Chapter 15 - Pregnancy at Risk: Pre-existing Conditions

In assessing the knowledge of a pregestational patient with type 1 diabetes concerning changing insulin needs during pregnancy, a nurse recognizes that further teaching is warranted when the patient 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.”

a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”

A nurse is aware that which is attributable to poor glycemic control before and during early pregnancy?

a. Frequent episodes of maternal hypoglycemia

b. Congenital anomalies in the fetus

c. Polyhydramnios

d. Hyperemesis gravidarum

b. Congenital anomalies in the fetus

In planning for the care of a 30-year-old woman with pregestational diabetes, what does a nurse recognize as the most important factor affecting pregnancy outcome?

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

d. Degree of glycemic control during pregnancy

What normal fasting glucose level should the nurse recommend for a woman with pregestational diabetes?

a. 2.5 to 3.5 mmol/L

b. 3.8 to 5.2 mmol/L

c. 5.5 to 7.7 mmol/L

d. 5.0 to 6.6 mmol/L

b. 3.8 to 5.2 mmol/L

A 26-year-old primigravida has come to the clinic for a regular prenatal visit at 12 weeks. They appear thin and somewhat nervous. They report that they eat a well-balanced diet, although their weight is 2.5 kg less than it was at their last visit. The results of laboratory studies confirm that they have a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What is the most important aspect of nursing care at this time?

a. Deficient fluid volume

b. Decreased nutrition

c. Anxiety

d. Disturbed sleep pattern

b. Decreased nutrition

Which should the nurse know regarding drug testing during pregnancy in Canada?

a. It is required at the first prenatal visit.

b. Only those drugs disclosed by the woman are tested for.

c. There is no legal requirement to test the mother or the newborn child.

d. Testing is required during the admission to the labour unit.

c. There is no legal requirement to test the mother or the newborn child.

What is a nurse aware of in relation to the incidence and classification of diabetes?

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.

b. Type 2 diabetes often goes undiagnosed.

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Which is important for a nurse to know?

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.

c. During the second and third trimesters pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

What should a nurse be aware of with regard to maternal diabetes affecting the pregnant patient and fetus?

a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

b. Hydramnios occurs less 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.

a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

What should a nurse be aware of in relation to diabetes in pregnancy?

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 central nervous system (CNS) defects as infants of mothers that do not have diabetes.

d. At birth the newborn of a diabetic mother is no longer at any risk.

b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

A nurse providing care for a patient with Type 1 diabetes understands which about a laboratory test for glycated hemoglobin Alc?

a. The test is now done for all pregnant patients, not just those with or likely to have diabetes.

b. The test is a snapshot of glucose control at the moment.

c. The test is completed to evaluate recent glycemic control.

d. The test is done on the patient’s urine, not her blood.

c. The test is completed to evaluate recent glycemic control.

A patient with asthma is experiencing a postpartum hemorrhage. Which medication would not be used to treat their bleeding because it may exacerbate their asthma?

a. Oxytocin

b. Nonsteroidal anti-inflammatory drugs (NSAIDs)

c. Hemabate

d. Fentanyl

c. Hemabate

A nurse teaches a patient with HIV that which factor increases the risk of mother-to-child perinatal HIV transmission?

a. Treatment with antiretroviral

b. Presence of chorioamnionitis

c. Bottle-feeding after birth

d. Maternal plasma viral level less than 1000 copies per mL

b. Presence of chorioamnionitis

Which statement is accurate in providing perinatal care for patients who use substances?

a. A decision to stop using substances must be made by the family.

b. Harm reduction practices are not effective with pregnant patients.

c. Effects of perinatal substance use in pregnancy and postpartum must be reviewed.

d. Use of community resources for women to eliminate a social bias for perinatal care must be avoided.

c. Effects of perinatal substance use in pregnancy and postpartum must be reviewed.

A nurse must be alert for which signs and symptoms of cardiac decompensation when caring for a pregnant patient with cardiac problems?

a. A regular heart rate and hypertension

b. An increased urinary output, tachycardia, and slow respirations

c. Shortness of breath, bradycardia, and hypertension

d. Frequent cough; crackles; and an irregular, weak pulse

d. Frequent cough; crackles; and an irregular, weak pulse

What should a nurse be aware of with regard to postpartum care of the patient with cardiac disease?

a. It should be the same as that for any pregnant patient.

b. It includes rest, stool softeners, and monitoring of the effect of activity.

c. It includes ambulating frequently, alternating with active range of motion.

d. It includes limiting visits with the newborn to once per day.

b. It includes rest, stool softeners, and monitoring of the effect of activity.

A patient with asthma is experiencing a postpartum hemorrhage. Which medication would be prescribed to treat the bleeding that would not exacerbate the asthma?

a. Prostaglandin E2

b. Ergonovine

c. Hemabate

d. Methylergonovine

a. Prostaglandin E2

Which is important to include in nursing care when caring for a pregnant patient at risk for the development of a thromboembolism?

a. Monitor the patient for loss of deep tendon reflexes.

b. Massage their calves when the patient states they have pain.

c. Apply compression stockings.

d. Maintain a restriction on fluid intake.

c. Apply compression stockings.

According to statistics, cystic fibrosis occurs once in how many live Caucasian births?

a. 1500

b. 2000

c. 2500

d. 3200

d. 3200

A nurse is aware that with which heart condition pregnancy usually contraindicated?

a. Pre-existing hypertension

b. Eisenmenger syndrome

c. Heart transplant

d. Aortic valve stenosis

b. Eisenmenger syndrome

During a physical assessment of an at-risk patient, what is the most likely cause of assessment findings that include generalized edema, crackles at the base of the lungs, and some pulse irregularity?

a. Euglycemia

b. Rheumatic fever

c. Pneumonia

d. Cardiac decompensation

d. Cardiac decompensation

What should a nurse caring for antepartum patients with cardiac conditions be aware of?

a. Stress on the heart is greatest in the first trimester and the last 2 weeks before labour.

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 get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.

d. Women with class I cardiac disease need bedrest through most of the pregnancy and face the possibility of hospitalization near term.

b. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.

 What should a nurse be aware of with regard to anemia?

a. It is the most common medical disorder of pregnancy.

b. It can trigger reflex bradycardia.

c. The most common form of anemia is caused by folate deficiency.

d. Thalassemia is a European version of sickle cell anemia.

a. It is the most common medical disorder of pregnancy.

What is the most common neurological disorder accompanying pregnancy?

a. Eclampsia

b. Bell palsy

c. Epilepsy

d. Multiple sclerosis

c. Epilepsy

While providing care to a patient with Marfan syndrome early in their pregnancy, which intervention should the nurse initially anticipate?

a. Antibiotic prophylaxis

b. Beta-blockers

c. Surgery

d. Regional anaesthesia

b. Beta-blockers

A nurse is aware that which congenital anomaly may occur with the use of anticonvulsant medication?

a. Gastroschisis

b. Congenital heart disease

c. Diaphragmatic hernia

d. Intrauterine growth restriction

b. Congenital heart disease

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

a. Hypoglycemia

b. Hypercalcemia

c. Hypobilirubinemia

d. Hypoinsulinemia

a. Hypoglycemia

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

a. increases throughout pregnancy and the after birth period.

b. decreases throughout pregnancy and the after birth period.

c. varies depending on the stage of gestation.

d. should not change because the fetus produces its own insulin.

c. varies depending on the stage of gestation.

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

a. anemia.

b. endometritis.

c. fever and pain.

d. urinary tract infection.

c. fever and pain.

Which are target blood glucose levels during pregnancy for a 2-hour postprandial plasma glucose? (Select all that apply.)

a. 3.8 mmol/L

b. 4.3 mmol/L

c. 4.8 mmol/L

d. 5.3 mmol/L

e. 5.8 mmol/L

f. 6.3 mmol/L

g. 6.8 mmol/L

D, E, F

d. 5.3 mmol/L, e. 5.8 mmol/L, f. 6.3 mmol/L

Which cardiac diseases have the highest mortality rate and are classified as group III? (Select all that apply.)

a. Pulmonary hypertension

b. Endocarditis

c. Atrial septal defect

d. Aortic stenosis

e. Eisenmenger’s syndrome

f. Bioprosthetic valve

A, B, E

a. Pulmonary hypertension, b. Endocarditis, e. Eisenmenger’s syndrome

Which signs assessed in a pregnant patient are indicative of cardiac decompensation? (Select all that apply.)

a. Frequent cough

b. Difficulty breathing

c. Bradycardia

d. Tachypnea

e. Generalized edema

f. Increased energy

A, B, D, E

a. Frequent cough, b. Difficulty breathing, d. Tachypnea, e. Generalized edema

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.

A, B, C

a. cleft lip., b. congenital heart disease., c. neural tube defects.

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 (Select all that apply.)

a. atherosclerosis.

b. retinopathy.

c. IUFD.

d. nephropathy.

e. neuropathy.

A, B, D, E

a. atherosclerosis., b. retinopathy., d. nephropathy., e. neuropathy.

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

a. Multiple sclerosis

b. Systemic lupus erythematosus

c. Antiphospholipid syndrome

d. Rheumatoid arthritis

e. Myasthenia gravis

B, C, D, E

b. Systemic lupus erythematosus, c. Antiphospholipid syndrome, d. Rheumatoid arthritis, e. Myasthenia gravis