1. The nurse is caring for a pregnant woman who admits to cocaine and ecstasy use on a regular basis. The client states, “Everybody knows that alcohol is bad during pregnancy, but what’s the big deal about ecstasy?” the best response by the nurse is “Ecstasy: A. Can Cause Fever in you and therefore cause the baby harm. B. Leads to deficiencies of thiamine and folic acid, which help baby develop. (Alcohol) C. Produces babies with small heads and short bodies with brain function alterations (Cocaine) D. Produces intrauterine growth restriction and meconium aspiration. (heroine)
2. The nurse is doing preconception counseling with a 28-year old woman with no prior pregnancies. Which of the following statements made by the client indicates to the nurse that the client has understood the teaching?
A. “I can continue to drink alcohol until I am diagnosed pregnant.” B. “I need to stop drinking alcohol completely when I start trying to get pregnant.” C. “A beer once a week will not damage the fetus.”
D. “I can drink alcohol while breastfeeding, since it doesn’t pass into breast milk.”
3. A woman’s history and appearance suggest drug abuse. The nurse’s best approach would be to: A.) Ask the woman directly, “Do you use any street drugs?” B.) Ask the woman if she would like to talk to a counselor.
C.) Ask some questions about over-the counter medications and avoid mention of illicit drugs. D.) Explain how harmful drugs can be for her baby.
4. 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 heroine. The nurse should recognize that the woman is at increased risk for:
A. Erythroblastocis fetalis (2ndary to physiological blood disorders i.e. Rh incompat)
B. Diabeted Mellitus (unrelated to drug use/abuse)
C. Abruptio placentae (more commonly seen with cocaine/crack use)
D. Pregnancy-induced hypertension.
5. A client with insulin-dependent type II diabetes and and HbA1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client? A. Insulin needs decrease in the 1st trimester and increase during the third trimester. B. The risk of ketoacidosis decreases during the length of pregnancy. (actually it increases) C. Vascular disease that accompanies diabetes slows progression. (actually progresses more rapidly during pregnancy) D. The baby is likely to have a congenital abnormality because of the diabetes. 6. A newly diagnosed type I, 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:
A. “Your baby may be smaller than average at birth.”
B. Your baby will probably be larger than average at birth.
C. As long as you control your blood sugar, your baby will not be affected at all.
D. Your baby might have high blood sugar for several days.
7. 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 client?
A. Exercise either just before meals or wait until 2 hours after a meal. B. Carry hard candy (or other simple sugar) when exercising. C. If your blood sugar is 120 mg/dL, eat 20g of carbs. D. If your blood sugar is more than 120 mg/dL, drink a glass of whole milk.
8. A 26 year old multipara is 26 weeks pregnant. Her previous births include two large-for-gestational age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes?
A. A 50 g, one hour glucose screening test.
B. A single fasting glucose level.
C. A 100 g, one hour glucose tolerance test.
D. A 100 g, three hour glucose tolerance test.
9. A pregnant client at 23 weeks’ gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective? (normal hemoglobin level is 12-16) A. Tofu with mixed vegetables in curry, milk, whole wheat bun. (high in calcium) B. Roast beef, steamed spinach, tomato soup, orange juice
C. Pork chop, mashed potatoes and gravy, cauliflower, tea. (moderate amt of protein, but no Vit C) D. Broiled fish, lettuce salad, grapefruit half, carrot sticks.(high in fiber, low in fat, and moderately high in protein but low in iron)
10. The client with b-thalassemia intermedia has a hemoglobin level of 9.0. the nurse is preparing an education session for the client. Which statement should the nurse include?
A. You need to increase your intake of meat and other iron rich foods.
B. Your low hemoglobin could put you into preterm labor.
C. Increasing your Vitamin C intake will help your hemoglobin level
D. You should not take iron or folic acid supplements. (b-thalassemia is due to an abnormal red blood cell structure, which leads to mircocytic anemia with normal ferritin and iron levels).
11. The client at 20 weeks’ gestation has had an ultrasound that revealed that her fetus has a neural tube defect. The client’s hemoglobin level is 8.5. the nurse should include which statement when discussing these findings with the client?
A. Your low iron intake has caused anemia, which leads to the neural tube defect. B. You should increase your vitamin C intake to improve your anemia C. You are too picky about food. Your poor diet caused your baby’s defect. D. You haven’t had enough folic acid in your diet. You should take a
12. Client at 9 weeks’ gestation has been told that her HIV test was positive. The client is very upset, and tells the nurse, “I didn’t know I had HIV! What will this do to my baby?” The nurse knows teaching has been effective when the client states:
A. I cannot take the medications that control HIV during my pregnancy because they will harm my baby. B. My baby will probably be born with anti-hiv antibodies, but that doesn’t mean it is infected. C. The pregnancy will increase the progression of my disease and will reduce my CD4 counts. D. The HIV won’t affect my baby, and I will have a low-risk pregnancy without additional testing.
13. During the history, client admits to being HIV + and says she knows that she is about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally? Select all that apply:
A. During labor and delivery, I can expect the zidovudine (AZT) to be given in my IV. B. After delivery the dose of zidovudine (AZT) will be doubled to prevent further infection. C. My baby will be started on zidovudine (AZT) within 12 hours of delivery. D. My baby’s zidovudine (AZT) will be given in cream form. E. My baby will not need zidovudine (AZT) if I take it during my pregnancy.
14. A woman is 32 weeks pregnant, she is HIV positive, but asymptomatic. What would be important in managing her pregnancy and delivery?
A. An aminocentesis at 30 and 36 weeks.
B. Weekly Non-Stress testing beginning at 32 weeks’ gestation.
C. Application of a fetal scalp electrode as soon as her membranes rupture in labor.
D. Administration of intravenous antibiotics during labor and delivery.
15. 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 client needs to be retested for HIV?
A. Hemoglobin of 11 g/dL and a rapid weight gain.
B. Elevated blood pressure and ankle edema.
C. Shortness of breath and frequent urination.
D. Unusual fatigue and recurring Candida Vaginitis
16. The nurse is reviewing prenatal charts. A client 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?
A. Dyspnea and chest pain with mild exertion.
B. Elective cesarean birth scheduled for 37 weeks.
C. Discussed need for labor epidural and vacuum extraction.
D. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally.
17. The prenatal clinic nurse has received four phone calls. Which client should be called first? A. Primip at 28 weeks with history of asthma reporting difficulty breathing and shortness of breath. B. Multip at 6 weeks with aseizure disorder inquiring what foods are good folic acid sources for her. C. Primip at 35 weeks with a positive HBsAG (Hep B) wondering what treatment her baby will receive after birth. D. Multip at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding. (not normal; indicative of spontaneous abortion, but health of both mother and fetus not in immediate danger)
18. The client was found to have Hep B surface antigen (HBsAG) early in her pregnancy. The nurse is explaining to the client what will happen during labor and birth because the client is contagious for hepatitis
B. Which statement by the client indicates that additional teaching is needed?
A. An internal fetal monitor will be applied as soon as possible during labor. B. My baby will get a bath as soon as its temperature is stable. (True) C. Two shots will be given to my baby to prevent transmission of hepatitis b. (True) D. Breastfeeding is a good feeding method for my baby. (True)
19. The nurse is listening to the fetal heart tones of a client at 37 weeks’ gestation while the client is in supine position. The client states, “I’m getting lightheaded and dizzy.” The best action by the nurse is:
A. Assist client to sit up.
B. Remind the client that you need to hear the baby.
C. Help the client turn onto her side (preferably left side)
D. Check the client’s blood pressure.