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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. Ultrasound examination
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 counts - a. Doppler blood flow analysis
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. Family history, BMI, drug and
alcohol abuse
,A 41-week pregnant multigravida arrives at the labor 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. Biophysical profile (BPP)
Adequate uterine activity necessary for a CST consists of three contractions in a
10minute time frame. If no decelerations are observed in the FHR pattern with the
contractions, then the findings are considered to be negative. A positive CST indicates
the presence of repetitive late FHR decelerations. The terms 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. Moderate coffee consumption
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. The fetal 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.
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. 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.
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. Presence of maternal abnormalities
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 the mother during the later 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. BPP is an accurate
indicator of impending fetal well-being.
A client in the third 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.
Administration of Rho(D) immunoglobulin may be necessary.
Which information is an important consideration when comparing the CST with the
NST?
a. The NST has no known contraindications.
b. The CST has fewer false-positive results when compared with the NST.
c. The CST is more sensitive in detecting fetal compromise, as opposed to the NST.
d. The CST is slightly more expensive than the NST.
- a. The NST has no known contraindications.
The nurse is planning the care for a laboring client with diabetes mellitus. This client is
at greater risk for which clinical finding? a. Oligohydramnios
b. Polyhydramnios
c. Postterm pregnancy
d. Chromosomal abnormalities