1) A type 1 diabetic has been diagnosed since the age of 4

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1) A type 1 diabetic has been diagnosed since the age of 4. She is now 34 years old. In view of the length of time she has been a diabetic, which instruction is most critical to a good pregnancy outcome?

a.     "Monitor the urine for glucose 4 times a day"

b.     "Restrict weight gain to 20 pounds to prevent macrosomia" 

c.     "Monitor fetal activity once daily while resting on your left side."

d.     "Maintain bed rest after 34 weeks"

2. A type 1 diabetic says to the nurse, "I've never understood why my babies may need to be delivered before my due date." The nurse's teaching would include which of the following?

a.     "If the fetus has anomalies it is best to terminate the pregnancy"

b.     "Big babies should not progress beyond 37 weeks."

c.     "Ketoacidosis is very dangerous with pregnancy, and delivery is the only way to stop this from occurring."

d.     "Placental insufficiency may not allow your fetus to grow properly."

3. A preeclamptic patient is going to be induced. Before initiating the Pitocin infusion the nurse reviews the woman's latest laboratory findings which reveal platelet count of 90,000, elevated AST, and hematocrit of 33%. What intervention is needed at this time?

a.     Observe the IV and orifices for bleeding

b.     Call the physician and report the findings

c.     Administer 150 mg of aspirin by mouth

d.     Give a 2 gram bolus dose of Magnesium Sulfate

4. A nurse is completing a newborn assessment and observes small white nodules on the bridge of a new nose. What nursing intervention would be required for this newborn?

a.     Explain to the parents that the condition can be treated with laser therapy

b.     Put the newborn into isolation and call the physician.

c.     Informing the parents the cyst will resolve over time

d.     Place a sign on the newborn's crib to wear gloves at all times

5. Screening at 24 weeks reveals that a pregnant woman has gestational diabetes mellitus (GDM). The nurse identifies that the fetus is at greatest risk for which of the following?

a.     Low birth weight

b.     Preterm birth

c.     Congenital anomalies

d.     Macrosomia

6. A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected  as evident by a variable deceleration on the fetal monitor. What intervention would be most important?

a.     Starting oxygen by face mask

b.     Preparing the woman for a cesarean birth

c.     Placing the woman in a knee-chest position

d.     Covering the exposed cord with sterile gauze

7. Prior to discharging a pregnant patient with a total placenta previa the doctor calls and gives the nurse the following orders. The patient is 34 weeks gestation and her Rh factor is (-). Which order should the nurse question?

a.     Perform a nonstress test prior to discharge

b.     Instruct the woman to monitor fetal activity daily until her next office visit

c.     Give 300 mcg of Rh(D) immune globulin prior to discharge

d.     Perform a vaginal examination prior to discharging the patient