Exam 1 - Chapter 26 / REVIEW FOR EXAM 2/3 Flashcards
A woman arrives at the clinic seeking confirmation that she is pregnant. The following
information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to
having used cocaine several times during the past year and occasionally drinks alcohol. Her
blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer.
Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics
places this client in a high-risk category?
a. Blood pressure, age, BMI
b. Drug and alcohol use, age, family history
c. Family history, blood pressure (BP), BMI
d. Family history, BMI, drug and alcohol abuse
D - The womans family history of an NTD, her low BMI, and her drug and alcohol use abuse are
high risk factors of pregnancy. The womans BP is normal, and her age does not put her at risk.
Her BMI is low and may indicate poor nutritional status, which is a high risk.
A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant,
although she has had irregular menstrual periods all her life. She has a history of smoking
approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut
down. Her laboratory data are within normal limits. What diagnostic technique would be useful
at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein (MSAFP) screening
c. Amniocentesis
d. Nonstress test (NST)
A - An ultrasound examination could be performed to confirm thepregnancy and to determine
thegestational age of thefetus. An MSAFP screening is performed at 16 to 18 weeks of gestation;
therefore, it is too early in thewomans pregnancy to perform this diagnostic test. An
amniocentesis is performed if theMSAFP levels are abnormal or if fetal or maternal anomalies
are detected. An NST is performed to assess fetal well-being in thethird trimester.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has
smoked throughout the pregnancy, and fundal height measurements now are suggestive of
intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size,
what is another tool useful in confirming the diagnosis?
a. Doppler blood flow analysis
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement count
A - Doppler blood flow analysis allows theexaminer to study theblood flow noninvasively in thefetus
and theplacenta. It is a helpful tool in themanagement of high-risk pregnancies because of IUGR,
diabetes mellitus, multiple fetuses, or preterm labor. Because of thepotential risk of inducing
labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm.
Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies,
assessment of pulmonary maturity, and thediagnosis of fetal hemolytic disease, not IUGR. Fetal
kick count monitoring is performed to monitor thefetus in pregnancies complicated by conditions
that may affect fetal oxygenation. Although this may be a useful tool at some point later in this
womans pregnancy, it is not used to diagnose IUGR.
A 41-week pregnant multigravida arrives at thelabor and delivery unit after a NST
indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool
yields more detailed information about the condition of the fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. MSAFP screening
d. Percutaneous umbilical blood sampling (PUBS)
B - Real-time ultrasound permits a detailed assessment of thephysical and physiologic characteristics
of thedeveloping fetus and a cataloging of normal and abnormal biophysical responses to stimuli.
TheBPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic
markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred
earlier in thepregnancy. It is too late in thepregnancy to perform an MSAFP. Furthermore, it does
not provide information related to fetal well-being. Indications for PUBS include prenatal
diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal
infection, determination of theacid-base status of thefetus with IUGR, and assessment and
treatment of isoimmunization and thrombocytopenia in the fetus.
At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic
medications are administered and she is placed on bed rest, she continues to experience regular
uterine contractions and her cervix is beginning to dilate and efface. What is an important test for
fetal well-being at this time?
a. PUBS
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. NST
C - Amniocentesis is performed to assess fetal lung maturity in theevent of a preterm birth. Thefluid
is examined to determine thelecithin to sphingomyelin (L/S) ratio. Indications for PUBS include
prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of
fetal infection, determination of theacid-base status of thefetus with IUGR, and assessment and
treatment of isoimmunization and thrombocytopenia in thefetus. Determination of fetal size by
ultrasound is typically performed during thesecond trimester and is not indicated in this scenario.
An NST measures thefetal response to fetal movement in a noncontracting mother.
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test
should the nurse recommend be ordered for this client?
a. BPP
b. Chorionic villi sampling
c. MSAFP screening
d. Screening for diabetes mellitus
C - The biochemical assessment MSAFP test is performed from week 15 to week 20 of gestation
(weeks 16 to 18 are ideal). A BPP is a method of biophysical assessment of fetal well-being in
the third trimester. Chorionic villi sampling is a biochemical assessment of the fetus that should be
performed from the10th to 12th weeks of gestation. Screening for diabetes mellitus begins with
the first prenatal visit.
An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is
repeated, and again the level is reported as higher than normal. What is the next step in
the assessment sequence to determine the well-being of the fetus?
a. PUBS
b. Ultrasound for fetal anomalies
c. BPP for fetal well-being
d. Amniocentesis for genetic anomalies
B - If MSAFP findings are abnormal, then follow-up procedures include genetic counseling for
families with a history of NTD, repeated MSAFP screenings, an ultrasound examination, and
possibly amniocentesis. Indications for theuse of PUBS include prenatal diagnosis of inherited
blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of
theacid-base status of fetuses with IUGR, and assessment and treatment of isoimmunization and
thrombocytopenia in thefetus. A BPP is a method of assessing fetal well-being in thethird
trimester. Before an amniocentesis, theclient would have an ultrasound for direct visualization of
thefetus.
A client asks her nurse, My doctor told me that he is concerned with the grade of my
placenta because I am overdue. What does that mean? What is the nurses best response?
a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates
how well it is functioning.
b. Your placenta isnt working properly, and your baby is in danger.
c. We need to perform an amniocentesis to detect if you have any placental damage.
d. Dont worry about it. Everything is fine.
A - An explanation of what is meant by the grade of my placenta is the most appropriate response. If
the client desires further information, the nurse can explain that calcium deposits are significant in
post term pregnancies, and ultrasonography can also be used to determine placental aging.
Although stating that the clients placenta is not working properly and that the baby is in danger
may be a valid response, it does not reflect therapeutic communication techniques and is likely to
alarm the client. An ultrasound, not amniocentesis, is the method of assessment used to determine
placental maturation. Telling theclient not to worry is not appropriate and discredits her
concerns.
A woman is undergoing a nipple-stimulated CST. She is having contractions that occur
every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats
per minute without any decelerations. What is the correct interpretation of this test?
a. Negative
b. Positive
c. Satisfactory
d. Unsatisfactory
A - Adequate uterine activity necessary for a CST consists of three contractions in a 10-minute time
frame. If no decelerations are observed in theFHR pattern with thecontractions, then thefindings
are considered to be negative. A positive CST indicates thepresence of repetitive late FHR
decelerations. Theterms satisfactory or unsatisfactory are not applicable.
Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus? a. Moderate coffee consumption b. Moderate alcohol consumption c. Cigarette smoke d. Emotional distress
A - Birth defects in humans have not been related to caffeine consumption. Pregnant women who
consume more than 300 mg of caffeine daily may be at increased risk for miscarriage or IUGR.
Although theexact effects of alcohol in pregnancy have not been quantified, it exerts adverse
effects on thefetus including fetal alcohol syndrome, fetal alcohol effects, learning disabilities,
and hyperactivity. A strong, consistent, causal relation has been established between maternal
smoking and reduced birth weight. Childbearing triggers profound and complex physiologic and
psychologic changes on themother. Evidence suggests a relationship between emotional distress
and birth complications.
Which information should nurses provide to expectant mothers when teaching them how
to evaluate daily fetal movement counts (DFMCs)?
a. Alcohol or cigarette smoke can irritate the fetus into greater activity.
b. Kick counts should be taken every hour and averaged every 6 hours, with every other 6-
hour stretch off.
c. Thefetal alarm signal should go off when fetal movements stop entirely for 12 hours.
d. A count of less than four fetal movements in 1 hour warrants future evaluation.
C - No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol
and cigarette smoke temporarily reduce fetal movement. Themother should count fetal activity
(kick counts) two or three times daily for 60 minutes each time. A count of less than 3 in 1 hour
warrants further evaluation by a NST.
In comparing the abdominal and transvaginal methods of ultrasound examination, which
information should the nurse provide to the client?
a. Both require the woman to have a full bladder.
b. The abdominal examination is more useful in the first trimester.
c. Initially, the transvaginal examination can be painful.
d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
D - The transvaginal examination allows pelvic anatomy to be evaluated in greater detail than
the abdominal method and also allows intrauterine pregnancies to be diagnosed earlier.
The abdominal examination requires a full bladder; the transvaginal examination requires an
empty one. The transvaginal examination is more useful in the first trimester; the abdominal
examination works better after the first trimester. Neither the abdominal nor the transvaginal
method of ultrasound examination should be painful, although the woman will feel pressure as
the probe is moved during the transvaginal examination
Which clinical finding is a major use of ultrasonography in the first trimester?
a. Amniotic fluid volume
b. Presence of maternal abnormalities
c. Placental location and maturity
d. Cervical length
B - Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and
ovarian cysts. Amniotic fluid volume, placental location and maturity, and cervical length are not
available via ultrasonography until the second or third trimester
Which information is the highest priority for the nurse to comprehend regarding the BPP?
a. BPP is an accurate indicator of impending fetal well-being.
b. BPP is a compilation of health risk factors of themother during thelater stages of
pregnancy.
c. BPP consists of a Doppler blood flow analysis and an amniotic fluid index (AFI).
d. BPP involves an invasive form of an ultrasonic examination.
A - An abnormal BPP score is one indication that labor should be induced. TheBPP evaluates
thehealth of thefetus, requires many different measures, and is a noninvasive procedure.
A client in thethird trimester has just undergone an amniocentesis to determine fetal lung
maturity. Which statement regarding this testing is important for the nurse in formulating a care
plan?
a. Because of new imaging techniques, an amniocentesis should have been performed in
the first trimester.
b. Despite the use of ultrasonography, complications still occur in the mother or infant in 5%
to 10% of cases.
c. Administration of Rho(D) immunoglobulin may be necessary.
d. The presence of meconium in the amniotic fluid is always a cause for concern.
C - As a result of thepossibility of fetomaternal hemorrhage, administration of Rho(D)
immunoglobulin is thestandard of practice after amniocentesis for women who are Rh negative.
Amniocentesis is possible after the14th week of pregnancy when theuterus becomes an
abdominal organ. Complications occur in less than 1% of cases; many have been minimized or
eliminated through theuse of ultrasonography. Meconium in theamniotic fluid before
thebeginning of labor is not usually a problem.
