant are among themost serious symptoms of PPD and
require immediate assessment and intervention. Although outbursts of anger and neglecting
personal hygiene are symptoms attributable to PPD, themajor concern remains thepotential of
harm to herself or her infant. Although this client is likely to lose interest in her spouse, it is not
thenurses primary concern.
During an inpatient psychiatric hospitalization, what is themost important nursing
intervention?
a. Contacting theclients significant other
b. Supervising and guiding visits with her infant
c. Allowing no contact with anyone who annoys her
d. Having theinfant with themother at all times
B - In thehospital setting, thereintroduction of theinfant to themother can and should occur at
themothers own pace. A schedule is set that increases thenumber of hours themother cares for
her infant over several days, culminating in theinfant staying overnight in themothers room.
These supervised and guided visits allow themother to experience meeting theinfants needs and
giving up sleep for theinfant. Reintroducing themother to her infant while in a supervised setting
is essential. Another important task for a mother under psychiatric care is to reestablish positive
interactions with others.
Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit
drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?
a. Respiratory conditions
b. Intellectual impairment
c. Neural development disorder
d. Alcohol-related birth defects (ARBDs)
A - Respiratory difficulties are not attributed to exposure to alcohol in utero. Other abnormalities
related to FAS include mental retardation, neurodevelopment disorders, and ARBDs.
As a powerful central nervous system (CNS) stimulant, which of these substances can
lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
a. Heroin
b. Alcohol
c. Phencyclidine (1-phenylcyclohexylpiperidine; PCP)
d. Cocaine
D - Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include
abruptio placentae, preterm labor, precipitous birth, and stillbirth
According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum? a. Prenatal depression b. Single-mother status c. Low socioeconomic status d. Unplanned or unwanted pregnancy
A - Prenatal depression has been found to be a major risk factor for PPD. Single-mother status and
low socioeconomic status are both small-relationship predictors for PPD. Although an unwanted
pregnancy may contribute to therisk for PPD, it does not pose as great an effect as prenatal
depression.
Which is themost accurate description of PPD without psychotic features?
a. Postpartum baby blues requiring thewoman to visit with a counselor or psychologist
b. Condition that is more common among older Caucasian women because they have higher
expectations
c. Distinguishable by pervasive sadness along with mood swings
d. Condition that disappears without outside help
C - PPD is characterized by an intense pervasive sadness along with labile mood swings and is more
persistent than postpartum baby blues. PPD, even without psychotic features, is more serious and
persistent than postpartum baby blues. PPD is more common among younger mothers and
African-American mothers. Most women need professional help to get through PPD, including
pharmacologic intervention.
While providing care to thematernity client, thenurse should be aware that one of these
anxiety disorders is likely to be triggered by theprocess of labor and birth. Which disorder fits
this criterion?
a. Phobias
b. Panic disorder
c. Posttraumatic stress disorder (PTSD)
d. Obsessive-compulsive disorder (OCD)
C - PTSD can occur as theresult of a past trauma such as rape. Symptoms of PTSD include reexperiencing theevent, numbing, irritability, angry outbursts, and exaggerated startle reflex. With
theincreased bodily touch and vaginal examinations that occur during labor, theclient may have
memories of theoriginal trauma. Theprocess of giving birth may result in her feeling out of
control. Thenurse should verbalize an understanding and reassure theclient as necessary.
Which substance used during pregnancy causes vasoconstriction and decreased placental
perfusion, resulting in maternal and neonatal complications?
a. Alcohol
b. Caffeine
c. Tobacco
d. Chocolate
C - Smoking in pregnancy is known to cause a decrease in placental perfusion and is thecause of
low-birth-weight infants. Prenatal alcohol exposure is thesingle greatest preventable cause of
mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage,
premature birth, stillbirth, and anemia. Caffeine may interfere with certain medications and
worsen arrhythmias. Chocolate, particularly dark chocolate, contains caffeine that may interfere
with certain medications
As part of thedischarge teaching, thenurse can prepare themother for her upcoming
adjustment to her new role by instructing her regarding self-care activities to help prevent PPD.
Which statement regarding this condition ismost helpful for theclient?
a. Stay home, and avoid outside activities to ensure adequate rest.
b. Be certain that you are theonly caregiver for your baby to facilitate infant attachment.
c. Keep your feelings of sadness and adjustment to your new role to yourself.
d. Realize that PPD is a common occurrence that affects many women.
D - Should thenew mother experience symptoms of thebaby blues, it is important that she be aware
that these symptoms are nothing to be ashamed of. As many as 10% to 15% of new mothers
experience similar symptoms. Although obtaining enough rest is important for themother, she
should not distance herself from her family and friends. Her spouse or partner can communicate
thebest visiting times to enable thenew mother to obtain adequate rest. It is also important that
she not isolate herself at home by herself during this time of role adjustment. Even if
breastfeeding, other family members can participate in theinfants care. If depression occurs, then
thesymptoms will often interfere with mothering functions; therefore, family support is essential.
Thenew mother should share her feelings with someone else and avoid overcommitting herself
or feel as though she has to besuperwoman. A telephone call to thehospital warm line may
provide reassurance with lactation issues and other infant care questions. Should symptoms
continue, a referral to a professional therapist may be necessary.
A woman at 24 weeks of gestation states that she has a glass of wine with dinner every
evening. Why would the nurse counsel the client to eliminate all alcohol?
a. Daily consumption of alcohol indicates a risk for alcoholism.
b. She will be at risk for abusing other substances as well.
c. The fetus is placed at risk for altered brain growth.
d. The fetus is at risk for multiple organ anomalies
C - No period exists when consuming alcohol during pregnancy is safe. Thedocumented effects of
alcohol consumption during pregnancy include mental retardation, learning disabilities, high
activity level, and short attention span. Thebrain grows most rapidly in thethird trimester and is
vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to
alcohol use.
A pregnant woman who abuses cocaine admits to exchanging sex to finance her drug
habit. This behavior places the client at the greatest risk for what?
a. Depression of the CNS
b. Hypotension and vasodilation
c. Sexually transmitted infections (STIs)
d. Postmature birth
C - Exchanging sex acts for drugs places thewoman at increased risk for STIs because of multiple
partners and thelack of protection. Cocaine is a CNS stimulant that causes hypertension and vasoconstriction. Premature delivery of theinfant is one of themore common problems associated
with cocaine use during pregnancy
What is themost dangerous effect on thefetus of a mother who smokes cigarettes while
pregnant?
a. Genetic changes and anomalies
b. Extensive CNS damage
c. Fetal addiction to thesubstance inhaled
d. Intrauterine growth restriction
D - Themajor consequences of smoking tobacco during pregnancy are low-birth-weight infants,
prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or
extensive CNS damage. Addiction to tobacco is not a usual concern related to theneonate.
Theuse of methamphetamine (meth) has been described as a significant drug problem in
theUnited States. Thenurse who provides care to this client population should be cognizant of
what regarding methamphetamine use?
a. Methamphetamines are similar to opiates.
b. Methamphetamines are stimulants with vasoconstrictive characteristics.
c. Methamphetamines should not be discontinued during pregnancy.
d. Methamphetamines are associated with a low rate of relapse.
B - Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are
similarly used. As is thecase with cocaine users, methamphetamine users are urged to
immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are
extremely psychologically addicted, therate of relapse is extremely high.
With one exception, thesafest pregnancy is one during which thewoman is drug and
alcohol free. What is theoptimal treatment for women addicted to opioids?
a. Methadone maintenance treatment (MMT)
b. Detoxification
c. Smoking cessation
d. 4 Ps Plus
A - MMT is currently considered thestandard of care for pregnant women who are dependent on
heroin or other narcotics. Buprenorphine is another medication approved for thetreatment of
opioid addiction that is increasingly being used during pregnancy. Opioid replacement therapy
has been shown to decrease opioid and other drug use, reduce criminal activity, improve
individual functioning, and decrease therates of infections such as hepatitis B and C, human
immunodeficiency virus (HIV), and other STIs. Detoxification is thetreatment used for alcohol
addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient
management. Women are more likely to stop smoking during pregnancy than at any other time in
their lives. A smoking cessation program can assist in achieving this goal
