A nurse is reinforcing teaching to a client who is at 28 weeks of gestation and reports heroin use.
Which of the following statements should the nurse include in the teaching?
"The use of heroin can cause placenta previa.”.
"The use of heroin can cause preterm labor.”.
"The use of heroin can cause chromosomal abnormalities.”.
"The use of heroin can cause an increase in amniotic fluid.”
The Correct Answer is B
Choice A rationale
Placenta previa, a condition where the placenta partially or completely covers the cervix, is primarily associated with risk factors such as previous cesarean sections, multiparity, and advanced maternal age. Heroin use does not have a direct causal link to the development of placenta previa.
Choice B rationale
Heroin use during pregnancy is strongly associated with an increased risk of preterm labor. Opioids can cause uterine contractions and alter placental blood flow, leading to premature cervical changes and the onset of labor before 37 weeks of gestation, impacting fetal development.
Choice C rationale
Chromosomal abnormalities, such as Down syndrome or Turner syndrome, result from errors in chromosome number or structure during cell division. These genetic errors are not caused by maternal heroin use, although substance abuse can affect fetal development in other ways.
Choice D rationale
An increase in amniotic fluid, known as polyhydramnios, is often associated with conditions such as maternal diabetes, fetal gastrointestinal anomalies, or multiple gestations. Heroin use does not typically lead to polyhydramnios; rather, it is more commonly associated with oligohydramnios due to fetal growth restriction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"D"}
Explanation
? Rationale for Correct Answers
Glucose level is the priority because the newborn’s blood glucose is 35 mg/dL, which is below the normal threshold of 40–45 mg/dL. Neonatal hypoglycemia can lead to seizures, apnea, and brain injury if untreated. Immediate intervention is critical to prevent neurologic damage.
Feeding difficulties are the next concern because they contribute to poor caloric intake and perpetuate hypoglycemia. The newborn exhibits poor latch, uncoordinated suck, and loose stools—hallmarks of neonatal abstinence syndrome (NAS), which impair feeding and weight gain.
❌ Rationale for Incorrect Response 1 Options
Respiratory rate (65/min) is mildly elevated but within the upper limit of normal for newborns (30–60/min). No signs of respiratory distress (e.g., nasal flaring, retractions, grunting) are present, making this a lower priority.
Heart rate (165/min) is within the normal neonatal range (120–160/min). Mild tachycardia can be attributed to irritability or crying and is not immediately life-threatening.
Temperature (37.5°C) is within the normal range for newborns (36.5–37.5°C). There is no evidence of fever or hypothermia requiring urgent intervention.
❌ Rationale for Incorrect Response 2 Options
Skin findings such as mottling are nonspecific and often seen in NAS or immature autonomic regulation. They are not immediately dangerous.
Cry characteristics like high-pitched crying are typical of NAS but are not life-threatening and do not require urgent intervention.
Tremors are a common NAS symptom but are not acutely harmful unless associated with seizures, which are not reported here.
? Take-Home Points
- Neonatal hypoglycemia (<40 mg/dL) is a medical emergency requiring prompt correction to prevent neurologic injury.
- Feeding difficulties in NAS exacerbate hypoglycemia and must be addressed to ensure adequate caloric intake.
- NAS presents with autonomic, gastrointestinal, and neurologic symptoms; diagnosis is clinical and supported by maternal and neonatal drug screens.
- NAS must be differentiated from neonatal sepsis, hypoxic-ischemic encephalopathy, and metabolic disorders, which may present similarly.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"D"}
Explanation
? Rationale for Correct Answers
Diabetic diet is appropriate because the client meets diagnostic criteria for gestational diabetes mellitus (GDM). The 3-hour oral glucose tolerance test (OGTT) shows two or more elevated values:
- 1-hour: 220 mg/dL (normal <180 mg/dL)
- 2-hour: 165 mg/dL (normal <140 mg/dL)
- 3-hour: 142 mg/dL (normal 70–115 mg/dL)
According to the American Diabetes Association and ACOG, GDM is diagnosed when at least two values exceed thresholds. GDM increases risks for macrosomia, preeclampsia, and neonatal hypoglycemia, and requires dietary management as first-line therapy.
30 cal/kg/day is the recommended caloric intake for overweight or obese pregnant individuals with GDM. Caloric needs are based on pre-pregnancy weight:
- Normal BMI: 30–35 kcal/kg/day
- Overweight (BMI 25–29.9): 25 kcal/kg/day
- Obese (BMI ≥30): 30 kcal/kg/day is often used to balance fetal growth and glycemic control.
❌ Rationale for Incorrect Response 1 Options
Low-sodium diet is used for hypertension or preeclampsia, but this client has no signs of preeclampsia (e.g., proteinuria, headache, visual changes, epigastric pain).
High-protein diet is not a standard intervention for GDM and may worsen insulin resistance if not balanced.
Gluten-free diet is indicated for celiac disease, which is not present here.
❌ Rationale for Incorrect Response 2 Options
15–25 cal/kg/day are too low for pregnancy and may risk fetal growth restriction, especially in obese clients.
20 cal/kg/day is used in severe obesity or when caloric restriction is medically necessary, but not standard for GDM.
25 cal/kg/day is more appropriate for overweight (not obese) clients.
? Take-Home Points
- GDM is diagnosed with ≥2 abnormal values on a 3-hour OGTT.
- Dietary therapy is first-line management for GDM, focusing on controlled carbohydrate intake.
- Obese pregnant clients with GDM should receive ~30 kcal/kg/day based on pre-pregnancy weight.
- GDM increases risks for maternal and fetal complications and requires close monitoring.
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