Chapter 26: Concurrent Disorders During Pregnancy

Chapter 26: Concurrent Disorders During Pregnancy

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant client with diabetes?

a.	Evaluation of retinopathy by an ophthalmologist
b.	The client’s stable emotional and psychological status
c.	Degree of glycemic control before and during the pregnancy
d.	Total protein excretion and creatinine clearance within normal limits

 

 

ANS:  C

The occurrence of complications can be greatly diminished by maintaining normal blood glucose levels before and during the pregnancy. Even nonpregnant diabetics should have an annual eye examination. Assessing a client’s emotional status is helpful. Coping with a pregnancy superimposed on preexisting diabetes can be very difficult for the whole family. However, it is not the top priority. Baseline renal function is assessed with a 24-hour urine collection and does not diminish the client’s risk for complications.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   539

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Health Promotion and Maintenance

 

2. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

a.	Hypoglycemia
b.	Hypercalcemia
c.	Hypoinsulinemia
d.	Hypobilirubinemia

 

 

ANS:  A

The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops, and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate’s circulation, which results in hyperbilirubinemia.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   539

OBJ:   Nursing Process Step: Planning        MSC:  Client Needs: Health Promotion and Maintenance

 

3. Which factor is known to increase the risk of gestational diabetes mellitus?

a.	Previous birth of large infant
b.	Maternal age younger than 25 years
c.	Underweight prior to pregnancy
d.	Previous diagnosis of type 2 diabetes mellitus

 

 

ANS:  A

Prior birth of a large infant suggests gestational diabetes mellitus. A client younger than 25 is not at risk for gestational diabetes mellitus. Obesity (>90 kg [198 lb]) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   541

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Health Promotion and Maintenance

 

4. Which disease process improves during pregnancy?

a.	Epilepsy
b.	Bell’s palsy
c.	Rheumatoid arthritis
d.	Systemic lupus erythematosus (SLE)

 

 

ANS:  C

Although the reason is unclear, marked improvement is seen with rheumatoid arthritis in pregnancy. Most women relapse 6 weeks to 6 months postpartum. With epilepsy, the effect of pregnancy is variable and unpredictable. Seizures may increase, decrease, or remain the same. Bell’s palsy was thought to be caused by a virus three times more common during pregnancy and generally occurring in the third trimester. The client with SLE can have a normal pregnancy but must be treated as high risk because 50% of all births will be premature. Pregnancy can exacerbate SLE.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   555

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Health Promotion and Maintenance

 

5. When a pregnant client with diabetes experiences hypoglycemia while hospitalized, which should the nurse have the client do?

a.	Eat a candy bar.
b.	Eat six saltine crackers or drink 8 oz of milk.
c.	Drink 4 oz of orange juice followed by 8 oz of milk.
d.	Drink 8 oz of orange juice with 2 teaspoons of sugar added.

 

 

ANS:  B

Crackers provide carbohydrates in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will help increase the blood sugar level but will not sustain it. Orange juice and sugar will increase the blood sugar level but will not provide a slow-burning carbohydrate to sustain it.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   545

OBJ:   Nursing Process Step: Implementation

MSC:   Client Needs: Physiologic Integrity