Perry - Chapter 11

Question 1

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:

a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
b. “Insulin dosage will likely need to be increased during the second and third trimesters.”
c. “Episodes of hypoglycemia are more likely to occur during the first 3 months.”
d. “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.”

Answer 1

ANS: A
Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. “Insulin dosage will likely need to be increased during the second and third trimesters,” “Episodes of hypoglycemia are more likely to occur during the first 3 months,” and “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding” are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.

Question 2

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:

a. Frequent episodes of maternal hypoglycemia.
b. Congenital anomalies in the fetus.
c. Polyhydramnios.
d. Hyperemesis gravidarum.

Answer 2

ANS: B
Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

Question 3

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:

a. Mother’s age.
b. Number of years since diabetes was diagnosed.
c. Amount of insulin required prenatally.
d. Degree of glycemic control during pregnancy.

Answer 3

ANS: D

Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

Question 4

Concerning the use and abuse of legal drugs or substances, nurses should be aware that:

a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health.
b. Caucasian women are more likely to experience alcohol-related problems.
c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects.
d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed.

Answer 4

ANS: B
African-American and poor women are more likely to use illicit substances, particularly cocaine, whereas Caucasian and educated women are more likely to use alcohol.
Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

Question 5

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:

a. Macrosomia.
b. Congenital anomalies of the central nervous system.
c. Preterm birth.
d. Low birth weight.

Answer 5

ANS: A
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman

Question 6

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time?

a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements
c. Imbalanced nutrition: more than body requirements
d. Disturbed sleep pattern

Answer 6

ANS: B
This client’s clinical cues include weight loss, which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume. This client reports weight loss, not weight gain. Imbalanced nutrition: more than body requirements is not an appropriate nursing diagnosis. Although the client reports nervousness, based on the client’s other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements.

Question 7

Maternal phenylketonuria (PKU) is an important health concern during pregnancy because:

a. It is a recognized cause of preterm labor.
b. The fetus may develop neurologic problems.
c. A pregnant woman is more likely to die without dietary control.
d. Women with PKU are usually retarded and should not reproduce.

Answer 7

ANS: B
Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of uncertain etiology, or who have given birth to microcephalic infants.

Question 8

In terms of the incidence and classification of diabetes, maternity nurses should know that:

a. Type 1 diabetes is most common.
b. Type 2 diabetes often goes undiagnosed.
c. Gestational diabetes mellitus (GDM) means that the woman will be receiving insulin treatment until 6 weeks after birth.
d. Type 1 diabetes may become type 2 during pregnancy.

Answer 8

ANS: B
Type 2 diabetes often goes undiagnosed because hyperglycemia develops gradually and often is not severe. Type 2 diabetes, sometimes called adult onset diabetes, is the most common. GDM refers to any degree of glucose intolerance first recognized during pregnancy. Insulin may or may not be needed. People do not go back and forth between types 1 and 2 diabetes.

Question 9

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should understand that:

a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own.
b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar.
c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
d. Maternal insulin requirements steadily decline during pregnancy.

Answer 9

ANS: C
Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own insulin around the tenth week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy.

Question 10

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:

a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios occurs approximately twice as often in diabetic pregnancies.
c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.

Answer 10

ANS: A
Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

Question 11

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:

a. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern.
b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.
d. At birth the neonate of a diabetic mother is no longer in any risk.

Answer 11

ANS: B
Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

Question 12

The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc:

a. Is now done for all pregnant women, not just those with or likely to have diabetes.
b. Is a snapshot of glucose control at the moment.
c. Would be considered evidence of good diabetes control with a result of 5% to 6%.
d. Is done on the patient’s urine, not her blood.

Answer 12

ANS: C
A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood.

Question 13

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?

a. 75 mg/dL before lunch. This is low; better eat now.
b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time.
c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin.
d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

Answer 13

ANS: D
60 mg/dL after waking from a nap is too low. During hours of sleep glucose levels should not be less than 70 mg/dL. Snacks before sleeping can be helpful. The premeal acceptable range is 65 to 95 mg/dL. The readings 1 hour after a meal should be less than 140 mg/dL. Two hours after eating, the readings should be less than 120 mg/dL.

Question 14

A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding?

a. Hyperthyroidism c. Hypothyroidism
b. Phenylketonuria (PKU) d. Thyroid storm

Answer 14

ANS: B
PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine. A woman with hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism.

Question 15

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than about her recent diagnosis of diabetes. Several nursing diagnoses are applicable to assist in planning adequate care. The most appropriate diagnosis at this time is:

a. Risk for injury to the fetus related to birth trauma.
b. Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan.
c. Deficient knowledge related to insulin administration.
d. Risk for injury to the mother related to hypoglycemia or hyperglycemia.

Answer 15

ANS: B
Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears to have greater concern for changes to her social life than adoption of a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy. At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made, and she may not participate in the plan of care until understanding takes place.

Question 16

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include:

a. A regular heart rate and hypertension.
b. An increased urinary output, tachycardia, and dry cough.
c. Shortness of breath, bradycardia, and hypertension.
d. Dyspnea; crackles; and an irregular, weak pulse.

Answer 16

ANS: D
Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds. A regular heart rate and hypertension are not generally associated with cardiac decompensation. Tachycardia would indicate cardiac decompensation, but increased urinary output and a dry cough would not. Shortness of breath would indicate cardiac decompensation, but bradycardia and hypertension would not.

Question 17

Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has:

a. Valvular disease. c. Arrhythmias.
b. Congestive heart disease. d. Postmyocardial infarction.

Answer 17

ANS: A
Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis. Prophylaxis for intrapartum endocarditis is not indicated for congestive heart disease, arrhythmias, or after myocardial infarction.

Question 18

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease:

a. Is the same as that for any pregnant woman.
b. Includes rest, stool softeners, and monitoring of the effect of activity.
c. Includes ambulating frequently, alternating with active range of motion.
d. Includes limiting visits with the infant to once per day.

Answer 18

ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the postpartum period is tailored to the woman’s functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.

Question 19

A woman with asthma is experiencing a postpartum hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma?

a. Pitocin
b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. Hemabate
d. Fentanyl

Answer 19

ANS: C
Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this woman’s bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding.

Question 20

The use of methamphetamine (meth) has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this client population the nurse must be cognizant that methamphetamine:

a. Is similar to opiates.
b. Is a stimulant with vasoconstrictive characteristics.
c. Should not be discontinued during pregnancy.
d. Is associated with a low rate of relapse.

Answer 20

ANS: B
Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is very high.

Question 21

Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births?

a. 1 in 100 c. 1 in 2500
b. 1 in 1200 d. 1 in 3000

Answer 21

ANS: D

Cystic fibrosis occurs in about 1 in 3000 Caucasian live births.

Question 22

Which heart condition is not a contraindication for pregnancy?

a. Peripartum cardiomyopathy c. Heart transplant
b. Eisenmenger syndrome d. All of these contraindicate pregnancy.

Answer 22

ANS: C
Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation

Question 23

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:

a. Euglycemia. c. Pneumonia.
b. Rheumatic fever. d. Cardiac decompensation.

Answer 23

ANS: D
Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not manifest with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation.

Question 24

Nurses caring for antepartum women with cardiac conditions should be aware that:

a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
c. Women with class III cardiac disease should have 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
d. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

Answer 24

ANS: B
Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32, when homodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less than ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can carry on limited normal activities with discretion, although they still need a good amount of sleep

Question 25

As related to the care of the patient with anemia, the nurse should be aware that:

a. It is the most common medical disorder of pregnancy.
b. It can trigger reflex brachycardia.
c. The most common form of anemia is caused by folate deficiency.
d. Thalassemia is a European version of sickle cell anemia.

Answer 25

ANS: A
Combined with any other complication, anemia can result in congestive heart failure. Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. The most common form of anemia is iron deficiency anemia. Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.

Question 26

The most common neurologic disorder accompanying pregnancy is:

a. Eclampsia. c. Epilepsy.
b. Bell’s palsy. d. Multiple sclerosis.

Answer 26

ANS: C
The effects of pregnancy on epilepsy are unpredictable. Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy. Bell’s palsy is a form of facial paralysis. Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth.

Question 27

Marfan syndrome is an autosomal dominant genetic disorder that displays as weakness of the connective tissue, joint deformities, ocular dislocation, and weakness to the aortic wall and root. While providing care to a client with Marfan syndrome during labor, which intervention should the nurse complete first?

a. Antibiotic prophylaxis c. Surgery
b. -Blockers d. Regional anesthesia

Answer 27

ANS: A
Because of the potential for cardiac involvement during the third trimester and after birth, treatment with prophylactic antibiotics is highly recommended. -Blockers and restricted activity are recommended as treatment modalities earlier in the pregnancy. Regional anesthesia is well tolerated by clients with Marfan syndrome; however, it is not essential to care. Adequate labor support may be all that is necessary if an epidural is not part of the woman’s birth plan. Surgery for cardiovascular changes such as mitral valve prolapse, aortic regurgitation, root dilation, or dissection may be necessary. Mortality rates may be as high as 50% in women who have severe cardiac disease.

Question 28

With one exception, the safest pregnancy is one in which the woman is drug and alcohol free. For women addicted to opioids, ________________________ treatment is the current standard of care during pregnancy.

a. Methadone maintenance c. Smoking cessation
b. Detoxification d. 4 Ps Plus

Answer 28

ANS: A
Methadone maintenance treatment (MMT) is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for opioid addiction treatment 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 rates of infections such as hepatitis B and C, HIV, and other sexually transmitted infections. Detoxification is the treatment 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. The 4 Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment related to substance abuse.

Question 29

_____ use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications.

a. Alcohol c. Tobacco
b. Caffeine d. Chocolate

Answer 29

ANS: C
Smoking in pregnancy is known to cause a decrease in placental perfusion and has serious health risks, including bleeding complications, low birth weight, prematurity, miscarriage, stillbirth, and sudden infant death syndrome. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine and chocolate may safely be consumed in small quantities during pregnancy.

Question 30

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

a. Hypoglycemia c. Hypobilirubinemia
b. Hypercalcemia d. Hypoinsulinemia

Answer 30

ANS: A
The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth and release large amounts of bilirubin into the neonate’s circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate presents with hyperinsulinemia.

Question 31

Which factor is known to increase the risk of gestational diabetes mellitus?

a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of large infant
d. Previous diagnosis of type 2 diabetes mellitus

Answer 31

ANS: C
Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

Question 32

Glucose metabolism is profoundly affected during pregnancy because:

a. Pancreatic function in the islets of Langerhans is affected by pregnancy.
b. The pregnant woman uses glucose at a more rapid rate than the nonpregnant woman.
c. The pregnant woman increases her dietary intake significantly.
d. Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

Answer 32

ANS: D
Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.

Question 33

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by:

a. Eating six small equal meals per day.
b. Reducing carbohydrates in her diet.
c. Eating her meals and snacks on a fixed schedule.
d. Increasing her consumption of protein.

Answer 33

ANS: C
Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates.

Question 34

When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient:

a. Eat six saltine crackers.
b. Drink 8 oz of orange juice with 2 tsp of sugar added.
c. Drink 4 oz of orange juice followed by 8 oz of milk.
d. Eat hard candy or commercial glucose wafers.

Answer 34

ANS: A
Crackers provide carbohydrates in the form of polysaccharides. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar. Milk is a disaccharide and orange juice is a monosaccharide. They will provide an increase in blood sugar but will not sustain the level. Hard candy or commercial glucose wafers provide only monosaccharides.

Question 35

Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin:

a. Increases throughout pregnancy and the postpartum period.
b. Decreases throughout pregnancy and the postpartum period.
c. Varies depending on the stage of gestation.
d. Should not change because the fetus produces its own insulin.

Answer 35

ANS: C
Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. The insulin needs change throughout the different stages of pregnancy.

Question 36

What form of heart disease in women of childbearing years usually has a benign effect on pregnancy?

a. Cardiomyopathy c. Congenital heart disease
b. Rheumatic heart disease d. Mitral valve prolapse

Answer 36

ANS: D
Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases produce pulmonary hypertension or endocarditis during pregnancy.

Question 37

In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include:

a. Anemia. c. Fever and pain.
b. Endometritis. d. Urinary tract infection.

Answer 37

ANS: C
Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Women with sickle cell anemia are not iron deficient. Therefore, routine iron supplementation, even that found in prenatal vitamins, should be avoided in order to prevent iron overload. Women with sickle cell trait usually are at greater risk for postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis.

Question 38

A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action?

a. Provide a low-protein diet.
b. Offer the vaccine.
c. Discuss the recommendation to bottle-feed her baby.
d. Practice respiratory isolation.

Answer 38

ANS: B
A person who has a history of high risk behaviors should be offered the hepatitis B vaccine. Care is supportive and includes bed rest and a high-protein, low-fat diet. The first trimester is too early to discuss feeding methods with a woman in the high risk category. Hepatitis B is transmitted through blood.

Question 39

Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (Select all that apply):

a. Cleft lip.
b. Congenital heart disease.
c. Neural tube defects.
d. Gastroschisis.
e. Diaphragmatic hernia.

Answer 39

ANS: A, B, C
Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, and neural tube defects. Gastroschisis and diaphragmatic hernia are not associated with the use of AEDs.

Question 40

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include:
a.	Atherosclerosis.
b.	Retinopathy.
c.	IUFD.
d.	Nephropathy.
e.	Neuropathy.
Autonomcs neuropathy.

Answer 40

ANS: A, B, D, E
These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.

Question 41

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Identify all disorders that fall into the category of collagen vascular disease.

a. Multiple sclerosis
b. Systemic lupus erythematosus
c. Antiphospholipid syndrome
d. Rheumatoid arthritis
e. Myasthenia gravis

Answer 41

ANS: B, C, D, E
Multiple sclerosis is not an autoimmune disorder. This patchy demyelinization of the spinal cord may be a viral disorder. Autoimmune disorders (collagen vascular disease) make up a large group of conditions that disrupt the function of the immune system of the body. They include those listed, as well as systemic sclerosis.

Question 42

Achieving and maintaining euglycemia comprise the primary goals of medical therapy for the pregnant woman with diabetes. These goals are achieved through a combination of diet, insulin, exercise, and blood glucose monitoring. The target blood glucose levels 1 hour after a meal should be: _________________

Answer 42

ANS:
130 to 140 mg/dL
Target levels of blood glucose during pregnancy are lower than nonpregnant values. Accepted fasting levels are between 65 and 95 mg/dL, and 1-hour postmeal levels should be less than 130 to 140 mg/dL. Two-hour postmeal levels should be 120 mg/dL or less.

Question 43

You are preparing to teach an antepartum patient with gestational diabetes the correct method of administering an intermediate acting insulin (NPH) with a short acting insulin (regular). In the correct order from 1 through 6, match the step number with the action that you would take to teach the patient self-administration of this combination of insulin.

a. Without adding air, withdraw the correct dose of NPH insulin.
b. Gently rotate the insulin to mix it, and wipe the stopper.
c. Inject air equal to the dose of NPH insulin into the vial, and remove the syringe.
d. Inject air equal to the dose of regular insulin into the vial, and withdraw the medication.
e. Check the insulin bottles for the expiration date.
f. Wash hands.

Answer 43

ANS:
F. Wash hands.
E. Check the insulin bottles for the expiration date.
B. Gently rotate the insulin to mix it, and wipe the stopper.
C. Inject air equal to the dose of NPH insulin into the vial, and remove the syringe.
D. Inject air equal to the dose of regular insulin into the vial, and withdraw the medication.
A. Without adding air, withdraw the correct dose of NPH insulin.