Anemia in Pregnancy Practice Exam

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1. The main reason for an expected increased need for iron in pregnancy is:

  1. The mother may have physiologic anemia due to the increased need for red bloodcell mass as well as the fetal requires about 350-400 mg of iron to grow
  2. The mother may suffer anemia because of poor appetite
  3. The fetus has an increased need for RBC which the mother must supply
  4. The mother may have a problem of digestion because of pica

2. Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy?

  1. Large for gestational age (LGA) fetus
  2. Hemorrhage
  3. Small for gestational age (SGA) baby
  4. Erythroblastosis fetalis

3. Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic leukemia?

  1. Instituting infection control precautions
  2. Encouraging adequate intake of iron-rich foods
  3. Assisting with coping with chronic illness
  4. Administering medications via IM injections

4. Which of the following statements best describes hyperemesis gravidarum?

  1. Severe anemia leading to an electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.
  2. Severe nausea and vomiting leading to an electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.
  3. Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients
  4. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding

5. Rho(D) immune globulin (RhoGAM) is given to a pregnant woman after delivery and the nurse is giving information to the patient about the indication of the medication. The nurse determines that the patient understands the purpose of the medication if the patient tells that it will protect her baby from which of the following?

  1. Developing German Measles.
  2. Developing Pernicious anemia.
  3. Developing Rh incompatibility.
  4. Having an RH+ blood.

6. A nurse instructor is about to administer a vitamin K injection to a newborn. The student nurse asks the instructor regarding the purpose of the injection. The appropriate response would be:

  1. “The vitamin K provides active immunity.”
  2. “The vitamin K will prevent the occurrence of hyperbilirubinemia.”
  3. “The vitamin K will protect the newborn from bleeding.”
  4. “The vitamin K will serve as protection against jaundice and anemia.”

7. The nurse is aware that a neonate of a mother with diabetes is at risk for what complication?

  1. Anemia
  2. Hypoglycemia
  3. Nitrogen loss
  4. Thrombosis

8. 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?

  1. A loud mouth
  2. Low self-esteem
  3. Hemorrhage
  4. Postpartum infections

9. Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy?

  1. Mastitis
  2. Metabolic alkalosis
  3. Physiologic anemia
  4. Respiratory acidosis

10. 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.

  1. Normal hemoglobin in each cell.
  2. Large, pale cells.
  3. Small and immature cells.
  4. Cells of normal size.
  5. Small, irregularly shaped cells.
Answers & Rationales

1. A. The mother may have physiologic anemia due to the increased need for red blood cell mass, as well as the fetal, requires about 350-400 mg of iron to grow. About 400 mgs of Iron is needed by the mother in order to produce more RBC mass to be able to provide the needed increase in blood supply for the fetus. Also, about 350-400 mgs of iron is need for the normal growth of the fetus. Thus, about 750-800 mgs iron supplementation is needed by the mother to meet this additional requirement.

2. C. Small for gestational age (SGA) baby. Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.

3. Answer: A. Instituting infection control precautions. Acute lymphocytic leukemia (ALL) causes leukopenia, resulting in immunosuppression and increasing the risk of infection, a leading cause of death in children with ALL. Therefore, the initial priority nursing intervention would be to institute infection control precautions to decrease the risk of infection.

  • Option B:  Iron-rich foods help with anemia, but dietary iron is not an initial intervention.
  • Option C: The prognosis of ALL usually is good. However, later on, the nurse may need to assist the child and family with coping since death and dying may still be an issue in need of discussion.
  • Option D: Injections should be discouraged, owing to increased risk of bleedingdue to thrombocytopenia.

4. B. Severe nausea and vomiting leading to the electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. The description of hyperemesis gravidarum includes severe nausea and vomiting, leading to the electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.

  • Option A: Hyperemesis is not a form of anemia.
  • Option C: Loss of appetite may occur secondary to nausea and vomiting of hyperemesis, which, if it continues, can deplete the nutrients transported to the fetus.
  • Option D:  Diarrhea does not occur with hyperemesis.

5. C. Developing Rh incompatibility. Rh incompatibility can develop when a Rh-negative mother becomes sensitized to the RH antigen. Sensitization may occur when a Rh-negative woman becomes pregnant with a fetus who is Rh positive. Blood cells from the baby may cross the maternal bloodstream, which can happen during pregnancy, labor, and delivery, causing the mother’s immune system to form antibodies, against Rh-positive blood. Administration of the Rhogam prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

  • Options A and B are not related to the Rh incompatibility.
  • Option D is not indicated for the administration of Rhogam.

6. C. “The vitamin K will protect the newborn from bleeding.” Vitamin K is administered to the newborn in order to prevent bleeding disorders. Vitamin K promotes the formation of clotting factors II, VII, IX & X in which the infants lack because of insufficient intestinal bacteria needed for synthesizing fat-soluble vitamin K.

  • Option A: Vitamin K does not promote the development of immunity.
  • Option B: Vitamin K does not prevent the occurrence of hyperbilirubinemia.
  • Option D: Vitamin K doesn’t prevent the newborn from having jaundice or anemia.

7. Answer: B. Hypoglycemia. Neonates of mothers with diabetes are at risk for hypoglycemia due to increased insulin levels. During gestation, an increased amount of glucose is transferred to the fetus across the placenta. The neonate’s liver cannot initially adjust to the changing glucose levels after birth. This may result in an overabundance of insulin in the neonate, resulting in hypoglycemia.

8. D. Postpartum infections.  Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage.

9. C. Physiologic anemia. Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.

10. D. Cells of normal size. Erythropoietin is a hormone that stimulates bone marrow to make red blood cells. Anemia of prematurity does not involve impaired hemoglobin production. The bone marrow will make an inadequate amount of red blood cells, but they will be of normal size, shape, and color. Anemia of prematurity is a normocytic, normochromic anemia.