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OB Test 6 > Maternity Nursing Chap 20 > Flashcards

Maternity Nursing Chap 20 Flashcards

1
Q

Hyperglycemia:

A

-causes hyperosmolarity of the blood which attracts intracellular fluid into the vascular system, resulting in cellular dehydration and expanded blood volume.

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2
Q

Polyuria:
glycosuria:

A
  • kidneys function to excrete large volumes of urine in an attempt to regulate excess vascular volume and to excrete the unusable glucose
  • causes excess thrist
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3
Q

weight loss:

A

-occurs as a result of the breakdown of fat and muscle tissue

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4
Q

polyphagia:

A

-tissue breakdown causes a state of starvation that compels the individual to eat excessive amounts of food

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5
Q

ketoacidosis and acetonuria:

A
  • body compensates for its inability to convert carbohydrate (glucose) into energy by burning proteins and fats
  • this is what is caused by the end products of this metabolism, ketones and fatty acids in excess quantities
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6
Q

What are the maternal risk/complications associated with diabetic pregnancies?

A
  • miscarriage
  • childbirth complications related to macrosomia
  • pregnancy induced hypertension
  • hydramnios
  • postpartum hemorrhage
  • premature rupture of membranes
  • infection
  • hypoglycemia
  • hyperglycemia
  • ketoacidosis
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7
Q

What are the fetal/neonatal risk/complications associated with diabetic pregnancies?

A
  • congenital anomalies
  • macrosomia with related birth injuries
  • IUGR
  • intrauterine death
  • RDS (respiratory distress syndrome)
  • neonatal hypoglycemia
  • hypocalcemia
  • hypomagnesemia
  • hyperbilirubinemia
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8
Q

What metabolic changes occur during the first trimester of pregnancy and what impact does it have on diabetes?

A
  • metabolic status is significantly influenced by the rising levels of estrogen and prgesterone
  • these stimulate the beta cells in the pancreas to increase insulin production
  • promotes increased peripheral use of glucose and decreased blood glucose
  • fasting levels are reduced by approximately 10%
  • women with insulin dependent diabetes are prone to hypoglycemia
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9
Q

What metabolic changes occur during the second and third trimester of pregnancy and what impact does it have on diabetes?

A
  • major hormonal changes occur
  • decreased tolerance to glucose
  • increased insulin resistance
  • decreased hepatic glycogen stores
  • increased hepatic production of glucose
  • rising levels of human chorionic somatomammotropin, estrogen, progesterone, prolactin, cortisol, & insulinase increase insulin resistance (insulin antagonists)
  • maternal insulin requirements gradually increase from approximately 18 to 24 weeks of gestation to approximately 36 weeks
  • insulin requirements may double or quadruple by the end of the pregnancy
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10
Q

What metabolic changes occur during the postpartum period and what impact does it have on diabetes?

A
  • expulsion of the placenta prompts an abrupt drop in levels of circulating placental hormones cortisol, and insulinase
  • maternal tissues quickly regain their prepregnancy sensitivity to insulin
  • nonbreastfeeding mothers insulin carbohydrate balance returns in about 7 to 10 days
  • lactation uses maternal glucose
  • breastfeeding mother’s insulin requirements will remain low during lactation.
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11
Q

True or False: Insulin requirements might decrease during the first trimester but need to increase during the second and third trimesters.

A

True

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12
Q

True or False: Fasting blood glucose levels should be between 40 and 75 mg/dL.

A

False – >65 but <120

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13
Q

True or False: Injections of both longer acting (NPH) and shorter acting (regular insulin) are usually required to maintain glucose control for the woman with pregestational diabetes.

A

True

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14
Q

True or False: Ketoacidosis occurring at any time during pregnancy can lead to intrauterine fetal death.

A

True

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15
Q

True or False: Congenital anomalies commonly associated with pregestational diabetes include malformations of the respiratory tract and sensory deficits.

A

false – primarily affect the cardiovascular system, the CNS, and the skeletal system

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16
Q

True or False: A glycosylated hemoglobin level of 13% to 20% indicates good glycemic control.

A

False – 6 to 7 A1C

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17
Q

True or False: Women with diabetes should avoid a bedtime snack when they are pregnant.

A

False – they should have a snack high in protein to make sure they do not become hypoglycemic during the night

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18
Q

True or False: It is recommended that the 2 hour postprandial blood glucose level be lower than 130 mg/dL.

A

False

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19
Q

True or False: Many women diagnosed with gestational diabetes require the use of oral hypoglycemic medications.

A

False

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20
Q

True or False: Gestational diabetes is primarily a condition that complicates the pregnancies of Caucasian women.

A

False

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21
Q

True or False: The incidence of congenital anomalies among infants of mothers with gestational diabetes is nearly the same as for infants of mothers in the general population.

A

True

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22
Q

True or False: A 1 hour, 50 g glucose tolerance test result higher than 140 mg/dL is diagnostic for gestational diabetes.

A

False – it should be followed by a 3 hour oral glucose tolerance test

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23
Q

True or False: Pregnant women with diabetes should test their urine for glucose to determine whether the dosage of insulin needs to be adjusted.

A

False – Blood glucose monitoring

24
Q

True or False: To avoid the risk of fetal intrauterine death, labor should be induced as soon as the fetal lugns are mature, usually at approximately 36 weeks of gestation.

A

False –

25
Q

True or False: Euglycemia reflects blood glucose levels ranging between 65 and 140 mg/dL.

A

True

26
Q

Hyperthyroidism:

A
  • weight loss
  • pulse greater than 100 beats/min
  • heat intolerance
  • diaphoresis
  • fatigue
  • anxiety
  • emotional lability
  • tachycardia
  • increased risk of miscarriage
  • preterm birth
  • giving birth to stillborn infants or infants with goiters, hyperthyroidism, or hypothyroidism
27
Q

Hypothyroidism:

A
  • weight gain
  • lethargy
  • decrease in exercise capacity
  • cold intolerance
  • constipation
  • hoarseness
  • hair loss
  • brittle nails
  • dry skin
  • increase risk of miscarriage
  • preeclampsia
  • gestational hypertension
  • placental abruption
  • preterm birth
  • stillbirth
  • infants born may be low birth weight
28
Q

What medication is most often used to treat hyperthyroidism?

A

-propylthiouracil (PTU)

29
Q

What medication is most often used to treat hypothyroidism?

A
  • thyroid hormone supplements

- Levothyroxine (l-thyroxine) (Synthroid)

30
Q

True or False: Anemia is the most common medical disorder of pregnancy.

A

True

31
Q

True or False: Folic acid anemia is the most common type of anemia in pregnancy.

A

False – iron deficiency

32
Q

True or False: Anemia increases the postpartum woman’s risk for infection.

A

True

33
Q

True or False: A well balanced diet alone is unable to prevent iron deficiency anemia in pregnancy.

A

True

34
Q

True or False: Oral iron supplementation should be taken in a dose of 60 mg 3 times a day, beginning in the first trimester.

A

False – One 325 mg tablet of ferrous sulfate taken twice daily

35
Q

True or False: Exacerbations of sickle cell crises are diminished in pregnant women with sickle cell disease.

A

False – increased during pregnancy

36
Q

True or False: Preeclampsia is more common in pregnancies complicated by thalassemia major.

A

False – usually experience severe anemia and congestive heart failure

37
Q

True or False: Asthma increases the incidence of miscarriage and preterm labor.

A

False – appears to be associated with intrauterine growth restriction and preterm birth.

38
Q

True or False: Morphine should not be used to provide analgesia for laboring women with bronchial asthma because it releases histamine.

A

True

39
Q

True or False: In the management of care for a laboring women with cystic fibrosis, close monitoring of the serum sodium level and fluid balance is critical.

A

True

40
Q

True or False: Infection is the leading complication among pregnant women with systemic lupus erythematosus.

A

False – hypertension, proteinuria or evidence of IUGR

41
Q

True or False: A pregnant woman with a cardiac problem might be experiencing cardiovascular decompensation if she notices a sudden inability to perform her usual activities as a result of fatigue and dyspnea.

A

True

42
Q

True or False: Epidural anesthesia is more effective than narcotics for providing pain relief for a woman with cardiac problems who is in labor.

A

True

43
Q

True or False: Health care providers are required by federal law to test the urine of all newborns for the presence of alcohol and drugs.

A

False – there is no requirement at this time.

44
Q

True or False: Every pregnant woman should be screened at least verbally for substance abuse at the first prenatal visit.

A

True

45
Q

True or False: Meconium from the newborn can be analyzed to determine past drug use over a longer period of time.

A

True

46
Q

True or False: Disulfiram (Antabuse) is an effective substance to use during pregnancy for alcohol detoxification.

A

False – benzodiazepines (diazepam, Valium or lorazepam Ativan)

47
Q

True or False: A women dependent on a drug tends to exhibit a high degree of depression with the abuse because drugs are a way for women to blunt feelings and relieve psychologic distress.

A

True

48
Q

True or False: Breastfeeding is safe for women who smoke marijuana.

A

False –

49
Q

True or False: Substance abusers often exhibit poor control over their behavior and a low threshold of pain during labor.

A

True

50
Q

A woman with pregestational diabetes at 20 weeks of gestation exhibits the following: thirst, nausea and vomiting, abdominal pain, drowsiness, and increased urination. Her skin is flushed and dry, and her breathing is rapid with a fruity odor. A priority nursing action when caring for this woman is to:

a. provide her with a simple carbohydrate immediately
b. request an order for an antiemetic
c. assist her into a lateral position to rest
d. administer insulin according to her blood glucose level

A

d. administer insulin according to her blood glucose level

51
Q

During her pregnancy a woman with pregestational diabetes has been monitoring her blood glucose level several times a day. Which of the following levels would require further assessment?

a. 85 mg/dl before breakfast
b. 90 mg/dl before lunch
c. 135 mg/dl 2 hours after supper
d. 100 mg/dl at bedtime

A

c. 135 mg/dl 2 hours after supper

52
Q

Specific guidelines should be followed when planning a diet with a woman with pregestational diabetes to ensure a euglycemic state. An appropriate diet reflects:

a. about 40 cal/kg of prepregnancy weight daily
b. a caloric distribution among three meals and at least 2 snacks
c. a minimum of 350 mg of carbohydrate daily
d. a protein intake of at least 30% of the total kilocalories in a dy

A

b. a caloric distribution among three meals and at least 2 snacks

53
Q

An obese pregnant woman with gestational diabetes is learning self injection of insulin. While evaluating the woman’s technique for self injection, the nurse recognizes that the woman understands the instruction when she:

a. washes her hands and puts on a pair of clean gloves
b. shakes the NPH insulin vial vigorously to mix the insulin fully
c. draws the NPH insulin into her syringe first
d. spreads her skin taut and punctures the skin at a 90 degree angle

A

d. spreads her skin taut and punctures the skin at a 90 degree angle

54
Q

When assessing a pregnant woman at 28 weeks of gestation who is diagnosed with rheumatic heart disease, it is important that the nurse be alert for signs indicating cardiac decompensation is:

a. dry, hacking cough
b. supine hypotension
c. wheezing with inspiration and expiration
d. rapid, irregular, weak pulse

A

d. rapid, irregular, weak pulse

55
Q

A woman at 30 weeks gestation with a class II cardiac disorder calls her primary health care provider’s office and speaks to the nurse practitioner. She tells the nurse that she has been experiencing a frequent moist cough for the past few days. In addition, she has been feeling more tired and is having difficulty completing her routine activities as a result of some difficulty with breathing. The nurse’s best response is:

a. have someone bring you to the office so we can assess your cardiac status
b. try to get more rest during the day because that is a difficult time for your heart
c. take an extra diuretic tonight before you go to bed because you might be developing some fluid in your lungs
d. ask your family to come over and do your housework for the next few days so you can rest

A

a. have someone bring you to the office so we can assess your cardiac status

56
Q

At a previous antepartal visit, the nurse taught a pregnant woman diagnosed with a class II cardiac disorder about measures to use to lower her risk for cardiac decompensation. This woman demonstrates a need for further instruction if she:

a. increases roughage in her diet
b. remains on bed rest, only getting out of bed to go to the bathroom
c. sleeps 10 hours every night and rests after meals
d. states that she will call the nurse immediately if she experiences any pain or swelling in her legs

A

b. remains on bed rest, only getting out of bed to go to the bathroom

OB Test 6 (5 decks)

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