Chapter 20: Pregnancy at Risk: Preexisting Conditions

Chapter 20: Pregnancy at Risk: Preexisting Conditions

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

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 woman 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.”

 

ANS: A

 

	Feedback
A	Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin.
B	This statement is accurate and signifies that the woman has understood the teachings regarding control of her diabetes during pregnancy.
C	This statement is accurate and signifies that the woman has understood the teachings regarding control of her diabetes during pregnancy.
D	This statement is accurate and signifies that the woman has understood the teachings regarding control of her diabetes during pregnancy.

 

DIF:   Cognitive Level: Application        REF:  584

OBJ:  Client Needs: Physiologic Integrity                                         TOP:   Nursing Process: Evaluation

 

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.

 

ANS: B

 

	Feedback
A	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.
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.
C	Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy.
D	Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

 

DIF:   Cognitive Level: Comprehension  REF:  584

OBJ:  Client Needs: Physiologic Integrity                                         TOP:   Nursing Process: Planning

 

3. In teaching the woman with pregestational diabetes about desired glucose levels, the nurse explains that a normal fasting glucose level, such as before breakfast, is in the range of:

a.	65 to 95 mg/dl.
b.	130 to 140 mg/dl.
c.	200 mg/dl.
d.	55 mg/dl.

 

ANS: A

 

	Feedback
A	Target glucose levels during a fasting period are 65 to 95 mg/dl.
B	This glucose level is consistent with 1 hour postprandial levels.
C	A glucose level of 200 mg/dl is an indication of hyperglycemia. The physician should be contacted immediately for further orders.
D	This level indicates hypoglycemia. An adjustment will need to be made to both diet and insulin.

 

DIF:   Cognitive Level: Knowledge        REF:  589

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

4. 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.

 

ANS: A

	Feedback
A	Poor glycemic control later in pregnancy increases the rate of fetal macrosomia.
B	Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies.
C	Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes.
D	Increased weight, or macrosomia, is the greatest risk factor for this woman.

 

DIF:   Cognitive Level: Comprehension  REF:  586

OBJ:  Client Needs: Physiologic Integrity

TOP:    Nursing Process: Planning, Implementation