1. The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy.
Which client statement indicates that the nurse's
... [Show More] teaching was successful?
A. "I'll basically follow the same diet that I was following before I became pregnant."
B. "Because I need extra protein, I'll have to increase my intake of milk and meat."
C. "Pregnancy affects insulin production, so I'll need to make adjustments in my diet."
D. "I'll adjust my diet and insulin based on the results of my urine tests for glucose."
Answer: C
Rationale: In pregnancy, placental hormones cause insulin resistance at a level that tends to
parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining
balanced glucose levels. Thus, the woman will probably need to make adjustments in her diet.
Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose
monitoring results typically guide therapy.
2. A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin
(HbA1c) level of 13%. At this time the nurse should be most concerned about which possible
fetal outcome?
A. congenital anomalies
B. incompetent cervix
C. placenta previa
D. placental abruption (abruptio placentae)
Answer: A
Rationale: A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the
woman being in the first trimester, increases the risk for congenital anomalies in the fetus.
Elevated glucose levels are not associated with incompetent cervix, placenta previa, or placental
abruption (abruptio placentae).
3. A nurse is conducting a review class for a group of perinatal nurses working at the local clinic.
The clinic sees a high population of women who are HIV positive. After discussing the
recommendations for antiretroviral therapy with the group, the nurse determines that the teaching
was successful when the group identifies which rationale as the underlying principle for the
therapy?
A. reduction in viral loads in the blood
B. treatment of opportunistic infections
C. adjunct therapy to radiation and chemotherapy
D. can cure acute HIV/AIDS infections
Answer: A
Rationale: Drug therapy is the mainstay of treatment and is important in reducing the viral load
as much as possible. Antiretroviral agents do not treat opportunistic infections and are not
adjunctive therapy. There is no cure for HIV/AIDS.
4. Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is
also evidence suggesting vasoconstriction. The nurse would question the woman about use of
which substance?
A. marijuana
B. alcohol
C. heroin
D. cocaine
Answer: D
Rationale: Cocaine use produces vasoconstriction, tachycardia, and hypertension in both the
mother and fetus. The effects of marijuana are not yet fully understood. Alcohol ingestion would
lead to cognitive and behavioral problems in the newborn. Heroin is a central nervous system
depressant.
5. When teaching a class of pregnant women about the effects of substance use during
pregnancy, the nurse would include which effect?
A. low-birthweight infants
B. excessive weight gain
C. higher pain tolerance
D. longer gestational periods
Answer: A
Rationale: Substance use during pregnancy is associated with low birth weight infants, preterm
labor, abortion, intrauterine growth restriction, abruptio placentae, neurobehavioral
abnormalities, and long-term childhood developmental consequences. Excessive weight gain,
higher pain tolerance, and longer gestational periods are not associated with substance use.
6. A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices
concern about her newborn's risk for the infection. Which statement by the nurse would be most
appropriate?
A. "You'll probably have a cesarean birth to prevent exposing your newborn."
B. "Antibodies cross the placenta and provide immunity to the newborn."
C. "Wait until after the infant is born, and then something can be done."
D. "Antiretroviral medications are available to help reduce the risk of transmission."
Answer: D
Rationale: Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The
goal of therapy is to reduce the viral load as much as possible; this reduces the risk of
transmission to the fetus. Decisions about the method of birth should be based on the woman's
viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors.
The newborn is at risk for HIV because of potential perinatal transmission. Waiting until after
the infant is born may be too late.
7. When preparing a schedule of follow-up visits for a pregnant woman with chronic
hypertension, which schedule would be most appropriate?
A. monthly visits until 32 weeks, then bi-monthly visits
B. bi-monthly visits until 28 weeks, then weekly visits
C. monthly visits until 20 weeks, then bi-monthly visits
D. bi-monthly visits until 36 weeks, then weekly visits
Answer: B
Rationale: For the woman with chronic hypertension, antepartum visits typically occur every 2
weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal
surveillance.
8. A woman with a history of asthma comes to the clinic for evaluation for pregnancy. The
woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen
for asthma, which medication would the nurse identify as problematic for the woman now that
she is pregnant?
A. ipratropium
B. albuterol
C. salmeterol
D. Prednisone
Answer: D
Rationale: Oral corticosteroids such as prednisone are not preferred for the long-term treatment
of asthma during pregnancy. Inhaled steroids are the choice for maintenance medications to
reduce inflammation that leads to bronchospasm. Common ones prescribed include
beclomethasone and salmeterol. Rescue agents such as albuterol or ipratropium provide
immediate symptomatic relief by reducing acute bronchospasm.
9. A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron
supplement. After teaching her about her prescribed iron supplement, which statement indicates
successful teaching?
A. "I should take my iron with milk."
B. "I should avoid drinking orange juice."
C. "I need to eat foods high in fiber."
D. "I'll call the primary care provider if my stool is black and tarry."
Answer: C
Rationale: Iron supplements can lead to constipation, so the woman needs to increase her intake
of fluids and high-fiber foods. Milk inhibits absorption and should be discouraged. Vitamin Ccontaining
fluids such as orange juice are encouraged because they promote absorption. Ideally
the woman should take the iron on an empty stomach to improve absorption, but many women
cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman should take it
with meals. Iron typically causes the stool to become black and tarry; there is no need for the
woman to notify her primary care provider.
10. The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which
newborn finding would provide additional evidence to support this suspicion?
A. wide, large eyes
B. thin upper lip
C. protruding jaw
D. elongated nose
Answer: B
Rationale: Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper
lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a
low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear
abnormalities.
11. After teaching a group of nurses working at the women's health clinic about the impact of
pregnancy on the older woman, which statement by the group indicates that the teaching was
successful?
A. "The majority of women who become pregnant over age 35 experience complications."
B. "Women over the age of 35 who become pregnant require a specialized type of assessment."
C. "Women over age 35 and are pregnant have an increased risk for spontaneous abortions."
D. "Women over age 35 are more likely to have a substance use disorder."
Answer: C
Rationale: Whether childbearing is delayed by choice or by chance, women starting a family at
age 35 or older are not doing so without risk. Women in this age group may already have chronic health conditions that can put the pregnancy at risk. In addition, numerous studies have shown
that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational
diabetes, chronic hypertension, postpartum hemorrhage, preeclampsia, preterm labor and birth,
multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal
growth restriction, low Apgar scores, and surgical births (Dillion et al. 2019). However, even
though increased age implies increased complications, most women today who become pregnant
after age 34, have healthy pregnancies and healthy newborns. Nursing assessment of the
pregnant woman over age 35 is the same as that for any pregnant woman. Women of this age
have the same risk for a substance use disorder as any other age group.
12. A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually
transmitted infections and their effect on pregnancy. The nurse determines that the teaching was
successful when the group identifies which infection as being responsible for ophthalmia
neonatorum?
A. syphilis
B. gonorrhea
C. chlamydia
D. HPV
Answer: B
Rationale: Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the
newborn from birth through an infected birth canal. Infection with syphilis can cause congenital
syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the
newborn. Exposure to HPV during birth is associated with laryngeal papillomas.
13. A nurse is preparing a presentation for a group of young adult pregnant women about
common infections and their effect on pregnancy. When describing the infections, which
infection would the nurse include as the most common congenital and perinatal viral infection in
the world?
A. rubella
B. hepatitis B
C. cytomegalovirus
D. parvovirus B19
Answer: C
Rationale: Although rubella, hepatitis B, and parovirus B19 can affect pregnant women and their
fetuses, cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in
the world. CMV is the leading cause of congenital infection, with morbidity and mortality at
birth and sequelae. Each year approximately 1% to 7% of pregnant women acquire a primary
CMV infection. Of these, about 30% to 40% transmits infection to their fetuses.
14. A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee
hurt my baby?" Which response by the nurse would be most appropriate?
A. "The caffeine in coffee has been linked to birth defects."
B. "Caffeine has been shown to restrict growth in the fetus."
C. "Caffeine is a stimulant and needs to be avoided completely."
D. "If you keep your intake to less than 200 mg/day, you should be okay."
Answer: D
Rationale: The effect of caffeine intake during pregnancy on fetal growth and development is
still unclear. A recent study found that caffeine intake of no more than 200 mg/day during
pregnancy does not affect pregnancy duration and the condition of the newborn. Birth defects
have not been linked to caffeine consumption, but maternal coffee consumption decreases iron
absorption and may increase the risk of anemia during pregnancy. It is not known if there is a
correlation between high caffeine intake and miscarriage due to lack of sufficient studies.
15. A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of
withdrawal. Which signs would the nurse assess? Select all that apply.
A. low whimpering cry
B. hypertonicity
C. lethargy
D. excessive sneezing
E. overly vigorous sucking
F. tremors
Answer: B, D, F
Rationale: Signs and symptoms of withdrawal, or neonatal abstinence syndrome, include:
irritability, hypertonicity, excessive and often high-pitched crying, vomiting, diarrhea, feeding
disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal
stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures.
16. A nurse has been invited to speak at a local high school about adolescent pregnancy. When
developing the presentation, the nurse would incorporate information related to which aspects?
Select all that apply.
A. peer pressure to become sexually active
B. rise in teen birth rates over the years.
C. Asian Americans as having the highest teen birth rate
D. loss of self-esteem as a major impact
E. about half occurring within a year of first sexual intercourse
Answer: A, D
Rationale: Adolescent pregnancy has emerged as one of the most significant social problems
facing our society. Early pregnancies among adolescents have major health consequences for
mothers and their infants. The latest estimates show that approximately 1 million teenagers
become pregnant each year in the United States, accounting for 13% of all U.S. births, but the
rates have been declining in the last several years. Teen birth rates in the United States have
declined but remain high,especially among African American and Hispanic teenagers and
adolescents in southern states. The most important impact lies in the psychosocial area as it
contributes to a loss of self-esteem, a destruction of life projects, and the maintenance of the
circle of poverty. Moreover, about half of all teen pregnancies occur within 6 months of first
having sexual intercourse. About one in four teen mothers under age 18 have a second baby
within 2 years after the birth of the first baby.
17. A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can
be used during pregnancy. The nurse would emphasize the need to avoid which medication at
this time?
A. hydroxychloroquine
B. nonsteroidal anti-inflammatory drugs
C. glucocorticoid
D. methotrexate
Answer: D
Rationale: Methotrexate is contraindicated during pregnancy. For rheumatoid arthritis,
medications are limited to hydroxychloroquine, glucocorticoids, and NSAIDS.
18. A nurse is preparing a teaching program for a group of pregnant women about preventing
infections during pregnancy. When describing measures for preventing cytomegalovirus
infection, which measure would the nurse include as a priority?
A. frequent handwashing
B. immunization
C. prenatal screening
D. antibody titer screening
Answer: A
Rationale: Most women are asymptomatic and do not know they have been exposed to CMV.
Prenatal screening for CMV infection is not routinely performed. Since there is no therapy that
prevents or treats CMV infections, nurses are responsible for educating and supporting
childbearing-age women at risk for CMV infection. Stressing the importance of good
handwashing and use of sound hygiene practices can help to reduce transmission of the virus.
There is no immunization for CMV. Antibody titer levels would be useful for identifying women
at risk for rubella.
19. A pregnant woman comes to the clinic for her first evaluation. The woman is screened for
hepatitis B (HBV) and tests positive. The nurse would anticipate administering which agent?
A. HBV immune globulin
B. HBV vaccine
C. acylcovir
D. valacyclovir
Answer: A
Rationale: If a woman tests positive for HBV, expect to administer HBV immune globulin. The
newborn will also receive HBV vaccine within 12 hours of birth. Acyclovir or valacyclovir
would be used to treat herpes simplex virus infection.
20. After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse
determines that the teaching was successful when the woman identifies which foods as being
good sources of iron in her diet? Select all that apply.
A. dried fruits
B. peanut butter
C. meats
D. milk
E. white bread
Answer: A, B, C
Rationale: Foods high in iron include meats, green leafy vegetables, legumes, dried fruits, whole
grains, peanut butter, bean dip, whole-wheat fortified breads, and cereals.
21. A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose
level. When reviewing the results, the nurse determines that the woman is achieving good
glucose control based on which result?
A. 88 mg/dL
B. 100 mg/dL
C. 110 mg/dL
D. 120 mg/dL
Answer: A
Rationale: For a pregnant woman with diabetes, the ADA and ACOG recommend maintaining a
fasting blood glucose level below 95 mg/dL, with postprandial levels below 140 mg/dL at 1
hour, below 120 mg/dL at 2 hours.
22. A nurse is conducting a program for pregnant women with gestational diabetes about
reducing complications. The nurse determines that the teaching was successful when the group
identifies which factor as being most important in helping to reduce complications associated
with pregnancy and diabetes?
A. stability of the woman's emotional and psychological status
B. degree of blood glucose control achieved during the pregnancy
C. reduction in retinopathy risk by frequent ophthalmologic evaluations
D. control of blood urea nitrogen (BUN) levels for optimal kidney function
Answer: B
Rationale: Therapeutic management for the woman with diabetes focuses on tight glucose
control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional
and psychological status is highly variable and may or may not affect the pregnancy. Evaluating
for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by
laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that
the mother enters the pregnancy in an optimal state. [Show Less]