CH 15: Pregestational Problems

Question 139447
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139447
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:
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Question
Title:
Difficulty
Level:
Question Stem
The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The
patient states, Everybody knows that alcohol is bad during pregnancy, but whats the big deal about ecstasy?
The best response by the nurse is: Ecstasy:
Stimulus
Answer
Choice 1
Can cause a high fever in you and therefore cause the baby harm.
Rationale 1
High body temperature is a side effect of MDMA (ecstasy). Increased body

temperature increases fetal oxygen needs, which can lead to hypoxia and
subsequent brain and major organ damage.
Answer 1
true
Choice 2
Leads to deficiencies of thiamine and folic acid, which help the baby
develop.
Rationale 2
Alcohol, not ecstasy, causes deficiencies of thiamine and folic acid. Folic
acid helps prevent neural tube defects.
Answer 2
false
Choice 3
Produces babies with small heads and short bodies with brain function
alterations.
Rationale 3
Cocaine causes these fetal effects, not ecstasy.
Answer 3
false
Choice 4
Produces intrauterine growth restriction and meconium aspiration.
Rationale 4
Heroin causes these fetal effects, not ecstasy.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Health Promotion and Maintenance
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Planning
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Topical SubCategory:
Pearson Nursing Taxonomy #:
Taxonomy Category Comments:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO03_Q01
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LO01 - Summarize the effects of alcohol and illicit drugs on the childbearing
woman and her fetus/newborn.
Question 139448
Id:
139448
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which of
the following statements made by the patient indicates to the nurse that the patient has understood the
teaching?
Stimulus
Answer
Choice 1
I can continue to drink alcohol until I am diagnosed as pregnant.
Rationale 1
Women should discontinue drinking alcohol when they start to attempt

pregnancy.
Answer 1
false
Choice 2
I need to stop drinking alcohol completely when I start trying to get

pregnant.
Rationale 2
Women should discontinue drinking alcohol when they start to attempt

pregnancy.
Answer 2
true
Choice 3
A beer once a week will not damage the fetus.
Rationale 3
It is not known how much alcohol will cause fetal damage; therefore, alcohol
during pregnancy is contraindicated.
Answer 3
false
Choice 4
I can drink alcohol while breastfeeding since it doesnt pass into breast
milk.
Rationale 4
Alcohol passes readily into breast milk; therefore, it should be avoided, or

the milk should be pumped and dumped after alcohol consumption.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Evaluation
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO03_Q02

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Learning Outcome 1:
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Standard 1:
Standard 2:
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Standard 5:
Standard 6:
Question 139449
Id:
139449
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A womans history and appearance suggest drug abuse. The nurses best approach would be to:
Stimulus
Answer
Choice 1
Ask the woman directly, Do you use any street drugs?
Rationale 1
The best method of dealing with the patient that the nurse suspects of using
drugs is to be direct and ask the question in a direct fashion without
prejudice, bias, or negative body language. Lack of judgmental
attitudes/body language typically results in honest answers.
Answer 1
true
Choice 2
Ask the woman if she would like to talk to a counselor.
Rationale 2
It is the responsibility of the nurse to question the patient.
Answer 2
false
Choice 3
Ask some questions about over-the-counter medications and avoid the

mention of illicit drugs.
Rationale 3
It is the responsibility of the nurse not to avoid the issue.
Answer 3
false
Choice 4
Explain how harmful drugs can be for her baby.
Rationale 4
When talking to patients in a therapeutic manner, it is important not to be

threatening or judgmental; an example of the latter behavior would be stating
that the drugs will harm the baby.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Implementation
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO03_Q03

Source Au Title Ed:
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Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139450
Id:
139450
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A 20-year-old woman is at 28 weeks gestation. Her prenatal history reveals past drug abuse, and urine
screening indicates that she has recently used heroin. The nurse should recognize that the woman is at
increased risk for:
Stimulus
Answer
Choice 1
Erythroblastosis fetalis.
Rationale 1
Erythroblastosis fetalis is secondary to physiological blood disorders such as

Rh incompatibility.
Answer 1
false
Choice 2
Diabetes mellitus.
Rationale 2
Diabetes is an endocrine disorder that is unrelated to drug use/abuse.
Answer 2
false
Choice 3
Abruptio placentae.
Rationale 3
Abruptio placentae is seen more commonly with cocaine/crack use.
Answer 3
false
Choice 4
Pregnancy-induced hypertension.
Rationale 4
Women who use heroin are at risk for poor nutrition, anemia, and pregnancyinduced hypertension (or pre-eclampsia).
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Assessment
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO03_Q04

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
admin
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139451
Id:
139451
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The patient with insulin-dependent type 2 diabetes and an HbA1c of 5.0% is planning to become pregnant soon.
What anticipatory guidance should the nurse provide this patient?
Stimulus
Answer
Choice 1
Insulin needs decrease in the first trimester and increase during the third
trimester.
Rationale 1
In addition, insulin requirements drop suddenly after delivery of the

placenta.
Answer 1
true
Choice 2
The risk of ketoacidosis decreases during the length of the pregnancy.
Rationale 2
The risk of ketoacidosis increases during pregnancy.
Answer 2
false
Choice 3
Vascular disease that accompanies diabetes slows progression.
Rationale 3
Vascular disease progresses more rapidly during pregnancy, especially if

blood sugar control is not good. Problems such as nephropathy and
retinopathy can result.
Answer 3
false
Choice 4
The baby is likely to have a congenital abnormality because of the diabetes.
Rationale 4
Infants of diabetic mothers have a 510% greater risk of having a congenital

abnormality. This risk increases to 2025% if the HbA1c is over 10%.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO01 _Q05

Source Au Title Ed:
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Writer Last Name:
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Comments:
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Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
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Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO02 - Discuss the pathology, treatment, and nursing care of pregnant women
with diabetes mellitus.
Question 139452
Id:
139452
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control is at 20 weeks gestation.
She asks the nurse how her diabetes will affect her baby. The best explanation would include:
Stimulus
Answer
Choice 1
Your baby may be smaller than average at birth.
Rationale 1
Poorly controlled type 1 diabetics who have developed vascular problems

will have infants who are small for gestational age (SGA) due to placental
insufficiency.
Answer 1
false
Choice 2
Your baby will probably be larger than average at birth.
Rationale 2
The infant of a diabetic mother produces excessive amounts of insulin in

response to the high blood sugar. This hyperinsulinism stimulates growth (or
macrosomia) in the infant because the infant utilizes the glucose in the
bloodstream.
Answer 2
true
Choice 3
As long as you control your blood sugar, your baby will not be affected at
all.
Rationale 3
The demands of pregnancy will make it difficult for the best of patients to
control blood sugar on a regular basis.
Answer 3
false
Choice 4
Your baby might have high blood sugar for several days.
Rationale 4
Within minutes of delivery, the baby of an insulin-dependent diabetic can

begin to have low blood sugar.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
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Stakes:
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Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
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Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139453
Id:
139453
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A 26-year-old multigravida is 28 weeks pregnant. She has developed gestational diabetes. She is following a
program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be
included in a teaching plan for this patient?
Stimulus
Answer
Choice 1
Exercise either just before meals or wait until two hours after a meal.
Rationale 1
It is best to exercise just after the meal in order to utilize the glucose.
Answer 1
false
Choice 2
Carry hard candy (or other simple sugar) when exercising.
Rationale 2
A patient should be encouraged to continue any exercise programs in which

she already is involved. She should keep hard candy (simple sugar) with her
at all times, just in case the exercise induces hypoglycemia.
Answer 2
true
Choice 3
If your blood sugar is 120 mg/dl, eat 20 g of carbohydrate.
Rationale 3
A finger stick result of 120 mg/dl is considered to be normal.
Answer 3
false
Choice 4
If your blood sugar is more than 120 mg/dl, drink a glass of whole milk.
Rationale 4
Such patients need no additional carbohydrate or protein intake.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
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Comments:
Meta 4
admin
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139454
Id:
139454
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit,
which is the accurate approach to evaluating the patient for diabetes?
Stimulus
Answer
Choice 1
Begin serial testing of the patient's serum glucose and HA1c at 24 weeks'
gestation.
Rationale 1
Women at high risk for type 2 DM should be screened for diabetes as soon as
possible.
Answer 1
false
Choice 2
If diabetes is diagnosed, consider this condition to be gestational diabetes

mellitus (GDM).
Rationale 2
Women who are determined to have diabetes at this visit should be

diagnosed as having overt diabetes and not GDM.
Answer 2
false
Choice 3
Recognize HA1c equal to or greater than 4.5% or a fasting plasma glucose

level equal to or greater than 90 mg/dl as being diagnostic of diabetes.
Rationale 3
HA1c equal to or greater than 6.5% would be considered diagnostic as

would a fasting plasma glucose level equal to or greater than 126 mg/dl or a
2-hour plasma glucose equal to or greater than 200 mg/dl during an oral
glucose tolerance test (OGTT).
Answer 3
false
Choice 4
Conduct screening for type 2 diabetes mellitus as soon as possible.
Rationale 4
Women at high risk for type 2 DM should be screened for diabetes as soon as
possible.
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
admin
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139455
Id:
139455
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The pregnant patient at 23 weeks gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching
has been effective?
Stimulus
Answer
Choice 1
Tofu with mixed vegetables in curry, milk, whole-wheat bun
Rationale 1
This diet is high in calcium. The patient has iron-deficiency anemia and
requires a high-iron diet.
Answer 1
false
Choice 2
Roast beef, steamed spinach, tomato soup, orange juice
Rationale 2
This patient is anemic and needs iron. This meal contains iron in the beef,
folic acid in the spinach, and vitamin C in the tomato soup and orange juice.
Vitamin C helps absorption of the iron; folic acid is needed for production of
red cells.
Answer 2
true
Choice 3
Pork chop, mashed potatoes and gravy, cauliflower, tea
Rationale 3
This meal has a moderate amount of protein, but no vitamin C. The meal
containing beef is better.
Answer 3
false
Choice 4
Broiled fish, lettuce salad, grapefruit half, carrot sticks
Rationale 4
This meal is high in fiber, low in fat, and moderately high in protein, but low
in iron. This patient is anemic and needs iron.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO03 - Distinguish among the four major types of anemia associated with
pregnancy with regard to signs, treatment, and implications for pregnancy.
Question 139456
Id:
139456
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A woman at 30 weeks' gestation and a history including sickle cell anemia presents to the clinic complaining of
fever, chills, and diarrhea for three days. What are the most serious potential complications faced by this
patient?
Stimulus
Answer
Choice 1
Electrolyte imbalance
Rationale 1
While the patient may experience electrolyte imbalance, sickle cell crisis is
the most serious potential complication of dehydration and fever.
Answer 1
false
Choice 2
Sickle cell crisis
Rationale 2
Dehydration and fever can trigger sickling and crisis; for this reason,
maternal infections are treated promptly.
Answer 2
true
Choice 3
Fetal neural tube defects
Rationale 3
Fever, chills, and dehydration in the patient with sickle cell anemia are not
associated with an increased incidence of neural tube defects.
Answer 3
false
Choice 4
Severe lethargy
Rationale 4
While the patient may develop severe lethargy, her greatest risk concerns
development of sickle cell crisis.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Physiological Integrity
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139457
Id:
139457
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A patient who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which statement
by the patient indicates that she understands the teaching?
Stimulus
Answer
Choice 1
I should include fresh leafy green vegetables, red meat, fish, poultry, and
legumes in my diet.
Rationale 1
Folic acid, which is used to treat megaloblastic anemia, is readily available

in foods such as fresh leafy green vegetables, red meat, fish, poultry, and
legumes.
Answer 1
true
Choice 2
Whenever possible, I should boil my vegetables in at least 2 quarts of

water.
Rationale 2
Folic acid, which is crucial for inclusion in the diet of patients with
megaloblastic anemia, is easily destroyed by overcooking or cooking with
large quantities of water.
Answer 2
false
Choice 3
Megaloblastic anemia is not known to cause any serious risks to my baby.
Rationale 3
Maternal folic acid deficiency has been associated with an increased risk of
neural tube defects (NTDs) such as spina bifida, meningomyelocele, and
anencephaly in the newborn.
Answer 3
false
Choice 4
My body makes red blood cells that are smaller than they should be."
Rationale 4
In megaloblastic anemia, red blood cells become enlarged and are fewer in
number.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
admin
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
Question 139458
Id:
139458
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The patient at 9 weeks gestation has been told that her HIV test was positive. The patient is very upset and
tells the nurse, I didnt know I had HIV! What will this do to my baby? The nurse knows teaching has been
effective when the patient states:
Stimulus
Answer
Choice 1
I cannot take the medications that control HIV during my pregnancy

because they will harm the baby.
Rationale 1
Most of the medications that control HIV progression are safe to take during
pregnancy. Antiretroviral medications are recommended during pregnancy to
prevent perinatal transmission.
Answer 1
false
Choice 2
My baby will probably be born with anti-HIV antibodies, but that doesnt
mean it is infected.
Rationale 2
Babies of HIV-positive women or women with AIDS are born with maternal
anti-HIV antibodies. These antibodies clear over time, and an accurate test
can be obtained by 15 months of age.
Answer 2
true
Choice 3
The pregnancy will increase the progression of my disease and will reduce
my CD4 counts.
Rationale 3
There is no evidence to indicate that pregnancy increases the progression of

HIV/AIDS.
Answer 3
false
Choice 4
The HIV wont affect my baby, and I will have a low-risk pregnancy
without additional testing.
Rationale 4
Pregnancy affected by HIV/AIDS is considered complicated, and the fetus is

monitored closely. Fetal assessments include weekly nonstress tests
beginning at 32 weeks.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO05_Q12

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
admin
Royalty:
Stakes:
Special Handling:
Comments:
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Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO05 - Describe acquired immunodeficiency syndrome (AIDS), including

care of the pregnant woman with HIV/AIDS, neonatal implications, and
ramifications for the childbearing family.
Question 139459
Id:
139459
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
During her first antepartal visit, a patient who is at 10 weeks' gestation reports that she is HIV-positive. Which
statement made by the patient indicates an understanding of the plan of care both during the pregnancy and
postpartally?
Stimulus
Answer
Choice 1
"I'm supposed to take highly active antiretroviral therapy (HAART), but only
during the first trimester."
Rationale 1
Longer duration therapy is preferable to shorter duration approaches, and it

is best to start prophylaxis after the first trimester and no later than 28
weeks gestation in women who do not require immediate therapy for their
own health.
Answer 1
false
Choice 2
"I should not breastfeed my baby."
Rationale 2
HIV transmission can occur during pregnancy and through breast milk;
however, it is believed that the majority of all infections occur during labor
and birth.
Answer 2
true
Choice 3
"If I have a cesarean section, there's an increased risk that my HIV will be
passed to my baby."
Rationale 3
Cesarean section reduces the transmission of HIV from mother to infant.
Answer 3
false
Choice 4
"When my baby is 2 months old, he or she will be tested for HIV."
Rationale 4
Following birth, HIV infection in infants should be diagnosed using HIV

virologic assays as soon as possible, with initiation of infant antiretroviral
prophylaxis immediately if the test is positive.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Physiological Integrity
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO05_Q13

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
admin
Stakes:
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

Question 139460
Id:
139460
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A woman is 32 weeks pregnant. She is HIV-positive, but asymptomatic. What would be important in managing
her pregnancy and delivery?
Stimulus
Answer
Choice 1
An amniocentesis at 30 and 36 weeks
Rationale 1
All invasive procedures that would expose the uninfected infant to the HIV
virus are avoided.
Answer 1
false
Choice 2
Weekly nonstress testing beginning at 32 weeks gestation
Rationale 2
Patients who are HIV-positive are considered high-risk pregnancies.

Therefore, beginning at about 32 weeks, these patients have weekly
nonstress tests to assess for placental function and an ultrasound every 23
weeks to assess for intrauterine growth retardation (IUGR).
Answer 2
true
Choice 3
Application of a fetal scalp electrode as soon as her membranes rupture in

labor
Rationale 3
All invasive procedures that would expose the uninfected infant to the HIV
virus are avoided.
Answer 3
false
Choice 4
Administration of intravenous antibiotics during labor and delivery
Rationale 4
Antibiotics would be ineffective for either the mother or the infant who was
HIV-positive.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO05_Q14

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

Question 139461
Id:
139461
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after
missing her first menstrual period. What would indicate that the patient needs to be retested for HIV?
Stimulus
Answer
Choice 1
Hemoglobin of 11 g/dL and a rapid weight gain
Rationale 1
The patient would be anemic and anorexic.
Answer 1
false
Choice 2
Elevated blood pressure and ankle edema
Rationale 2
The patient would have a decrease in blood pressure and no ankle edema.
Answer 2
false
Choice 3
Shortness of breath and frequent urination
Rationale 3
Shortness of breath and frequent urination do not indicate a need to retest for
HIV.
Answer 3
false
Choice 4
Unusual fatigue and recurring Candida vaginitis
Rationale 4
The patient who is HIV-positive would have a suppressed immune system

and would experience symptoms of fatigue and opportunistic infections such
as Candida vaginitis.
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO05_Q15

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
admin
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

Question 139462
Id:
139462
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The nurse is reviewing prenatal charts. A patient at 24 weeks has a history of class II heart disease secondary to
rheumatic fever. What would the nurse expect to see in the chart?
Stimulus
Answer
Choice 1
Dyspnea and chest pain with mild exertion
Rationale 1
Dyspnea and angina with mild exertion are not expected with class II heart
disease even during pregnancy, but are symptoms seen in class IV heart
disease.
Answer 1
false
Choice 2
Elective cesarean birth scheduled for 37 weeks
Rationale 2
Cesarean birth is only undertaken in cardiac patients for fetal or maternal

intrapartal indications, not for cardiac reasons alone.
Answer 2
false
Choice 3
Discussed need for labor epidural and vacuum extraction
Rationale 3
Lumbar epidural analgesia decreases the stress response during labor, while
vacuum extraction or forceps decreases maternal pushing efforts. Both of
these decrease stress on the heart during birth.
Answer 3
true
Choice 4
Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally
Rationale 4
3+ pre-tibial edema is never an expected finding during pregnancy. Pulse

over 100 and respiratory rate over 24 are indicators of cardiac
decompensation.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO06_Q16

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO06 - Describe the effects of various heart disorders on pregnancy,

including their implications for nursing care.
Question 139463
Id:
139463
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The prenatal clinic nurse has received four phone calls. Which patient should be called first?
Stimulus
Answer
Choice 1
Primip at 28 weeks with history of asthma reporting difficulty breathing and

shortness of breath
Rationale 1
Asthma exacerbations are most common between 24 and 36 weeks. Asthma

attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This
patient is the top priority.
Answer 1
true
Choice 2
Multip at 6 weeks with a seizure disorder inquiring what foods are good folic
acid sources for her
Rationale 2
Women with seizure disorders should be started on folic acid supplements

prior to pregnancy, and should continue throughout pregnancy. This patient
is not the highest priority.
Answer 2
false
Choice 3
Primip at 35 weeks with a positive HBsAG wondering what treatment her

baby will receive after birth
Rationale 3
A patient with a positive HBsAG is contagious for hepatitis B. The risk of

transmission to the fetus at birth is reduced by bathing the neonate as soon as
possible after birth and giving the infant immunoprophylaxis and the first
HBsAG vaccine dose. The patient seeking information about what will
happen after delivery is a low priority when there are pregnant patients
currently experiencing physiologic problems.
Answer 3
Choice 4
false
Multip at 11 weeks with untreated hyperthyroidism describing the onset of
vaginal bleeding
Rationale 4
Pregnant women with untreated hyperthyroidism have an increased risk of

fetal loss. Vaginal bleeding at 11 weeks could indicate that spontaneous
abortion is taking place. But the majority of spontaneous abortions prior to
12 weeks gestation are complete and without complications. This patient is
not experiencing a normal pregnancy, but the health of both mother and fetus
are not in immediate danger.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO07_Q17
Source Au Title Ed:

Source Usage:
Writer First Name:
admin
Writer Last Name:

Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO07 - Compare the effects of selected pregestational medical conditions on

pregnancy.
Question 139464
Id:
139464
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The patient was found to have hepatitis B surface antigen (HBsAG) early in her pregnancy. The nurse is
explaining to the patient what will happen during labor and birth because the patient is contagious for hepatitis
B. Which statement by the patient indicates that additional teaching is needed?
Stimulus
Answer
Choice 1
An internal fetal monitor will be applied as soon as possible during labor.
Rationale 1
An internal fetal monitor will be avoided.
Answer 1
true
Choice 2
My baby will get a bath as soon as its temperature is stable.
Rationale 2
The presence of hepatitis B surface antigen (HBsAG) indicates that the

patient is contagious for and capable of transmitting hepatitis B. Perinatal
transmission is most likely to occur at the time of birth; thus, measures are
taken to prevent exposing the fetus to the mothers blood and body fluids and
to clean the babys skin thoroughly of fluids as soon as possible after birth.
Answer 2
false
Choice 3
Two shots will be given to my baby to prevent transmission of hepatitis B.
Rationale 3
A newborn of a mother with HBsAG will receive an injection of hepatitis B

immune globulin and a hepatitis B vaccine injection.
Answer 3
false
Choice 4
Breastfeeding is a good feeding method for my baby.
Rationale 4
Breastfeeding is not contraindicated in a patient with HBsAG.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 15_LO07_Q18

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO07 - Compare the effects of selected pregestational medical conditions on

pregnancy.

CH 15: Pregestational Problems

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CH 15: Pregestational Problems

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Question 139447

High body temperature is a side effect of MDMA (ecstasy). Increased body

Cocaine causes these fetal effects, not ecstasy.

Produces intrauterine growth restriction and meconium aspiration.

Heroin causes these fetal effects, not ecstasy.

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Planning

Source Chapter Number:

I can continue to drink alcohol until I am diagnosed as pregnant.

Women should discontinue drinking alcohol when they start to attempt

I need to stop drinking alcohol completely when I start trying to get

Women should discontinue drinking alcohol when they start to attempt

A beer once a week will not damage the fetus.

Alcohol passes readily into breast milk; therefore, it should be avoided, or

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Evaluation

Source Chapter Number:

Ask the woman directly, Do you use any street drugs?

Ask the woman if she would like to talk to a counselor.

It is the responsibility of the nurse to question the patient.

Ask some questions about over-the-counter medications and avoid the

It is the responsibility of the nurse not to avoid the issue.

Explain how harmful drugs can be for her baby.

When talking to patients in a therapeutic manner, it is important not to be

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Implementation

Source Chapter Number:

Erythroblastosis fetalis is secondary to physiological blood disorders such as

Diabetes is an endocrine disorder that is unrelated to drug use/abuse.

Abruptio placentae is seen more commonly with cocaine/crack use.

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Assessment

Source Chapter Number:

In addition, insulin requirements drop suddenly after delivery of the

The risk of ketoacidosis decreases during the length of the pregnancy.

The risk of ketoacidosis increases during pregnancy.

Vascular disease that accompanies diabetes slows progression.

Vascular disease progresses more rapidly during pregnancy, especially if

The baby is likely to have a congenital abnormality because of the diabetes.

Infants of diabetic mothers have a 510% greater risk of having a congenital

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Planning

Chapter 15_LO01 _Q05

Source Chapter Number:

Your baby may be smaller than average at birth.

Poorly controlled type 1 diabetics who have developed vascular problems

Your baby will probably be larger than average at birth.

The infant of a diabetic mother produces excessive amounts of insulin in

Within minutes of delivery, the baby of an insulin-dependent diabetic can

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Implementation

Chapter 15_LO01 _Q06

Source Chapter Number:

Carry hard candy (or other simple sugar) when exercising.

A patient should be encouraged to continue any exercise programs in which

If your blood sugar is 120 mg/dl, eat 20 g of carbohydrate.

A finger stick result of 120 mg/dl is considered to be normal.