Preconception counseling is critical to the outcome of a pregnancy for a patient with diabetes because poor glycemic control before and during early pregnancy is associated with:

Oligohydramnios

Congenital fetal anomalies.

Intrauterine fetal seizures

Polyhydramnios.

Answer and Explanation

The Correct Answer is B

A. Oligohydramnios. Oligohydramnios, or low amniotic fluid levels, is not a primary complication of pregestational diabetes. It is more commonly associated with conditions such as fetal growth restriction, post-term pregnancy, and rupture of membranes rather than maternal hyperglycemia.

B. Congenital fetal anomalies. Poor glycemic control during preconception and early pregnancy increases the risk of congenital anomalies, particularly affecting the heart, spine, and central nervous system. Hyperglycemia during organogenesis (first 8 weeks of gestation) can lead to defects such as neural tube defects and cardiac malformations.

C. Intrauterine fetal seizures. Fetal seizures in utero are extremely rare and are not a common complication of maternal diabetes. While neonatal hypoglycemia after birth can lead to seizures, maternal hyperglycemia does not directly cause seizures in the fetus.

D. Polyhydramnios. While polyhydramnios (excess amniotic fluid) can occur in pregnancies complicated by diabetes due to fetal polyuria, it is more associated with later pregnancy. The question specifically asks about preconception and early pregnancy risks, making congenital anomalies the best answer.

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Correct Answer is B

Explanation

A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. While systemic analgesics do cross the placenta, they actually affect the fetus more readily than the mother because the fetal liver and kidneys are immature, making drug metabolism and excretion slower. This leads to prolonged effects on the newborn.

B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. Opioid analgesics, such as fentanyl, meperidine, or morphine, can cause neonatal respiratory depression, reduced alertness, and difficulty initiating breastfeeding due to delayed sucking reflex. If administered too close to delivery, the newborn may require respiratory support or naloxone to reverse opioid effects.

C. Intravenous (IV) patient-controlled analgesia (PCA) results in increased use of an analgesic. PCA allows controlled dosing of pain medication, often leading to less total medication use because the patient receives smaller, more frequent doses rather than large, single doses. This helps maintain stable pain control without excessive sedation.

D. Intramuscular (IM) administration is preferred over IV administration. IV administration is preferred over IM because it provides faster pain relief and better dose control. IM injections have delayed absorption and an unpredictable effect, making IV the preferred route for labor analgesia.

A. Chronic Hypertension B. This is a normal Blood Pressure C. Preeclampsia D. Pregnancy induced hypertension.

Correct Answer is A

Explanation

A. Chronic Hypertension. Chronic hypertension is diagnosed when a woman has hypertension (≥140/90 mmHg) that was present before pregnancy or develops before 20 weeks gestation. Since this patient has a history of hypertension and is only 16 weeks pregnant, her condition is classified as chronic hypertension rather than pregnancy-related hypertension.

B. This is a normal Blood Pressure. A blood pressure of 169/94 mmHg is not normal. This reading indicates hypertension, which requires monitoring and possible medication adjustments to prevent complications such as preeclampsia or fetal growth restriction.

C. Preeclampsia. Preeclampsia is diagnosed after 20 weeks of gestation and includes hypertension along with signs of organ dysfunction (e.g., proteinuria, liver abnormalities, or neurological symptoms). Since this patient is only 16 weeks pregnant and does not show other preeclampsia symptoms, this diagnosis is incorrect.

D. Pregnancy-induced hypertension. Pregnancy-induced hypertension, also known as gestational hypertension, develops after 20 weeks gestation in women with previously normal blood pressure. Because this patient has a prior history of hypertension and is only 16 weeks pregnant, her condition is classified as chronic hypertension, not pregnancy-induced hypertension.

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Preconception counseling is critical to the outcome of a pregnancy for a patient with diabetes because poor glycemic control before and during early pregnancy is associated with:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

With regard to systemic analgesics administered during labor, nurses should be aware that:

Correct Answer is B

Explanation

A woman comes in to her physician’s office at 16 weeks of pregnancy complaining of headache. On examination her Blood Pressure is 169/94. As the physician looks over her record he notices that she has a prior history of hypertension. He explains to her that she has

Correct Answer is A

Explanation

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