A client at 24 weeks has a history of class II heart disease ...

[madam-professor]

A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What should the nurse expect to see in the medical record?
 
  1. Dyspnea and chest pain with mild exertion
  2. Elective cesarean birth scheduled for 37 weeks
  3. Discussed need for labor epidural and vacuum extraction
  4. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally

Question 2

A pregnant woman married to an intravenous drug user had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV?
 
  1. Elevated blood pressure and ankle edema
  2. Shortness of breath and frequent urination
  3. Hemoglobin of 11 g/dL and a rapid weight gain
  4. Unusual fatigue and recurring Candida vaginitis

[bookworm410]

Answer to Question 1

3
Explanation:
1. Dyspnea and angina with mild exertion are not expected with class II heart disease even during pregnancy, but are symptoms seen in class IV heart disease.
2. Cesarean birth is only undertaken in cardiac clients for fetal or maternal intrapartal indications, not for cardiac reasons alone.
3. Lumbar epidural analgesia decreases the stress response during labor, while vacuum extraction or forceps decreases maternal pushing efforts. Both of these decrease stress on the heart during birth.
4. 3+ pre-tibial edema is never an expected finding during pregnancy. Pulse over 100 and respiratory rate over 24 are indicators of cardiac decompensation.

Answer to Question 2

4
Explanation:
2. The client would have a decrease in blood pressure and no ankle edema.
3. Shortness of breath and frequent urination do not indicate a need to retest for HIV.
1. The client would be anemic and anorexic.
4. The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as Candida vaginitis.