Final Exam NSG 432 Comprehensive Questions
(Frequently Tested) and Complete Solutions Graded
A+
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 drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg,
her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. 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 place the
woman in a high risk category?
a. Blood pressure, age, and BMI
b. Drug/alcohol use, age, and family history
c. Family history, blood pressure, and BMI
d. Family history, BMI, and drug/alcohol abuse
Family history, BMI, and drug/alcohol abuse
Her family history of NTD, low BMI, and substance abuse all are high risk factors
of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her
BMI is low and may indicate poor nutritional status, which would be a high risk.
The woman's drug/alcohol use and family history put her in a high risk category,
but her age does not. The woman's family history puts her in a high risk category.
Her BMI is low and may indicate poor nutritional status, which would be high risk.
Her BP is normal.
,The nurse sees a woman for the first time when she is 30 weeks pregnant. The
woman has smoked throughout the pregnancy, and fundal height measurements
now are suggestive of growth restriction in the fetus. In addition to ultrasound to
measure fetal size, what other tool would be useful in confirming the diagnosis? a.
Doppler blood flow analysis
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement counts Doppler blood flow analysis Doppler blood flow
analysis allows the examiner to study the blood flow noninvasively in the fetus
and the placenta. It is a helpful tool in the management of high risk pregnancies
because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple
fetuses, or preterm labor. Because of the potential risk of inducing labor and
causing fetal distress, CST is not performed on a woman whose fetus is preterm.
Indications for amniocentesis include diagnosis of genetic disorders or
congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal
hemolytic disease, not IUGR. Fetal kick count monitoring is performed to
monitor the fetus in pregnancies complicated by conditions that may affect fetal
oxygenation. Although this may be a useful tool at some point later in this
woman's pregnancy, it is not used to diagnose IUGR.
A 39-year-old primigravida thinks that she is about 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, but she tells you that she is trying to
cut down. Her laboratory data are within normal limits. What diagnostic technique
could be used with this pregnant woman at this time? a. Ultrasound examination
b. Maternal serum alpha-fetoprotein (MSAFP) screening
c. Amniocentesis
,d. Nonstress test (NST) Ultrasound examination
An ultrasound examination could be done to confirm the pregnancy and determine
the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP
screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18
weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if
fetal/maternal anomalies are detected. NST is performed to assess fetal well-being
in the third trimester.
A 41-week pregnant multigravida presents in the labor and delivery unit after a
nonstress test indicated that her fetus could be experiencing some difficulties in
utero. Which diagnostic tool would yield more detailed information about the
fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein (MSAFP) screening
d. Percutaneous umbilical blood sampling (PUBS)
Biophysical profile (BPP)
Real-time ultrasound permits detailed assessment of the physical and physiologic
characteristics of the developing fetus and cataloging of normal and abnormal
biophysical responses to stimuli. BPP 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 been performed earlier in the pregnancy. It
is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening
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 the acid-base status of a fetus
with IUGR, and assessment and treatment of isoimmunization and
thrombocytopenia in the fetus.
, When nurses help their expectant mothers assess the daily fetal movement counts,
they should be aware that
a. alcohol or cigarette smoke can irritate the fetus into greater activity.
b. ―kick counts‖ should be taken every half hour and averaged every 6 hours, with
every other 6-hour stretch off.
c. the fetal alarm signal should go off when fetal movements stop entirely for 12
hours.
d. obese mothers familiar with their bodies can assess fetal movement as well as
average-size women.
the fetal alarm signal should go off when fetal movements stop entirely for 12
hours.
No movement in a 12-hour period is cause for investigation and possibly
intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The
mother should count fetal activity (―kick counts‖) two or three times daily for 60
minutes each time. Obese women have a harder time assessing fetal movement.
In comparing the abdominal and transvaginal methods of ultrasound examination,
nurses should explain to their patients that
a. both require the woman to have a full bladder.
b. the abdominal examination is more useful in the first trimester.
(Frequently Tested) and Complete Solutions Graded
A+
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 drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg,
her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. 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 place the
woman in a high risk category?
a. Blood pressure, age, and BMI
b. Drug/alcohol use, age, and family history
c. Family history, blood pressure, and BMI
d. Family history, BMI, and drug/alcohol abuse
Family history, BMI, and drug/alcohol abuse
Her family history of NTD, low BMI, and substance abuse all are high risk factors
of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her
BMI is low and may indicate poor nutritional status, which would be a high risk.
The woman's drug/alcohol use and family history put her in a high risk category,
but her age does not. The woman's family history puts her in a high risk category.
Her BMI is low and may indicate poor nutritional status, which would be high risk.
Her BP is normal.
,The nurse sees a woman for the first time when she is 30 weeks pregnant. The
woman has smoked throughout the pregnancy, and fundal height measurements
now are suggestive of growth restriction in the fetus. In addition to ultrasound to
measure fetal size, what other tool would be useful in confirming the diagnosis? a.
Doppler blood flow analysis
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement counts Doppler blood flow analysis Doppler blood flow
analysis allows the examiner to study the blood flow noninvasively in the fetus
and the placenta. It is a helpful tool in the management of high risk pregnancies
because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple
fetuses, or preterm labor. Because of the potential risk of inducing labor and
causing fetal distress, CST is not performed on a woman whose fetus is preterm.
Indications for amniocentesis include diagnosis of genetic disorders or
congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal
hemolytic disease, not IUGR. Fetal kick count monitoring is performed to
monitor the fetus in pregnancies complicated by conditions that may affect fetal
oxygenation. Although this may be a useful tool at some point later in this
woman's pregnancy, it is not used to diagnose IUGR.
A 39-year-old primigravida thinks that she is about 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, but she tells you that she is trying to
cut down. Her laboratory data are within normal limits. What diagnostic technique
could be used with this pregnant woman at this time? a. Ultrasound examination
b. Maternal serum alpha-fetoprotein (MSAFP) screening
c. Amniocentesis
,d. Nonstress test (NST) Ultrasound examination
An ultrasound examination could be done to confirm the pregnancy and determine
the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP
screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18
weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if
fetal/maternal anomalies are detected. NST is performed to assess fetal well-being
in the third trimester.
A 41-week pregnant multigravida presents in the labor and delivery unit after a
nonstress test indicated that her fetus could be experiencing some difficulties in
utero. Which diagnostic tool would yield more detailed information about the
fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein (MSAFP) screening
d. Percutaneous umbilical blood sampling (PUBS)
Biophysical profile (BPP)
Real-time ultrasound permits detailed assessment of the physical and physiologic
characteristics of the developing fetus and cataloging of normal and abnormal
biophysical responses to stimuli. BPP 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 been performed earlier in the pregnancy. It
is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening
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 the acid-base status of a fetus
with IUGR, and assessment and treatment of isoimmunization and
thrombocytopenia in the fetus.
, When nurses help their expectant mothers assess the daily fetal movement counts,
they should be aware that
a. alcohol or cigarette smoke can irritate the fetus into greater activity.
b. ―kick counts‖ should be taken every half hour and averaged every 6 hours, with
every other 6-hour stretch off.
c. the fetal alarm signal should go off when fetal movements stop entirely for 12
hours.
d. obese mothers familiar with their bodies can assess fetal movement as well as
average-size women.
the fetal alarm signal should go off when fetal movements stop entirely for 12
hours.
No movement in a 12-hour period is cause for investigation and possibly
intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The
mother should count fetal activity (―kick counts‖) two or three times daily for 60
minutes each time. Obese women have a harder time assessing fetal movement.
In comparing the abdominal and transvaginal methods of ultrasound examination,
nurses should explain to their patients that
a. both require the woman to have a full bladder.
b. the abdominal examination is more useful in the first trimester.
