Chapter 20 – Pregnancy at Risk: Selected Health Conditions & Vulnerable Populations

40 question-and-answer style flashcards summarizing critical nursing concepts for managing high-risk pregnancies in Chapter 20.

Name four major categories of conditions that can make a pregnancy high-risk.

Diabetes, cardiac and respiratory disorders, anemia, and autoimmune or specific infectious diseases.

What are the four main clinical classifications of diabetes mellitus?

Type 1, Type 2, impaired fasting glucose/impaired glucose tolerance (pre-diabetes), and gestational diabetes.

During pregnancy, diabetes is clinically categorized into which two groups?

Pregestational diabetes and gestational diabetes.

True or False: A patient who develops diabetes while pregnant is classified as having type 2 diabetes.

False. Development of diabetes during pregnancy is classified as gestational diabetes.

In diabetes-affected pregnancies, an HbA1c goal of less than ___ % is recommended before conception and throughout gestation.

7 %.

List two key maternal screening time points for gestational diabetes.

At the first prenatal visit and again at 24–28 weeks for at-risk patients.

What are the fasting and 1-hour post-prandial glucose targets for patients with gestational diabetes?

Fasting blood sugar < 95 mg/dL; 1-hour post-prandial < 120 mg/dL.

Give two benefits of breastfeeding for a patient with gestational diabetes.

Helps normalize maternal blood glucose and reduces the recurrence risk of gestational diabetes mellitus in future pregnancies.

Macrosomia related to gestational diabetes often leads to what mode of birth?

Cesarean section.

Which four structural defects make up Tetralogy of Fallot?

Ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy.

List three common acquired heart conditions that may complicate pregnancy.

Mitral valve prolapse, mitral or aortic stenosis, and peripartum cardiomyopathy.

How is a patient with class II heart disease expected to respond to increased physical activity?

They become symptomatic (e.g., dyspnea, chest pain) with increased activity.

Define chronic hypertension in pregnancy.

Hypertension present before pregnancy, diagnosed before 20 weeks’ gestation, or persisting longer than 12 weeks postpartum.

Which dietary plan is recommended for patients with chronic hypertension during pregnancy?

The DASH (Dietary Approaches to Stop Hypertension) diet.

Name two rescue or maintenance drugs considered safe for asthma management during pregnancy.

Budesonide (inhaled corticosteroid) and albuterol (short-acting beta-agonist).

Which three first-line medications form the standard regimen for treating tuberculosis in pregnancy?

Isoniazid, rifampin, and ethambutol.

List three typical clinical findings in a pregnant patient with iron-deficiency anemia.

Fatigue, pale mucous membranes, and tachycardia.

Which vitamin enhances the absorption of oral iron supplements?

Vitamin C (ascorbic acid).

Differentiate between alpha and beta thalassemia regarding pregnancy impact.

Alpha (minor) usually causes mild persistent anemia with little pregnancy effect; beta (major) often precludes pregnancy due to severe lifelong hemolysis and anemia.

State two priorities in intrapartum care for a laboring patient with sickle cell anemia.

Adequate pain control and maintenance of oxygenation/hydration (IV fluids and supplemental O₂).

Give one localized and one systemic autoimmune disease that may affect pregnancy.

Localized: Hashimoto thyroiditis or Graves disease; Systemic: systemic lupus erythematosus.

Which congenital infection is most commonly associated with sensorineural hearing loss and neuro-disability in newborns?

Cytomegalovirus (CMV).

Rubella infection during pregnancy primarily increases the risk for which three fetal anomalies?

Sensorineural hearing loss, cataracts/glaucoma (eye defects), and congenital heart defects.

What antibiotic is routinely administered intrapartum to mothers colonized with Group B Streptococcus?

Penicillin (PCN).

List two common routes of toxoplasmosis transmission to pregnant people.

Handling cat litter or soil (gardening) and eating undercooked meat.

Outline the antiretroviral therapy (ART) schedule for an HIV-positive pregnancy.

Oral ART twice daily from 14 weeks until birth, IV ART during labor, and oral ART syrup for the newborn for the first 6 weeks of life.

True or False: All HIV-positive pregnant patients must deliver via cesarean section.

False. Mode of delivery depends on viral load, membrane status, labor progress, and other clinical factors.

List five vulnerable maternal populations highlighted in Chapter 20.

Adolescents, persons of advanced maternal age (≥ 35), pregnant patients with obesity, those living with HIV, and those who misuse substances.

Name three key areas to assess when caring for a pregnant adolescent.

Vision of future goals, knowledge of health/nutrition, and availability of financial or emotional support systems.

What prenatal diagnostic test is commonly offered to pregnant persons over age 35 for genetic evaluation?

Amniocentesis.

Identify two hallmark facial features of fetal alcohol spectrum disorder (FAS/FASD).

Smooth/thin upper lip and short palpebral fissures (small eye openings).

Which illicit substance exposure in utero is most associated with neonatal abstinence syndrome?

Opiates or narcotics (e.g., heroin, methadone).

State one essential nursing approach when managing pregnant patients who misuse substances.

Maintain a nonjudgmental, supportive attitude to foster honest disclosure and adherence to care.

What physiological change of pregnancy can exacerbate existing cardiac disease?

Increased blood volume and cardiac workload, elevating myocardial oxygen demand.

Name four signs of cardiac decompensation nurses should monitor for during pregnancy.

Dyspnea, fatigue, palpitations, and pedal edema/orthopnea.

Which classes of cardiac drugs are commonly used during pregnancy, and which should be avoided because it crosses the placenta?

Diuretics, beta blockers, calcium-channel blockers, and anticoagulants like heparin are used; warfarin is avoided.

What fetal surveillance method combines ultrasound with fetal heart rate reactivity to assess well-being in diabetic pregnancies?

Biophysical profile (BPP).

State two lifestyle recommendations for preventing gestational hypertension in patients with pre-existing chronic hypertension.

Daily rest periods and home blood-pressure monitoring, along with diet and exercise modifications.

During respiratory assessment of a pregnant patient with asthma, what key lung sound indicates airway narrowing?

Wheezing.