Chapter 29: Endocrine and Metabolic Disorders Lowdermilk: Maternity & Women’s Health Care, 11th Edition

TEST BANK FOR MATERNITY & WOMEN’S HEALTH CARE 11TH EDITION BY LOWDERMILK Chapter 29: Endocrine and Metabolic Disorders Lowdermilk: Maternity & Women’s Health Care, 11th Edition MULTIPLE CHOICE 1. Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy? a. Frequent episodes of maternal hypoglycemia b. Congenital anomalies in the fetus c. Hydramnios d. Hyperemesis gravidarum CORRECT ANSWER: B Preconception counseling is particularly important since strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risk of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormonal changes and the effects on insulin production and use. Hydramnios occurs approximately 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is observed in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose trCORRECT ANSWERfer to the fetus contribute to hypoglycemia. DIF: Cognitive Level: Understand REF: p. 687 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 2. During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? a. ―I will need to eat 600 more calories per day because I am pregnant.‖ b. ―I can continue with the same diet as before pregnancy as long as it is well balanced.‖ c. ―Diet and insulin needs change during pregnancy.‖ d. ―I will plan my diet based on the results of urine glucose testing.‖ CORRECT ANSWER: C Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs may double or even quadruple. The diet is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be based on blood, not urine, glucose changes. DIF: Cognitive Level: Analyze REF: p. 689 TOP: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity 3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight CORRECT ANSWER: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this fetus. DIF: Cognitive Level: Understand REF: p. 690 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 4. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern CORRECT ANSWER: B This client‘s clinical cues include weight loss, which supports a nursing diagnosis of ―Imbalanced nutrition: less than body requirements.‖ No clinical signs or symptoms support a nursing diagnosis of deficient fluid volume. This client reports weight loss, not weight gain. Although the client reports nervousness, the most appropriate nursing diagnosis, based on the client‘s other clinical symptoms, is ―Imbalanced nutrition: less than body requirements.‖ DIF: Cognitive Level: Analyze REF: p. 706 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity 5. A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy? a. PKU is a recognized cause of preterm labor. b. The fetus may develop neurologic problems. c. A pregnant woman is more likely to die without strict dietary control. d. Women with PKU are usually mentally handicapped and should not reproduce. CORRECT ANSWER: B Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of an uncertain cause, or who have given birth to microcephalic infants. DIF: Cognitive Level: Understand REF: p. 707 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity