Pitterilli Chapter 14 High-Risk Pregnancy: The Woman With A Preexisting Or Newly Acquired Illness

Front 1

An innocent, transient escape of fluid through heart valves due to increased blood flow past valves that can occur during pregnancy?

Back 1

Functional heart murmur

Front 2

Suddenly waking during the night with sever shortness of breath?

Back 2

Paroxysmal nocturnal dyspnea

Front 3

Low blood levels with enlarged red blood cells related to folic acid deficiency?

Back 3

Megaloblastic anemia

Front 4

Occurs when mitral valve stenosis or insufficiency or aortic coarctation causes a decrease in cardiac output and back pressure to the lungs?

Back 4

Left heart failure

Front 5

Kidney infection that can result in premature labor or rupture of membranes?

Back 5

Pyelonephritis

Front 6

A portion of the stomach extended through the diaphragm that can result in inability to eat due to heartburn?

Back 6

Hiatal hernia

Front 7

Lateral curvature of the spine that may cause pelvic distortion that can interfere with childbirth?

Back 7

Scoliosis

Front 8

A multisystem connective tissue disease that may result in acute nephritis?

Back 8

Systemic lupus erythematosus

Front 9

A normal decrease in the red blood cell count due to the expanded blood volume of pregnancy?

Back 9

Pseudoanemia

Front 10

The most common vaginal infection seen during pregnancy?

Back 10

Chlamydia trachomatis

Front 11

Antigens can be spread to the infant from breast milk?

Back 11

Viral hepatitis

Front 12

Dangerous to mother and fetus due to carbon monoxide and fluid and electrolyte losses?

Back 12

Human immunodeficiency virus

Front 13

May need to be treated with teratogenic medication?

Back 13

Schizophrenia

Front 14

Could result in anoxia from spasm of chest muscles?

Back 14

Tonic-clonic seizures

Front 15

Dangerous to mother and fetus due to carbon monoxide and fluid and electrolyte losses?

Back 15

Burns

Front 16

Exploratory abdominal surgery performed to detect bleeding due to traumatic injury?

Back 16

Celiotomy

Front 17

Melle, 12 years old, is 2 months pregnant and has a history of heart disease. Which of the following is true about her risk factors for high-risk pregnancy?

A. Good nutrition and exercise will eliminate any added risk factors Melle may have for complications.
B.Melle's heart condition will not affect her pregnancy because she has not reached adolescence.
C. Melle's youth will protect her from many problems experienced by older women with heart disease.
D. Both Melle's age and heart condition will place her at risk for complications during pregnancy.

Back 17

D. Both Melle's age and heart condition will place her at risk for complications during pregnancy.

Front 18

Which of the following could be included in the outcome criteria for a patient with the nursing diagnosis, "Knowledge deficit related to potential for altered tissue perfusion in fetus or mother related to maternal cardiovascular disease"?
A. Bed rest is maintained at home after the 36th week of gestation.
B. Fetal heart rate will remain between 120 and 160 beats/minute.
C. Jugular vein distention is evident when lying at 45 degrees.
D. Maternal blood pressure is maintained above 150 systolic.

Back 18

B. Fetal heart rate will remain between 120 and 160 beats/minute.

Front 19

When planning care for a pregnant woman with heart disase, the nurse should do which of the following?
A. Assess all complaints of fatigue and note any accompanying dyspnea or pulmonary congestion.
B. Discourage the mother from taking any medications during pregnancy because they will affect the baby.
C. Instruct the patient to eat as much food as desired to promote maximum fetal and maternal nutrition.
D. Plan an exercise schedule to prevent thrombus formation during labor.

Back 19

A. Assess all complaints of fatigue and note any accompanying dyspnea or pulmonary congestion.

Front 20

Which of the following interventions should be implemented with caution when caring for a postpartal woman who has heart disase or hypertensive vascular disease?
A. Administration of prenatatl vitamins.
B. Early ambulation with antiembolism stockings.
C. Encouraging bulk and high fiber in the diet.
D. Suggesting oral contraceptives as a birth control method.

Back 20

D. Suggesting oral contraceptives as a birth control method.

Front 21

Pregnant women with venous thromboembolic disease:
A. Are at risk for death from a pulmonary embolism
B. Must have oral fluids restricted throughout the pregnancy
C. Receive heparin as soon as their labor begins
D. Should be taught to keep their legs crossed at the knee when sitting

Back 21

A. Are at risk for death from a pulmonary embolism

Front 22

Patients with megaloblastic anemia should be encouraged to do which of the following?
A. Avoid pregnancy because they cannot carry the baby to term
B. Avoid excessive fluid intake, which has caused this hemodilution
C. Take over-the-counter multivitamins
D. Take the prescribed polic acid supplements

Back 22

D. Take the prescribed polic acid supplements

Front 23

When planning care for a pregnant patient with sicle cell anemia, the nuse might establish which of the following outcome criteria? The patient:
A. Lies on her back in a semi-Fowler's position when sleeping
B. Rests with her legs elevated when sitting in a chair
C. Reports intent to get a sickle cell antigen shot after delivery
D. Sates understanding of need to limit fluid intake to 16 ounces/day

Back 23

B. Rests with her legs elevated when sitting in a chair

Front 24

Patients with chronic renal disease or who have had kidney transplants may have difficulty in pregnancy for which of the following reasons?
A. Fetal waste products must be excreted in addition to maternal.
B. Hormones released in pregnancy can cause rejection of transplant.
C. Increased glomerular filtration rate causes decreased serum creatinine level.
D. Steroids may cause excessive fetal growth stimulation.

Back 24

A. Fetal waste products must be excreted in addition to maternal.

Front 25

Measures the nurse should implement for the pregnant patient with rheumatid arthritis include which of the following?
A. Discuss the woman's intent to breast-feed so that medications can be changed if necessary.
B. Instruct the woman to increase her intake of aspirin 2 weeks before term to offset the decrease in corticosteroids.
C. Encourage the woman to contact her physician for a higher dosage, if methotrexate is prescribed.
D. Assess the patient each week to monitor for blood clots due to alicylate ingestion.

Back 25

A. Discuss the woman's intent to breast-feed so that medications can be changed if necessary.

Front 26

Teresa, who is at 20 weeks' gestation, has ben diagnosed with acute appendicitis. She expresses concern that the doctor is going to perform surgery. The nurse could explain which of the following?
A. Delivery of the baby during cesarean birth at this point would be safer than trying to complete the pregnanacy.
B. Because the appendix cannot be removed at this stage of the pregnancy without disruption of the pregnancy, an abortion is necessary.
C. If she prefers, the doctor can delay removal of the appendix until later in the pregnancy.
D. Peritonitis could result from rupture of the appendix and would be dangerous for both mother and child.

Back 26

D. Peritonitis could result from rupture of the appendix and would be dangerous for both mother and child.

Front 27

Which of the following evaluation data would indicate that the nurse's teaching plan for the pregnant patient with cholecystitis had been effective?
A. Aching occurs only in the right epigastrium after eating.
B. Jaundice and pain remain absent throughout the pregnanacy.
C. The patient prepares a menu that is fat free.
D. The patient reports ingestion of high-cholesterol foods.

Back 27

B. Jaundice and pain remain absent throughout the pregnanacy.

Front 28

A pregnant woman diagnosed with diabetes should be instructed to do which of the following to control her glucose level?
A. Discontinue insulin injections until pregnancy is completed because hormones will regulate glucose levels.
B. Ingest a smaller amount of food before sleep to prevent nocturnal hyperglycemia.
C. Notify the physician if unable to eat cecause of nausea and vomiting.
D. Prepare foods with increased fat content to provide needed calories.

Back 28

C. Notify the physician if unable to eat cecause of nausea and vomiting.

Front 29

After delivery, a diabetic woman might need to do which of the following?

A. Change to oral hypoglycemia agents, which will control glucose levels more effectively than insulin.
B. Bottle-feed her infant because insulin received through breast-feeding may cause hypoglycemia in the child.
C. Refrain from taking insulin during the immediate postpartal period because insulin resistance is gone.
D. Take medications to decrease uterine hypertonicity if hydromnios was present during pregnancy.

Back 29

C. Refrain from taking insulin during the immediate postpartal period because insulin resistance is gone.

Front 30

Which of the following data would support a diagnosis of "Ineffective family coping, compromised, related to poor communication between partners or potentially abusive father"?

A. The woman and her husband always report together for prenatal visits.
B. The woman states concern that her baby may not have a good heartbeat because she "fell down recently."
C. You notice that the woman wears a low-cut dress or blouse at each prenatal visit.
D. Examination reveals that fetal heart tones and fundal height indicate the baby might weigh more than 8 pounds.

Back 30

B. The woman states concern that her baby may not have a good heartbeat because she "fell down recently."

Front 31

When preparing for a postmortem delivery, the nurse should do which of the following?

A. Begin the oxytocin drip and regulate slowly to aid vaginal delivery.
B. Determine whether the pregnancy is earlier than 24 weeks' gestation because a young fetus will be more likely to survive.
C. Obtain equipment necessary for immediate resuscitation of the newborn.
D. Prepare a consent form because the surgery cannot be performed without a consent.

Back 31

C. Obtain equipment necessary for immediate resuscitation of the newborn.

Front 32

Which of the following nursing interventions would be appropriate when caring for a pregnant patient who has the nursing diagnosisi "Altered tissue perfusion related to blood loss through gunshot or stab wound"?
A. Encourage a sitting position that will maintain pressure to abdominal organs and control bleeding.
B. Prepare to administer antihypotension drugs, which will cause peripheral vasoconstriction and maintain blood pressure.
C. Recognize that because pregnant women have higher than normal fluid volume, small losses of blood will have severe vascular effects.
D. Position the patient in a side-lying position to decrease vena caval pressure.

Back 32

D. Position the patient in a side-lying position to decrease vena caval pressure.

Front 33

Nursing measure implemented with a pregnant patient who has experienced trauma would include which of the following?

A. Concentrating on controlling the patient's anxiety first and foremost
B. Monitoring for other signs of shock because the patient's skin might not be cold and clammy.
C. Positioning the patient on her back in reverse Trendelenburg position
D. Recognizing that a heart rate increase of 15 to 20 beats above the nonpregnant rate indicates hypovolemia

Back 33

B. Monitoring for other signs of shock because the patient's skin might not be cold and clammy.

Front 34

Pregnant women should be taught to be careful to avoid accidental injury. They are prone to falls for which of the following reasons?

A. Additional weight from pregnancy may disturb balance when walking.
B. Fetal activity stimulates the nerves of the legs and causes weakness.
C. High levels of homones often impair judgment, resulting in reckless behavior.
D. Increased adrenalin released during pregnancy causes women to move faster than usual.

Back 34

A. Additional weight from pregnancy may disturb balance when walking.

Front 35

________ ________ _________ could cause cardiac failure, anemia and hypertensive vascular disease to result in fetal distress or low birthweight.

Back 35

Poor placental perfusion

Front 36

Three factors in pregnancy that can result in venous thromboembolic disease are ______ of ____, __________, and _______ vessel ________.

Back 36

Stasis of blood; hypercoagulability, blood vessel damage

Front 37

Multiple-Answer Multiple Choice

Name the common sexually transmitted diseases that may affect the newborn. (Select all that apply)

A. Herpes simplex virus type 1
B. Trichomoniasis
C. Cellulitis
D. Gonorrhea
E. Chlamydia

Back 37

B. Trichomoniasis
D. Gonorrhea
E. Chlamydia

Front 38

Multiple-Answer Multiple Choice

Which of the following is an appropriate outcome criterion for the pregnant patient who has seizures as a result of childhood meningitis? The patent: (Select all that apply)

A. Demonstrates ability to recognize the Moro reflex as an early indication of fetal seizures
B. Requires no supplemental oxygen administration during convulsions
C. States understanding that her child is not certain to have seizures just because she developed the condition
D. Refrains from taking anticonvulsant medications during the first tirmester to prevent congenital defects
E. Understands Chromosomal defects are not the etiology of her seizures

Back 38

C. States understanding that her child is not certain to have seizures just because she developed the condition
E. Understands Chromosomal defects are not the etiology of her seizures

Front 39

a test of the body's ability to metabolize carbohydrate by measuring the serum glucose level after ingestion of a fixed amount of glucose

Back 39

glucose tolerance test

Front 40

excess glucose in the urine

Back 40

glycosuria

Front 41

measure of the amount of glucose attached to hemoglobin

Back 41

glycosylated hemoglobin

Front 42

one in which a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the mother and/or fetus

Back 42

high-risk pregnancy

Front 43

an automatic pump about the size of a transistor radio used to deliver insulin continuously

Back 43

insulin pump

Front 44

enlarged red blood cells

Back 44

megaloblastic anemia

Front 45

position with the head and chest elevated to ease breathing

Back 45

orthopnea

Front 46

suddenly waking at night short of breath

Back 46

paroxysmal nocturnal dyspnea

Front 47

myocardial failure apparently due to the effect of the pregnancy on the circulatory system

Back 47

peripartal cardiomyopathy

Front 48

protein in the urine

Back 48

proteinuria