ANGELES UNIVERSITY FOUNDATION

Angeles City
College of Nursing

NCM 0109

CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)

Second Semester, Academic Year 2021-2022

MODULE 1: CONTENT
HIGH-RISK PRENATAL CLIENTS

PRE-DISCUSSION ACTIVITY: (UNGRADED)

PRETEST:

1. In order to determine whether prior knowledge of the topics is adequate, a pretest will have to be answered. The questions are included
and enumerated as pretest.

1. Healthy habits during which trimester are most crucial for the well-being of the developing fetus?

A. First

B. Second

C. Last

D. All

2. Women in their 30s and 40s can have healthy pregnancies, but are at increased risk of which condition?

A. Chronic Fatigue Syndrome

B. Diabetes

C. Hypertension

D. B and C

3. It's safe to drink alcohol during pregnancy as long as you don't drink a lot or every day.

A. TRUE

B. False

4. Babies born to women who used narcotics while they were pregnant can have withdrawal symptoms.

A. TRUE

B. FALSE
5. Women who use IV drugs while pregnant may get hepatitis or HIV. These diseases can be passed on to their babies.

A. TRUE

B. FALSE

6. What is the difference between HIV and AIDS?

A. HIV is a virus and AIDS is a bacterial Disease

B. There is No difference between HIV and AIDS

C. HIV is a virus that causes AIDS

D. HIV is more severe than AIDS

7. Mother-Fetus Rh blood type incompatibility problems can occur if the mother is _________________ and her fetus is _________.

A. Rh positive; Rh positive

B. Rh positive; Rh Negative

C. Rh negative; Rh Positive

D. Rh negative; Rh negative

E. B and C

8. If the father of a fetus is Rh positive and the mother is Rh negative, what are the chances that there will be a mother-fetus incompatibility
problem? Assume that the couple has already had a child and that there has been no medical treatment to prevent this problem.

A. 100 %

B. at least 50 %

C. less than 50 %

D. Zero %

9. An infant born at 33 weeks’ gestation has anemia of prematurity, which is characterized by an inadequate response to erythropoietin. The
healthcare provider expects that microscopic examination of this infant’s red blood cells would reveal.

A. Normal Hemoglobin in each Cell

B. Large, Pale Cells

C. Small and Immature Cells

D. Cells of normal size

E. Small, Irregularly shaped cells

10. A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client’s hemoglobin and
hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following?

A. A loudmouth

B. Low Self Esteem

C. Hemorrhage

D. Post-Partum Infections

Note: Rationalization of the answers for the pretest will be done by your instructors before the start of the discussion.

DISCUSSION:
VIDEO CONFERENCE 1:

HIGH-RISK PREGNANCY

A high-risk pregnancy is one in which a concurrent disorder, pregnancy-related complication, or external factor

jeopardizes the health of the woman, the fetus or both.

It is even possible to begin a normal pregnancy and develop conditions that put you into the high-risk category.

Regardless of what causes your pregnancy to become high-risk, it is likely that problems may persist with both

you and/or the baby during the pregnancy, birth process, or even after the delivery.

INDICATORS
● Maternal age <16 or >35
● Chronic Disease
-Hypertension
-Diabetes
-Cardiovascular or Renal Disease
-Thyroid Disorder
● Pre-Eclampsia-Abnormal Hypertension during Pregnancy
● Rh Isoimmunization-Negative or Positive in Blood (Coagulation)
● History of Stillbirth
● IUGR (Intrauterine Growth Restriction)
- a baby in the womb (a fetus) does not grow as expected
- baby is smaller than needs to be expected; growth retardation

The two types of IUGR are:

● symmetrical IUGR: all parts of the baby's body are similarly small in size
● asymmetrical IUGR: the baby's head and brain are the expected sizes, but the rest of the baby's body is small
● Post-term Pregnancy- 2 weeks past the due date
● Multiple Gestation
● History of Preterm labor
● Previous Cervical Incompetence
● Severe Anemia (Hb <7 mg/Dl)
● HIV/AIDS positive and Syphilis
SUBSTANCE ABUSE

The use of alcohol, illicit drugs, and other psychoactive substances during pregnancy can lead to multiple health and social problems for

both mother and child, including miscarriage, stillbirth, low birth weight, prematurity, physical malformations, and neurological damage.
Research shows that the use of tobacco, alcohol, or illicit drugs or misuse of prescription drugs by pregnant women can have severe health

consequences for infants. This is because many substances pass easily through the placenta, so substances that a pregnant woman takes also reach the

fetus. Recent research shows that smoking tobacco or marijuana, taking prescription pain relievers, or using illegal drugs during pregnancy is

associated with double or even triple the risk of stillbirth. Estimates suggest that about 5 percent of pregnant women use one or more addictive

substances.

Pregnancy may be an opportunity for women, their partners, and other people living in their households to change their patterns of alcohol

and other substance use. Health workers providing care for women with substance use disorders during pregnancy need to understand the

complexity of the woman’s social, mental, and physical problems to provide appropriate advice and support throughout pregnancy and the

postpartum period.

• 10-20% of pregnant women use illegal drugs during pregnancy

• Inability to meet major role obligations

• Increase in legal problems

• Increase risk-taking behavior

• Exposure to hazardous situations because of an addicting substance

Withdrawal Symptoms

• N and V • insomnia

• diarrhea • body aches

• abdominal pain • muscle jerks

• HPN • nervousness

• Restlessness • seizures

• shivering

ASSESSMENT

• Late in prenatal care

• Impatient during prenatal check-ups

• difficulty in following prenatal instructions for proper nutrition

• choosing drugs over food

• No money to buy vitamins and iron preparations

RISK FACTORS
• Women in the younger age group

• Inhalant use

• Binge drinking

EFFECTS ON THE MOTHER

• Hepatitis B / HIV (injected drugs)

• STD (prostitution to earn money)

• Increased risk for miscarriage

• Can cause migraines, seizures, hypertension

EFFECTS ON THE BABY:

94
Symptoms of drug withdrawal in a newborn can develop immediately or up to 14 days after birth and can include :

▪ blotchy skin coloring

▪ diarrhea
▪ excessive or high-pitched crying
▪ abnormal sucking reflex
▪ fever
▪ hyperactive reflexes
▪ increased muscle tone
▪ irritability
▪ poor feeding
▪ rapid breathing
▪ seizures
▪ sleep problems
▪ slow weight gain
▪ stuffy nose and sneezing
▪ sweating
▪ trembling
▪ vomiting

95
Effects of using some drugs could be long-term and possibly fatal to the baby:

▪ birth defects
▪ low birth weight
▪ premature birth
▪ small head circumference
▪ sudden infant death syndrome (SIDS)
DRUGS:

Drug Classification:

a. Stimulants:
Examples of stimulants are dextroamphetamine (Dexedrine, Dextrostat, ProCentra), lisdexamfetamine (Vyvanse), methylphenidate
(Concerta, Daytrana, Methylin, Ritalin), and the combination of amphetamine and dextroamphetamine (Adderall).
Medications that increase alertness, attention, energy, blood pressure, heart rate, and breathing rate
Short-term effects: Increased alertness, attention, energy; increased blood pressure and heart rate

Long-term effects: Heart problems, psychosis, anger, paranoia

b. Central Nervous System Depressants:
Examples include alcohol, Valium, Xanax, Librium, and barbiturates
Medications that slow brain activity, which makes them useful for treating anxiety and sleep problems
a. Short-term effects: Drowsiness, slurred speech, poor concentration, confusion, dizziness, problems with movement and memory,

lowered blood pressure, slowed breathing.

b. Long-term effects: Unknown
c. Hallucinogens

Examples of hallucinogens include ketamine, LSD, peyote, PCP, psilocybin, salvia, DMT, and ayahuasca.

Substances that distort the perception of reality

a. Short-term effects: increased heart rate, nausea, intensified feelings, and sensory experiences, changes in sense of time
b. Long-term effects: speech problems, memory loss, weight loss, anxiety, depression, and suicidal thoughts
c. Hallucinogens cause hallucinations. Their effects can last anywhere from 6 to 12 hours.

Commonly used during pregnancy

1. Cocaine: A powerfully addictive stimulant drug made from the leaves of the cocoa plant native to South America

Short-term effects: Narrowed blood vessels, enlarged pupils, increased body temperature, heart rate, and blood pressure, headache,
abdominal pain, and nausea, euphoria

Long-term effects: Loss of sense of smell, nosebleeds, nasal damage, and trouble swallowing from snorting, infection, and death of bowel
tissue from decreased blood flow

2. Amphetamines: Street names for the drug include "speed," "meth," and "crank."

A stimulant drug chemically related to amphetamine but with stronger effects on the central nervous system

Is used in pill form or in powdered form by snorting or injecting. Crystallized methamphetamine is known as "ice," "crystal," or "glass," is a
smokable and more powerful form of the drug.

Short-term effects: Increased wakefulness and physical activity, decreased appetite, increased breathing, heart rate, blood pressure,
temperature, irregular heartbeat

Long-term effects: Anxiety, confusion, insomnia, mood problems, violent behavior, paranoia, hallucinations, delusions, weight loss

3. Marijuana and Hashish:

Made from the hemp plant, Cannabis sativa. The main psychoactive (mind-altering) chemical
in marijuana is delta-9-tetrahydrocannabinol, or THC.
a. Short-term effects: Enhanced sensory perception and euphoria followed by drowsiness/relaxation; slowed reaction time; problems
with balance and coordination

b. Long-term effects: Mental health problems, chronic cough, frequent respiratory infections

4. Phencyclidine

5. Narcotic Agonist

6. Inhalants

7. Alcohol: A depressant, which means it slows the function of the central nervous system

Short-term effects: Reduced inhibitions, slurred speech, motor impairment, confusion, memory problems, concentration problems

Long-term effects: development of an alcohol use disorder, health problems, increased risk for certain cancers

8. Heroin:
An opioid drug made from morphine, a natural substance extracted from the seed pod of various opium poppy plants
a. Short-term effects: Euphoria, dry mouth, itching, nausea, vomiting, analgesia, slowed breathing, and heart rate
b. Long-term effect: Collapsed veins, abscesses (swollen tissue with pus), infection of the lining and valves in the heart, constipation

and stomach cramps, liver or kidney disease, pneumonia

Possible Nursing Interventions

Anticipatory guidance and nursing support all during pregnancy

• require a long time to change lifestyle

• have few effective support people

• Substance abuse treatment program

• with good support and active participation (pregnancy become a stimulus for drug withdrawal)

VIDEO CONFERENCE 2:

Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome

⮚ HIV is a virus that causes AIDS. An AIDS-infected person cannot fight off diseases as they would
normally and are more susceptible to infection and other health problems that can be life-threatening or fatal.
⮚ Acquired Immunodeficiency Syndrome (AIDS) is defined in terms of either a CD4 T cell count below
200 cells/mm3 or the occurrence of a specific disease in association with an HIV infection.
⮚ In 2018 an estimated 37.9 million people were living with HIV (including 1.7 million children), with a global HIV prevalence of 0.8%
among adults. Around 21% of these same people do not know that they have the virus.% / 1,000 women giving birth are HIV (+)

⮚ IN THE PHILIPPINES: February 2018, there were 871 new HIV antibody seropositive individuals reported to the HIV/AIDS

⮚ About one-third (32%, 275) were from the National Capital Region (NCR). Region 4A (15%, 132 cases), Region 7 (10%, 86),
Region 3 (9%, 79), and Region 6 (8%, 67) round off the top five regions with the most number of newly diagnosed cases for the month,
together accounting for 74% of the total

⮚ Sexual contact remains the predominant mode of transmission (97%, 841). Among this, eighty-six percent (723) of newly
diagnosed infections were among males who have sex with males (MSM). Other modes of transmission were needle sharing among injecting
drug users (2%, 20) and mother-to-child transmission (<1%, 2)

st
• If untreated, 20-50% of infants will develop AIDS in the 1 year of life

• Anti-virals; Mother not receiving antiviral drugs has a 15-35% chance of m-b transmission

• ZDV (zidovudine) administered 14th week + antiviral therapy beginning with the birth

• Nevirapine

• The virus infects and disables T-lymphocytes (CD4)

RISK FACTORS

• Multiple sex partners (sexual intercourse)

• Bisexual partners

• IV drug user (sharing of contaminated needles)

• BT (rare) (exposure to infected blood)

• Vertical transmission (mother to child during pregnancy, delivery; breastfeeding)

• Body secretions (Semen, vaginal fluids, breastmilk)

SIGNS AND SYMPTOMS

• Early symptoms are more subtle and difficult to determine

• Fatigue

• Anemia

• Diarrhea

• Progressive weight loss

• Malaise

• Lymphadenopathy

• Mild flu-like symptoms (initial invasion of the virus)

• Seroconversion
⮚ Woman converts from having no HIV antibodies in her blood serum (HIV serum negative) to having antibodies against HIV (HIV
serum positive)
⮚ (6 weeks-1 years after exposure)

Asymptomatic period: The period during which a woman appears to be disease-free except for symptoms such as:

• “Wasting syndrome”

✔ Weight loss and Fatigue

• 3-11 years (virus replicating)

Symptomatic period: during which a woman develops an opportunistic infection and possibly malignancies

• CD4 count below 200 cells/mm

3

• Opportunistic infections

✔ Oral and Vaginal candidiasis

✔ GI illness

✔ Herpes simplex

✔ PCP (Pneumocystis carinii pneumonia)

✔ Candida esophagitis

✔ Kaposi sarcoma

✔ HIV associated dementia

COMPLICATIONS TO MOTHERS

• Intrapartum and Postpartum hemorrhage

• Postpartum infection

• Poor wound healing

• Genito-Urinary infections

SIGNS AND SYMPTOMS: BABY

• Poor resistance to infection

• Fever

• Swollen lymph nodes

• Recurrent respiratory tract infections

• Recurrent GI and GU infections

• Oral candidiasis

• Preterm births
• Small for Gestational Age (SGA)

• Failure to thrive

• Enlarged spleen and liver

DIAGNOSTIC PROCEDURES

• History taking

• CD4 cell count

• PCR: polymerase chain reaction (check antigen)

• ELISA

• Western Blot (confirmatory)

• IFA: immunofluorescence assay

MEDICAL MANAGEMENT

• The goal of therapy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering one or more protease inhibitors.
Ritonavir (Norvir), indinavir (Crixivan)

• Zidovudine (ZDV) 100mg five times a day from the 14

th
week of gestation to the beginning of labor. (It inhibits replication of some
retroviruses notably HIV from a pregnant woman to fetus)

• If with PCP develops, Bactrim can be given

• Child: 2mg/kg/dose PO q 6 hours after birth

• administered 14th week of pregnancy – 6 weeks after birth

• If a child has 2 negative HIV cultures at 4mos of age : (-) HIV

POSSIBLE NURSING DIAGNOSIS

• Risk for infection

• The risk for a compromised family coping

• Ineffective health maintenance

• Impaired skin Integrity

NURSING INTERVENTIONS

• Provide health teachings

Prescribed drugs to help prevent opportunistic infections

No fetal exposure to maternal blood

Avoid amniocentesis
Avoid forceps delivery (lesion at the fetal scalp)

Avoid episiotomy

Avoid scalp blood sampling

• Breastfeeding

• Breastmilk may transmit HIV

• Increase risk of mastitis
• Exhausting debilitated woman
• Provide patient education about the mode of transmission and safer sex practices

*can still transmit even being treated with anti-virals

• Health care providers must use standard precautions to protect against the spread of HIV

• Gloves and Gown - secretions; change diapers

• Goggles at birth - splash amniotic

• No blood sampling/injections

• Frequent handwashing

• AVOID close contact between the child and anyone who has a respiratory infection

• Bathing the child: warm water / mild soap bath

• Body fluid spills: household bleach diluted with water 1:10 at least 30 sec

VIDEO CONFERENCE 3: Rh INCOMPATIBILITY

⮚ Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the

baby in her womb has Rh-positive blood. If the mother is Rh-negative, her immune system treats Rh-positive fetal

cells as if they were a foreign substance. The mother's body makes antibodies against the fetal blood cells. These

antibodies may cross back through the placenta into the developing baby. They destroy the baby's circulating red

blood cells, and it will develop only when the mother is Rh-negative and the infant is Rh-positive.

⮚ Approximately 15% of whites and 10% of African Americans in the US are missing the Rh (D) factor in their blood or have an Rh-

negative Blood type.

● Occurs only when: Rh (-) mother is carrying Rh (+) fetus

Rh (+) blood have protein factor (D antigen) that Rh (-) do not have

Rh (+) fetus grow inside Rh (-) mother

Mixing of blood

Mother forms antibodies against invading substance

Cross placenta

Rh factor is a portion of RBC

Destruction (hemolysis) of fetal RBCs

↓ oxygen

Hemolytic disease of NB

(Erythroblastosis fetalis)
EFFECTS: BABY

• Hemolysis

• Anemia

• Fetal edema (hydrops fetalis)

• CHF

• Jaundice

• Jaundice (icterus gravis)

• Neurologic damage (kernicterus)

MEDICAL MANAGEMENT

All women with Rh (-) blood should have antibody titer done at 1st prenatal visit

Normal (0)

A titer is minimal (ratio below 1:8)

test repeated at 28 weeks of pregnancy

NORMAL - X therapy needed

If elevated (1:16 or ↑ = Rh sensitization)

titer monitored every 2 weeks by Doppler velocity of the fetal middle cerebral artery to check anemia

Results of Doppler velocity of the fetal middle cerebral artery

• ↑ artery velocity

• = X anemia

• = Rh (-) fetus

• ↓artery velocity

• = fetus in danger; immediate birth; intrauterine blood infusion

• GOAL: ↓ number of antibodies

• Determine infant’s blood type (sample of cord blood)

• Rh (+) / Coombs (-)

• = √ Rhogam

• Rh (-) / Coombs (+)

• = X Rhogam

• RhoGam (28 weeks of pregnancy)

DIAGNOSIS
Rh-Negative Pregnant Women

• Rosette screening test to detect the presence of an alloimmunization duet o a fetomaternal hemorrhage

• Kleihauer-Bekta test for quantitative measurement of fetal RBCs in maternal blood

• Indirect Coombs test for the woman to screen for IgG antibodies

• Point-of-care blood tests to determine Rh status

• Obtaining Maternal Rh antibody titers as the basis for future follow-up care

TEST: NEWBORN

• Amniocentesis or Cordocentesis be done to evaluate fetal status in cases of Rh sensitization

• Direct Coombs test is done to confirm an existing immune-mediated hemolytic anemia of the fetus or neonate

• Complete blood count to check the hemoglobin level of the newborn with its platelet count

• Total and indirect bilirubin level of the newborn

COMPLICATIONS

Rh incompatibility rarely causes some complications during the first pregnancy of a woman. However, in cases where Rh antibodies are

formed, it can be a fatal risk for future pregnancies.

TREATMENT

If a pregnant woman has the potential to develop Rh incompatibility, doctors give her a series of two Rh immune-globulin shots during her first
pregnancy. She'll get:

● the first shot around the 28th week of pregnancy

● the second shot within 72 hours of giving birth

The treatment goal is directed at preventing the effects of Rh incompatibility among women of reproductive age.

Antenatal approach:
• Ultrasound and Doppler examinations to detect signs of fetal anemia and check for the presence of hydrops fetalis

• Quantitative analysis of maternal anti-RhD antibodies since an increasing level means an existing fetal Rh problem

• Intrauterine blood transfusion

• Early delivery of the woman mostly after  about the 36 weeks age of gestation

• Postnatal approach:

• Phototherapy to resolve neonatal jaundice in mild cases

• Exchange transfusion in moderate to severe cases of the fatal problem

Video Viewing Activity No. 1 RH INCOMPATIBILITY

When a woman and her unborn baby carry different Rhesus (Rh) protein factors, their condition is called Rh

incompatibility. It occurs when a woman is Rh-negative and her baby is Rh-positive. The Rh factor is a specific
protein found on the surface of your red blood cells. The existence of severe cases, in which the effects of Rh incompatibility aren’t prevented,

can result in severe complications, and the situation of maternal mortality with the inclusion of healthcare practices and clientele’s tradition

related to one of the high risks of pregnancy a video viewing activity is an optimal medium in facilitating the understanding of the national

predicament and the measures that can potentially be in congruence with health policies and clinical protocols of WHO and the Department of

Health (DOH). You will be directed through this link: (https://youtu.be/Fu-ZBlESfKQ)

VIDEO CONFERENCE 4: ANEMIA DURING PREGNANCY

During pregnancy, your body produces more blood to support the growth of your baby. If you're not

getting enough iron or certain other nutrients, your body might not be able to produce the number of

red blood cells it needs to make this additional blood.

• 15-25% of all pregnancies

• Inadequate levels of Hg in the blood

• Serum iron = ↓ 30 micrograms/dl

• Hemoglobin = ↓ 10.5-11 g/dL (1st or 3rd)

• Hematocrit = ↓ 32-33% (1st or 3rd)

• A most common form of anemia in pregnancy

• Characterized by microcytic, hypochromic anemia

TYPES OF ANEMIA: PREGNANCY

• Iron-deficiency anemia
• Folate-deficiency anemia
• Vitamin B12 deficiency

EFFECTS TO PREGNANCY

• LBW

• Prematurity

• Restless leg syndrome

• Irresistible urge to move legs

• “itchy” “pins and needles” creepy-crawly”

• Fetal death
• Hypoxia during labor

RISK FACTORS

• Low iron in the diet

• Heavy menstrual periods

• Unwise weight-reducing programs

• Women from low socio-economic communities (X iron-rich diets)

• Women who experience a short period (less than 2 years) between pregnancy

SIGNS AND SYMPTOMS

• Extreme fatigue and poor exercise tolerance (cannot transport oxygen effectively)

• ↑ infection

• ↑ pre-eclampsia

• ↑ hemorrhage

• delayed healing of episiotomy/incision

• Pica

• persistent craving and compulsive eating of food substances

• Ice/starch

• Soil, cigarette butts, ashes, hair, paper, paint chips, stones, paper clips

• (body recognizes that it needs ↑ nutrients)

MEDICAL MANAGEMENT

Iron supplementation

● = ferrous sulfate / ferrous gluconate

● = 27 mg as prophylactic therapy during pregnancy

● = 120-200 mg / day (if with IDA)

Possible Nursing Diagnosis

• The risk for ineffective tissue perfusion related to maternal anemia during pregnancy

NURSING MANAGEMENT

• Advise women to take iron supplements with orange juice or a vitamin C supplement

• Eat a diet high in iron and vitamins (green leafy vegetables, meat, legumes, fruits)
• Increase roughage in diet and increase fluid intake (X constipation)

• Take the pills with food

• Black stools (X internal bleeding)

• Severe anemia and difficulty with oral iron therapy =

IM/IV iron dextran prescribed

Folic Acid-Deficiency Anemia

• Folic acid/folacin

✔ Normal formation of RBC in the mother

✔ Prevents neural tube defects in the fetus (SA)

nd
• 1-5% of pregnancies; common in 2 trimester

• megaloblastic anemia (enlarged RBC)

• COMPLICATIONS: early miscarriage and premature separation of the placenta

Risk Factors

• Occurs in multiple pregnancies (↑ fetal demand)

• Secondary hemolytic illness (rapid destruction and production of new RBCs)

• Hydantoin (anticonvulsant) (interferes with folate absorption)

• Women taking oral contraceptives

• Women who had gastric bypass for morbid obesity (interferes with folate absorption)

TEST FOR ANEMIA

● Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein in red blood cells that carries oxygen from the

lungs to tissues in the body.

● Hematocrit test. It measures the percentage of red blood cells in a sample of blood.

Medical Management

• 400 micrograms folic acid daily

• 600 micrograms folic acid daily

• folacin rich foods (green leafy vegetables, oranges, dried beans, red meat, fish, poultry, legumes)

POST-TEST:
1. In order to determine whether prior knowledge of the topics is adequate, a pretest will have to be answered. The questions are included
and enumerated as a pretest.

1. Healthy habits during which trimester are most crucial for the well-being of the developing fetus?

A. First

B. Second

C. Last

D. All

2. Women in their 30s and 40s can have healthy pregnancies, but are at increased risk of which condition?

A. Chronic Fatigue Syndrome

B. Diabetes

C. Hypertension

D. B and C

3. It's safe to drink alcohol during pregnancy as long as you don't drink a lot or every day.

A. TRUE

B. False

4. Babies born to women who used narcotics while they were pregnant can have withdrawal symptoms.

A. TRUE

B. FALSE

5. Women who use IV drugs while pregnant may get hepatitis or HIV. These diseases can be passed on to their babies.

A. TRUE

B. FALSE

6. What is the difference between HIV and AIDS?

A. HIV is a virus and AIDS is a bacterial Disease

B. There is No difference between HIV and AIDS

C. HIV is a virus that causes AIDS

D. HIV is more severe than AIDS

7. Mother-Fetus Rh blood type incompatibility problems can occur if the mother is _________________ and her fetus is _________.

A. Rh positive; Rh positive

B. Rh positive; Rh Negative

C. Rh negative; Rh Positive
D. Rh negative; Rh negative

E. B and C

8. If the father of a fetus is Rh positive and the mother is Rh negative, what are the chances that there will be a mother-fetus incompatibility
problem? Assume that the couple has already had a child and that there has been no medical treatment to prevent this problem.

A. 100 %

B. at least 50 %

C. less than 50 %

D. Zero %

9. An infant born at 33 weeks’ gestation has anemia of prematurity, which is characterized by an inadequate response to erythropoietin. The
healthcare provider expects that microscopic examination of this infant’s red blood cells would reveal.

A. Normal Hemoglobin in each Cell

B. Large, Pale Cells

C. Small and Immature Cells

D. Cells of normal size

E. Small, Irregularly shaped cells

10. A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client’s hemoglobin and
hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following?

A. A loudmouth

B. Low Self Esteem

C. Hemorrhage

D. Post-Partum Infections