Ch.11 Pregnancy at risk: Preexisting conditions(questions and answers)
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Ch.11 Pregnancy at risk: Preexisting conditions
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Ch.11 Pregnancy At Risk: Preexisting Conditions
1. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:
a."I will need to increase my insulin dosage during the first 3 months of pregnancy."
b....
ch11 pregnancy at risk preexisting conditionsquestions and answers
1 in assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy
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Ch.11 Pregnancy at risk: Preexisting
conditions
1. In assessing the knowledge of a pregestational woman with type 1 diabetes
concerning changing insulin needs during pregnancy, the nurse recognizes that further
teaching is warranted when the client states:
a."I will need to increase my insulin dosage during the first 3 months of pregnancy."
b."Insulin dosage will likely need to be increased during the second and third
trimesters."
c."Episodes of hypoglycemia are more likely to occur during the first 3 months."
d."Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-
feeding." - Answer ANS: A
Insulin needs are reduced in the first trimester because of increased insulin production
by the pancreas and increased peripheral sensitivity to insulin. "Insulin dosage will likely
need to be increased during the second and third trimesters," "Episodes of
hypoglycemia are more likely to occur during the first 3 months," and "Insulin needs
should return to normal within 7 to 10 days after birth if I am bottle-feeding" are accurate
statements and signify that the woman has understood the teachings regarding control
of her diabetes during pregnancy.
2. Preconception counseling is critical to the outcome of diabetic pregnancies because
poor glycemic control before and during early pregnancy is associated with:
a.Frequent episodes of maternal hypoglycemia.
b.Congenital anomalies in the fetus.
c.Polyhydramnios.
d.Hyperemesis gravidarum. - Answer ANS: B
Preconception counseling is particularly important because strict metabolic control
before conception and in the early weeks of gestation is instrumental in decreasing the
risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur
during the first trimester (not before conception) as a result of hormone changes and the
effects on insulin production and usage. Hydramnios occurs about 10 times more often
in diabetic pregnancies than in nondiabetic pregnancies. Typically it is seen in the third
trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events
because the decreased food intake by the mother and glucose transfer to the fetus
contribute to hypoglycemia.
3. In planning for the care of a 30-year-old woman with pregestational diabetes, the
nurse recognizes that the most important factor affecting pregnancy outcome is the:
a.Mother's age.
b.Number of years since diabetes was diagnosed.
c.Amount of insulin required prenatally.
d.Degree of glycemic control during pregnancy. - Answer ANS: D
, Women with excellent glucose control and no blood vessel disease should have good
pregnancy outcomes.
4. Concerning the use and abuse of legal drugs or substances, nurses should be aware
that:
a.Although cigarette smoking causes a number of health problems, it has little direct
effect on maternity-related health.
b.Caucasian women are more likely to experience alcohol-related problems.
c.Coffee is a stimulant that can interrupt body functions and has been related to birth
defects.
d.Prescription psychotherapeutic drugs taken by the mother do not affect the fetus;
otherwise, they would not have been prescribed. - Answer ANS: B
African-American and poor women are more likely to use illicit substances, particularly
cocaine, whereas Caucasian and educated women are more likely to use alcohol.
5. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational
diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree
that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse
identifies that the fetus is at greatest risk for:
a.Macrosomia.
b.Congenital anomalies of the central nervous system.
c.Preterm birth.
d.Low birth weight. - Answer ANS: A
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor
glycemic control during the preconception time frame and into the early weeks of the
pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely
to occur with severe diabetes and is the greatest risk in women with pregestational
diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.
6. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12
weeks. She appears thin and somewhat nervous. She reports that she eats a well-
balanced diet, although her weight is 5 pounds less than it was at her last visit. The
results of laboratory studies confirm that she has a hyperthyroid condition. Based on the
available data, the nurse formulates a plan of care. What nursing diagnosis is most
appropriate for the woman at this time?
a.Deficient fluid volume
b.Imbalanced nutrition: less than body requirements
c.Imbalanced nutrition: more than body requirements
d.Disturbed sleep pattern - Answer ANS: B
This client's clinical cues include weight loss, which would support the nursing diagnosis
of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms
support the nursing diagnosis of Deficient fluid volume. This client reports weight loss,
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