Exam 1 - Chapter 30 / REVIEW FOR EXAM 2/3 Flashcards
When caring for a pregnant woman with cardiac problems, thenurse must be alert for
thesigns and symptoms of cardiac decompensation. Which critical findings would thenurse find
on assessment of theclient experiencing this condition?
a. Regular heart rate and hypertension
b. Increased urinary output, tachycardia, and dry cough
c. Shortness of breath, bradycardia, and hypertension
d. Dyspnea, crackles, and an irregular, weak pulse
D - Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, and rapid pulse;
rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue; and
cyanosis of thelips and nailbeds. A regular heart rate and hypertension are not generally
associated with cardiac decompensation. Of thesymptoms of increased urinary output,
tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation. Of
thesymptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative of
cardiac decompensation.
Which condition would require prophylaxis to prevent subacute bacterial endocarditis (SBE) both antepartum and intrapartum? a. Valvular heart disease b. Congestive heart disease c. Arrhythmias d. Postmyocardial infarction
A - Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women
who have mitral valve prolapse. Prophylaxis for intrapartum endocarditis is not indicated for a
client with congestive heart disease, underlying arrhythmias, or postmyocardial infarction.
Which information should thenurse take into consideration when planning care for a
postpartum client with cardiac disease?
a. The plan of care for a postpartum client is the same as the plan for any pregnant woman.
b. The plan of care includes rest, stool softeners, and monitoring of the effect of activity.
c. The plan of care includes frequent ambulating, alternating with active range-of- motion
exercises.
d. The plan of care includes limiting visits with the infant to once per day.
B - Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress
or strain for thewoman are promoted with stool softeners, diet, and fluids. Care of thewoman
with cardiac disease in thepostpartum period is tailored to thewomans functional capacity.
Thewoman will be on bed rest to conserve energy and to reduce thestrain on theheart. Although
thewoman may need help caring for theinfant, breastfeeding and infant visits are not
contraindicated
A woman has experienced iron deficiency anemia during her pregnancy. She had been
taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has
been having problems with constipation. After assisting her back to bed from the bathroom,
the nurse notes that the womans stools are dark (greenish-black). What should the nurses initial
action be?
a. Perform a guaiac test, and record the results.
b. Recognize the finding as abnormal, and report it to the primary health care provider.
c. Recognize the finding as a normal result of iron therapy.
d. Check the womans next stool to validate the observation.
C - The nurse should recognize that dark stools are a common side effect in clients who are taking
iron replacement therapy. A guaiac test would be indicated if gastrointestinal (GI) bleeding was
suspected. GI irritation, including dark stools, is also a common side effect of iron therapy.
Observation of stool formation is a normal nursing activity.
A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be
avoided when treating postpartum bleeding to avoid exacerbating asthma?
a. Oxytocin (Pitocin)
b. Nonsteroidal antiinflammatory drugs (NSAIDs)
c. Hemabate
d. Fentanyl
C - Prostaglandin derivatives should not be used to treat women with asthma, because they may
exacerbate symptoms. Oxytocin is thedrug of choice to treat this womans bleeding; it will not
exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not
bleeding
Which important component of nutritional counseling should thenurse include in health
teaching for a pregnant woman who is experiencing cholecystitis?
a. Assess thewomans dietary history for adequate calories and proteins.
b. Teach thewoman that thebulk of calories should come from proteins.
c. Instruct thewoman to eat a low-fat diet and to avoid fried foods.
d. Instruct thewoman to eat a low-cholesterol, low-salt diet.
C - Eating a low-fat diet and avoiding fried foods is appropriate nutritional counseling for this client.
Caloric and protein intake do not predispose a woman to thedevelopment of cholecystitis.
Thewoman should be instructed to limit protein intake and choose foods that are high in
carbohydrates. A low-cholesterol diet may be theresult of limiting fats. However, a low-salt diet
is not indicated
Postoperative care of the pregnant woman who requires abdominal surgery for
appendicitis includes which additional assessment?
a. Intake and output (I&O) and intravenous (IV) site
b. Signs and symptoms of infection
c. Vital signs and incision
d. Fetal heart rate (FHR) and uterine activity
D - Care of a pregnant woman undergoing surgery for appendicitis differs from that for a
nonpregnant woman in one significant aspect: thepresence of thefetus. Continuous fetal and
uterine monitoring should take place. An assessment of I&O levels, along with an assessment of
theIV site, are normal postoperative care procedures. Evaluating theclient for signs and
symptoms of infection is also part of routine postoperative care. Routine vital signs and
evaluation of theincision site are expected components of postoperative care.
Since thegene for cystic fibrosis was identified in 1989, data can be collected for
the purposes of genetic counseling for couples regarding carrier status. According to the most
recent statistics, how often does cystic fibrosis occur in Caucasian live births?
a. 1 in 100
b. 1 in 1000
c. 1 in 2000
d. 1 in 3200
D - Cystic fibrosis occurs in approximately 1 in 3200 Caucasian live births. 1 in 100, 1 in 1000, and
1 in 2000 occurrences of cystic fibrosis in live births are all too frequent rates
Which information regarding thecare of antepartum women with cardiac conditions is
most
important for thenurse to understand?
a. Stress on theheart is greatest in thefirst trimester and thelast 2 weeks before labor.
b. Women with class II cardiac disease should avoid heavy exertion and any activity that
causes even minor symptoms.
c. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and
limit housework, shopping, and exercise.
d. Women with class I cardiac disease need bed rest through most of thepregnancy and face
thepossibility of hospitalization near term.
B - Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to
avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between
weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III
cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most
of theday and face thepossibility of hospitalization near term. Class I cardiac disease is
asymptomatic at normal levels of activity. These women can perform limited normal activities
with discretion, although they still need a good amount of sleep
A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a
fall. The nurse must closely observe the client for what?
a. Alteration in maternal vital signs, especially blood pressure
b. Complaints of abdominal pain
c. Placental absorption
d. Hemorrhage
C - Electronic fetal monitoring (EFM) tracings can help evaluate maternal status after trauma and
can reflect fetal cardiac responses to hypoxia and hypoperfusion. Signs and symptoms of
placental absorption include uterine irritability, contractions, vaginal bleeding, and changes in
FHR characteristics. Hypoperfusion may be present in thepregnant woman before theonset of
clinical signs of shock. EFM tracings show thefirst signs of maternal compromise, such as when
thematernal heart rate, blood pressure, and color appear normal, yet theEFM printout shows
signs of fetal hypoxia. Abdominal pain, in and of itself, is not themost important symptom.
However, if it is accompanied by contractions, changes in theFHR, rupture of membranes, or
vaginal bleeding, then theclient should be evaluated for abruptio placentae. Clinical signs of
hemorrhage do not appear until after a 30% loss of circulating volume occurs. Careful
monitoring of fetal status significantly assists in maternal assessment, because thefetal monitor
tracing works as an oximeter of internal well-being.
Which neurologic condition would require preconception counseling, if at all possible?
a. Eclampsia
b. Bell palsy
c. Epilepsy
d. Multiple sclerosis
C - Women with epilepsy should receive preconception counseling, if at all possible. Achieving
seizure control before becoming pregnant is a desirable state. Medication should also be
carefully reviewed. Eclampsia may sometimes be confused with epilepsy, and Bell palsy is a
form of facial paralysis; preconception counseling for either condition is not essential to care.
Multiple sclerosis is a patchy demyelination of thespinal cord that does not affect thenormal
course of pregnancy or birth.
The client makes an appointment for preconception counseling. The woman has a known
heart condition and is unsure if she should become pregnant. Which is the only cardiac condition
that would cause concern?
a. Marfan syndrome
b. Eisenmenger syndrome
c. Heart transplant
d. Ventricular septal defect (VSD)
B - Pregnancy is contraindicated in clients with Eisenmenger syndrome. Women who have had heart
transplants are successfully having babies. However, conception should be postponed for at least
1 year after transplantation.
What form of heart disease in women of childbearing years generally has a benign effect on pregnancy? a. Cardiomyopathy b. Rheumatic heart disease c. Congenital heart disease d. Mitral valve prolapse
D - Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy
produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart
failure during pregnancy. Some congenital heart diseases produce pulmonary hypertension or
endocarditis during pregnancy.
A pregnant woman at 33 weeks of gestation is brought to thebirthing unit after a minor
automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs
are stable, and the FHR is 132 beats per minute with variability. What is the nurses highest
priority?
a. Monitoring the woman for a ruptured spleen
b. Obtaining a physicians order to discharge her home
c. Monitoring her for 24 hours
d. Using continuous EFM for a minimum of 4 hours
D - Monitoring theexternal FHR and contractions is recommended after blunt trauma in a viable
gestation for a minimum of 4 hours, regardless of injury severity. Fetal monitoring should be
initiated as soon as thewoman is stable. In this scenario, no clinical findings indicate
thepossibility of a ruptured spleen. If thematernal and fetal findings are normal, then EFM should
continue for a minimum of 4 hours after a minor trauma or a minor automobile accident. Once
themonitoring has been completed and thehealth care provider is reassured of fetal well-being,
theclient may be discharged home. Monitoring for 24 hours is unnecessary unless theERM strip
is abnormal or nonreassuring.
Bell palsy is an acute idiopathic facial paralysis, the cause for which remains unknown.
Which statement regarding this condition is correct?
a. Bell palsy is the sudden development of bilateral facial weakness.
b. Women with Bell palsy have an increased risk for hypertension.
c. Pregnant women are affected twice as often as nonpregnant women.
d. Bell palsy occurs most frequently in the first trimester.
B - Theclinical manifestations of Bell palsy include thedevelopment of unilateral facial weakness,
pain surrounding theears, difficulty closing theeye, and hyperacusis. Thecause is unknown;
however, Bell palsy may be related to a viral infection. Pregnant women are affected at a rate of
three to five times that of nonpregnant women.
