Risk Conditions Related to Pregnancy NCLEX Questions

Risk Conditions Related to Pregnancy NCLEX Questions Leave the first rating Students also studied Terms in this set (20) Science MedicineNursing Save Maternity Nclex questions 68 terms crystalrose_rivera Preview High Risk Pregnancy NCLEX Questi...14 terms brittbarnwell91 Preview Newborn at Risk NCLEX Questions 64 terms Brooke_Lewis47 Preview Pregna 109 term Bro The nurse is providing instructions to a pregnant client with human immunodeficiency virus (HIV) infection regarding care to the newborn after delivery. The client asks the nurse about the feeding options that are available. Which response should the nurse make to the client?

• "You will need to bottle-feed your newborn."
• "You will need to feed your newborn by nasogastric

tube feeding."

• "You will be able to breast-feed for 6 months and then

will need to switch to bottle-feeding."

• "You will be able to breast-feed for 9 months and then

will need to switch to bottle feeding."

• "You will need to bottle-feed your newborn."

Prenatal transmission of HIV can occur during the antepartum period, during labor and birth, or in the postpartum period if the mother is breast feeding.Clients who has HIV will most likely be advised not to breast feed; however, PHCPs recommendations regarding breast feeding are always followed. There is no physiological reason why newborn needs to be fed by nasogastric tube.The home care nurse visits a pregnant client who has a diagnosis of preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the PHCP?

• Urinary output has increased
• Dependent edema has resolved
• Blood pressure reading is at the prenatal baseline
• The client complains of a headache and blurred vision
• The client complains of a headache and blurred vision

If the client complains of a headache and blurred vision, the PHCP should be notified because thee are signs of worsening preeclampsia. Options 1, 2, and 3 are normal findings.

A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the baby. Which statement by the nurse would assist the family in their period of grief?

• "What can I do for you?"
• "Now you have an angel in heaven."
• "Don't worry, there is nothing you could have done to

prevent this from happening."

• "We will see to it that you have an early discharge so

that you don't have to be reminded of this experience."

• "What can I do for you?"

When a loss or death occurs, the nurse should ensure that parents have been honestly told about the situation by their primary health care provider or others on the health care team. It is important for the nurse to be with the parents at this time and to use therapeutic communication techniques. The nurse must also consider cultural and religious/spiritual practices and beliefs. The correct option provides a supportive, giving, and care response. Options 2, 3, and 4 are blocks to communication and devalue the parents' feelings.The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching?

• "I should stay on the diabetic diet."
• "I should perform glucose monitoring at home."
• "I should avoid exercise because of the negative

effects on insulin production."

• "I should be aware of any infections and report signs of

infection immediately to my obstetrician."

• "I should avoid exercise because of the negative effects on insulin production."

Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or obstetrician's office. Signs of infection need to be reported to the obstetrician.The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis?

• Enlargement of the breasts
• Complaints of feeling hot when the room is cool
• Periods of fetal movement followed by quiet periods
• Evidence of bleeding, such as in the gums, petechiae,

and purpura

• Evidence of bleeding, such as in the gums, petechiae, and purpura

Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the primary health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy.The nurse in a maternity unit is reviewing the client's records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply.

• A primigravida with abruptio placenta
• A primigravida who delivered a 10lb infant 3 hours ago
• A gravida 2 who has just been diagnosed with dead

fetus syndrome

• A gravida 4 who delivered 8 hours ago and has lost

500 mL of blood

• A primigravida at 29 weeks of gestation who was

recently diagnosed with gestational hypertension

• A primigravida with abruptio placenta
• A gravida 2 who has just been diagnosed with dead fetus syndrome
• A primigravida at 29 weeks of gestation who was recently diagnosed with

gestational hypertension In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Predisposing conditions include abruptio placentae, amniotic fluid embolism, gestational hypertension, HELLP syndrome, intrauterine fetal death, liver disease, sepsis, severe postpartum hemorrhage, and blood loss. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.

The home care nurse is monitoring a pregnant client who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which sign of preeclampsia?

• Hypertension
• Low grade fever
• Generalized edema
• Increased pulse rate
• Hypertension

A sign of a preeclampsia is persistent hypertension. A low grade fever or increased pulse rate is not associated with preeclampsia. Generalized edema may occur but is not a specific sign of preeclampsia because it can occur in many conditions.The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement?

• "I will need to increase my insulin dosage during the

first 3 months of pregnancy."

• "My insulin dose will likely need to be increased during

the second and third trimesters."

• "Episodes of hypoglycemia are most likely to occur

during the first 3 months of pregnancy."

• "My insulin needs should return to prepregnant levels

within 7 to 10 days after birth if I am bottle-feeding."

• "I will need to increase my insulin dosage during the first 3 months of

pregnancy." Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin.The statements in options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy.A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue.After assessment of the client, tuberculosis is suspected.A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan?

• Therapeutic abortion is required
• Isoniazid plus rifampin will be required for 9 months
• She will have to stay at home until treatment is

completed

• Medication will not be started until after delivery of the

fetus

• Isoniazid plus rifampin will be required for 9 months

More than one medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamind B6) often is administered with isoniazid to prevent fetal neurotoxicity. The client does not need to stay at home during treatment, and therapeutic abortion is not required.The nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse?

• "I should increase my sodium intake during pregnancy."
• "I should lower my blood volume by limiting my fluids."
• "I should maintain a low-calorie diet to prevent any

weight gain."

• "I should drink adequate fluids and increase my intake

of high-fiber foods."

• "I should drink adequate fluids and increase my intake of high-fiber foods."

Constipation can cause the client to use the Valsalva maneuver. The Valsalva maneuver should be avoided in clients with cardiac disease because it can caused blood to rush to the heart and overload the cardiac system. Constipation can be prevented by the addition of fluids and a high-fiber diet. A low calorie diet is not recommended during pregnancy and could be harmful to the fetus. Sodium should be restricted as prescribed by the primary health care provider, because excess sodium would cause an overload to the circulating blood volume and contribute to cardiac complications. Diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of nutrients.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting HIV? Select all that apply.

• The client has a history of intravenous drug use
• The client has a significant other who is heterosexual
• The client has a history of sexually transmitted

infections

• The client has had one sexual partner for the past 10

years

• The client has a previous history of gestational diabetes

mellitus

• The client has a history of intravenous drug use
• The client has a history of sexually transmitted infections

HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus.Clients who fall into the high risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. Gestational diabetes mellitus does not predispose the client to HIV. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV> The nurse in a maternity unit is providing emotional support to a client and her significant other who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicates a component of the normal grieving process?

• "We want to attend a support group."
• "We never want to try to have a baby again."
• "We are going to try to adopt a child immediately."
• "We are okay, and we are going to try to have another

baby immediately."

• "We want to attend a support group."

A support group can help the parents work through their pain by nonjudgmental sharing of feelings. The correct option identifies a statement that indicates positive, normal grieving. Although the other options may indicate reactions of the client and significant other, they are not specifically a part of the normal grieving process.The nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to her newborn during postpartum hospitalization. Which maternal action best exemplifies the mother's knowledge of potential disease transmission to the newborn?

• The mother requests that the window be closed before

feeding

• The mother holds the newborn properly during

feeding and burping

• The mother tests the temperature of the formula before

initiating feeding

• The mother washes and dries her hands before and

after self-care of the perineum and asks for a pair of gloves before feeding

• The mother washes and dries her hands before and after self-care of the

perineum and asks for a pair of gloves before feeding Hepatitis B virus is highly contagious and is transmitted by direct contact with blood and body fluids of infected persons. The rationale for identifying childbearing clients with this disease is to provide adequate protection of the fetus and the newborn, to minimize transmission to other individuals, and to reduce maternal complications. The correct option provides the best evaluation of maternal understanding of disease transmission. Option 1 will not affect disease transmission since hepatitis B does not spread through airborne transmission.Options 2 and 3 are appropriate feeding techniques for bottle feeding but do not minimize disease transmission for hepatitis B.