Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 17 Pregnancy at Risk: Pregestational Problems

1. The nurse is caring for a pregnant woman who admits to using cocaine and ecstasy on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about ecstasy?" What is the nurse's best response?
2. "Ecstasy can cause a high fever in you and therefore cause the baby harm."
3. "Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop."
4. "Ecstasy produces babies with small heads and short bodies with brain function alterations."
5. "Ecstasy produces intrauterine growth restriction and meconium aspiration."

Page Ref: 368

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 3 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the client indicates to the nurse that the client has understood the teaching?
2. "I can continue to drink alcohol until I am diagnosed as pregnant."
3. "I need to stop drinking alcohol completely when I start trying to get pregnant."
4. "A beer once a week will not damage the fetus."
5. "I can drink alcohol while breastfeeding because it doesn't pass into breast milk."

Page Ref: 368

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A woman's history and appearance suggest drug abuse. What is the nurse's best approach?
2. Ask the woman directly, "Do you use any street drugs?"
3. Ask the woman whether she would like to talk to a counselor.
4. Ask some questions about over-the-counter medications and avoid mention of illicit drugs.
5. Explain how harmful drugs can be for her baby.

Page Ref: 370

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Lifestyle Choices

Standards: Q S E N Competencies: Ⅰ. C. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. 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 which condition?
2. Erythroblastosis fetalis
3. Diabetes mellitus
4. Abruptio placentae
5. Pregnancy-induced hypertension

Page Ref: 369

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The client has just been diagnosed as diabetic. The nurse knows teaching was effective when the client makes which statement?
2. "Ketones in my urine mean that my body is using the glucose appropriately."
3. "I should be urinating frequently and in large amounts to get rid of the extra sugar."
4. "My pancreas is making enough insulin, but my body isn't using it correctly."
5. "I might be hungry frequently because the sugar isn't getting into the tissues the way it should."

Page Ref: 354—356

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The maternal health nurse is caring for a pregnant client with obsessive-compulsive disorder (O C D). Which action will the nurse take when teaching the client, based on the client's psychological disorder?
2. Allow the client opportunity for repetitive rituals.
3. Ask the client to follow along with written material.
4. Repeat instructions as needed.
5. Provide multiple handouts with various photographs

Page Ref: 371

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Explain the possible implications of maternal psychologic factors and disorders in caring for the childbearing family.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A newly diagnosed insulin-dependent type 1 diabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. What would the best explanation include?
2. "Your baby could be smaller than average at birth."
3. "Your baby will probably be larger than average at birth."
4. "As long as you control your blood sugar, your baby will not be affected at all."
5. "Your baby might have high blood sugar for several days."

Page Ref: 355

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A 26-year-old client 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?
2. "Exercise either just before meals or wait until 2 hours after a meal."
3. "Carry hard candy (or other simple sugar) when exercising."
4. "If your blood sugar is 120 m g/d L, eat 20 g of carbohydrate."
5. "If your blood sugar is more than 120 m g/d L, drink a glass of whole milk."

Page Ref: 362

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A 26-year-old client 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?
2. A 50g, 1-hour glucose screening test
3. A single fasting glucose level
4. A 100g, 1-hour glucose tolerance test
5. A 100g, 3-hour glucose tolerance test

Page Ref: 356

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high quality patient outcomes. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A woman asks her nurse what she can do before she begins trying to get pregnant to help her baby, as she is prone to anemia. What would the nurse correctly advise her to do?
2. Get pregnant, then start iron supplementation.
3. Add more carbohydrates to her diet.
4. Begin taking folic acid supplements daily.
5. Have a hemoglobin baseline done now so her progress can be followed.

Page Ref: 363

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. Which of the following may be the main presenting symptom of iron deficiency anemia?
2. Frequent urination
3. Fatigue
4. Nausea
5. Headaches

Page Ref: 363—364

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The client with 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?
2. "You need to increase your intake of meat and other iron-rich foods."
3. "Your low hemoglobin could put you into preterm labor."
4. "Increasing your vitamin C intake will help your hemoglobin level."
5. "You should not take iron supplements."

Page Ref: 366

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The client at 20 weeks' gestation has had an ultrasound that revealed a neural tube defect in her fetus. The client's hemoglobin level is 8.5. The nurse should include which statement when discussing these findings with the client?
2. "Your low iron intake has caused anemia, which leads to the neural tube defect."
3. "You should increase your vitamin C intake to improve your anemia."
4. "You are too picky about food. Your poor diet caused your baby's defect."
5. "You haven't had enough folic acid in your diet. You should take a supplement."

Page Ref: 364

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 10. Value active partnerships with patients or designated surrogates in planning, implementation, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The client at 9 weeks' gestation has been told that her H I V test was positive. The client is very upset, and tells the nurse, "I didn't know I had H I V! What will this do to my baby?" The nurse knows teaching has been effective when the client makes which statement?
2. "I cannot take the medications that control H I V during my pregnancy, because they will harm the baby."
3. "My baby can get H I V during the pregnancy and through my breast milk."
4. "The pregnancy will increase the progression of my disease and will reduce my C D4 counts."
5. "The H I V won't affect my baby, and I will have a low-risk pregnancy without additional testing."

Page Ref: 372—373

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations. | N L N Competencies: Relationship-Centered Care. Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 5 Discuss A I D S, including care of the pregnant woman with H I V/A I D S, neonatal implications, ramifications for the childbearing family, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. During the history, the client admits to being H I V-positive 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?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "During labor and delivery, I can expect the zidovudine (Z D V) to be given in my Ⅳ."
2. "After delivery, the dose of zidovudine (Z D V) will be doubled to prevent further infection."
3. "My baby will be started on zidovudine (Z D V) for six weeks following the birth."
4. "My baby's zidovudine (Z D V) will be given in a cream form."
5. "My baby will not need zidovudine (Z D V) if I take it during my pregnancy."

Page Ref: 372—373

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 4. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 5 Discuss A I D S, including care of the pregnant woman with H I V/A I D S, neonatal implications, ramifications for the childbearing family, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A woman is 32 weeks pregnant. She is H I V-positive but asymptomatic. The nurse knows that what would be important in managing her pregnancy and delivery?
2. An amniocentesis at 30 and 36 weeks
3. Weekly non-stress testing beginning at 32 weeks' gestation
4. Application of a fetal scalp electrode as soon as her membranes rupture in labor
5. Administration of intravenous antibiotics during labor and delivery

Page Ref: 372—373

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Discuss A I D S, including care of the pregnant woman with H I V/A I D S, neonatal implications, ramifications for the childbearing family, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A pregnant woman is married to an intravenous drug user. She had a negative H I V screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for H I V?
2. Hemoglobin of 11 g/d L and a rapid weight gain
3. Elevated blood pressure and ankle edema
4. Shortness of breath and frequent urination
5. Persistent candidiasis

Page Ref: 373

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Discuss A I D S, including care of the pregnant woman with H I V/A I D S, neonatal implications, ramifications for the childbearing family, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. Women with H I V should be evaluated and treated for other sexually transmitted infections and for what condition occurring more commonly in women with H I V?
2. Syphilis
3. Toxoplasmosis
4. Gonorrhea
5. Herpes

Page Ref: 373

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | N L N Competencies: Quality and Safety: Contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Discuss A I D S, including care of the pregnant woman with H I V/A I D S, neonatal implications, ramifications for the childbearing family, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A 21-year-old at 12 weeks' gestation with her first baby has known cardiac disease, class Ⅲ, as a result of childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompensation with her. The nurse will know that the client understands these signs and symptoms if she states that she would notify her doctor if she had which symptom?
2. "A pulse rate increase of 10 beats per minute"
3. "Breast tenderness"
4. "Mild ankle edema"
5. "A frequent cough"

Page Ref: 378

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A client is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurse's response be?
2. "Heparin is used when coagulation problems are resolved."
3. "Heparin is safer because it does not cross the placenta."
4. "They are the same drug, but heparin is less expensive."
5. "Coumadin interferes with iron absorption in the intestines."

Page Ref: 378

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A 21-year-old woman is at 12 weeks' gestation with her first baby. She has cardiac disease, class Ⅲ, as a result of having had childhood rheumatic fever. Which planned activity would indicate to the nurse that the client needs further teaching?
2. "I will be sure to take a rest period every afternoon."
3. "I would like to take childbirth education classes in my last trimester."
4. "I will have to cancel our trip to Disney World."
5. "I am going to start my classes in water aerobics next week."

Page Ref: 378

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. Which of the following symptoms, if progressive, are indicative of C H F, the heart's signal of its decreased ability to meet the demands of pregnancy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Palpitations
2. Heart murmurs
3. Dyspnea
4. Frequent urination
5. Rales

Page Ref: 378—379

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally, and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Describe the effects of various heart disorders on pregnancy, including their implications for nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The prenatal clinic nurse has received four phone calls. Which client should the nurse call back first?
2. Pregnant woman at 28 weeks with history of asthma who is reporting difficulty breathing and shortness of breath
3. Pregnant woman at 6 weeks with a seizure disorder who is inquiring which foods are good folic acid sources for her
4. Pregnant woman at 35 weeks with a positive H B s A G who is wondering what treatment her baby will receive after birth
5. Pregnant woman at 11 weeks with untreated hyperthyroidism who is describing the onset of vaginal bleeding

Page Ref: 381

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Compare the effects of selected gestational medical conditions on pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A patient in the second trimester of pregnancy with gestational diabetes is counseled to ingest 35 calories/k g of ideal body weight. The patient's ideal weight is 154 l b s. How many calories should the patient ingest every day?

Page Ref: 357

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A patient in the 10th week of pregnancy is diagnosed with gestational diabetes. The dietician determines that the patient's daily caloric intake should be 2200 calories and instructs the patient to ingest 40% of calories from carbohydrates, 20% of calories from protein, and 40% of calories from fats. How many calories should the patient ingest of protein each day?

Page Ref: 357

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. A patient with gestational diabetes (G D M) is instructed to measure capillary blood glucose levels 4 times a day. If the patient eats meals at 8 a.m., 1 p.m., and 7 p.m., at which times should the nurse reinforce glucose testing to occur?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. 10 a.m.
2. 12 noon
3. 4 p.m.
4. 3 p.m.
5. 9 p.m.

Page Ref: 362

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Discuss the pathology, treatment, and nursing care of pregnant women with diabetes.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. During a routine prenatal visit, the nurse suspects that the patient is experiencing undiagnosed depression. What findings did the nurse use to make this clinical determination?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Insomnia
2. Headaches
3. Fear of labor
4. Ritualistic behavior
5. Lack of interest in the pregnancy

Page Ref: 367

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation: Nursing Process.

Learning Outcome: 4 Explain the possible implications of maternal psychologic factors and disorders in caring for the childbearing family.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is preparing teaching material for a patient with multiple sclerosis who is in the third trimester of pregnancy. What information should the nurse emphasize with this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Plan for frequent rest periods
2. Breastfeeding should be avoided
3. Plan to experience heightened pain during labor
4. Determine the need for childcare help after delivery
5. Relapses may increase during the first 3 months after delivery

Page Ref: 383

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Compare the effects of selected gestational medical conditions on pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is providing care to a pregnant client who is diagnosed with iron deficiency anemia. Which teaching statement from the nurse to the client is appropriate?
2. "You will need to begin iron supplements at 30 m g/day."
3. "You will need to increase your intake of bananas."
4. "You will need to increase your intake of green leafy vegetables."
5. "You will need to begin iron supplements at 150 m g/day."

Page Ref: 363

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is providing care to a client who would like to become pregnant within the next year. The client has a history of folic acid deficiency anemia and asks, "What can I do to decrease the risk of neural tube defects?" Which response by the nurse is most appropriate?
2. "You will need to have genetic testing done to identify your risk."
3. "Do you have a family history of these disorders?"
4. "Daily consumption of orange juice decreases your risk."
5. "You will be prescribed an iron supplement, which decreases your risk."

Page Ref: 363

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is providing care to a laboring pregnant client who is diagnosed with sickle cell disease. What will the nurse prepare for upon delivery of the client's newborn, based on this diagnosis?
2. Hemorrhage
3. Intrauterine growth restriction
4. Neonatal resuscitation
5. Cesarean birth

Page Ref: 363

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is caring for a postpartum client who is experiencing a sickle cell crisis. Which is the priority assessment by the nurse?
2. Blood pressure
3. Lochia
4. Temperature
5. Fundal height

Page Ref: 363

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Discriminate among the four major types of anemia associated with pregnancy with regard to signs, treatment, implications for pregnancy, and nursing care.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is providing care to a client in labor who admits to using heroin throughout the pregnancy. Which will the neonate be at risk for following birth?
2. Seizure activity
3. Congenital anomalies
4. Large for gestational age
5. Cardiac anomalies

Page Ref: 367

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.

1. The nurse is conducting an admission assessment for a pregnant client who is in labor. Which finding would cause the nurse to expect that the client has been abusing an illegal substance?
2. The client is asking for an epidural and rates pain as an 8 on a 0 to 10 numeric scale.
3. The client is diaphoretic during the transition stage of labor.
4. The client has constricted pupils and inflamed nasal mucosa.
5. The client has a history of precipitous labor.

Page Ref: 367

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Summarize the effects of alcohol and illicit drugs on the childbearing woman and her fetus/newborn.

M N L L O: Demonstrate use of the nursing process in the care of a pregnant woman with a pregestational problem.