Chapter 13: Pregnancy Risk Factors and Assessment
MULTIPLE CHOICE
1. 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 indicates
that she has 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, BMI
b. Drug and alcohol use, age, family history
c. Family history, blood pressure, respiratory
rate
d. Family history, BMI, drug and alcohol
use
ANS: D
Her family history of NTD, low BMI, and substance use are all 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 and alcohol use and
family history also put her in a high-risk category.
DIF: Cognitive Level: ComprehensionREF: p. 293 | p. 295 OBJ:
Nursing Process: Assessment
2. 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.
b.
screening (MSAFP)
c. Amniocentesis
d. Nonstress test (NST)
ANS: A
Ultrasound examination
Maternal serum alpha-fetoprotein
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 the MSAFP, an
amniocentesis, or an NST. The MSAFP is performed at 16 to 18 weeks of gestation, followed by
amniocentesis if the MSAFP levels are abnormal or if fetal or maternal anomalies are detected.
An NST is performed to assess fetal well-being in the third trimester.
DIF: Cognitive Level: Comprehension REF: p. 297 | Box 13-4
OBJ: Nursing Process: Assessment
3. The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has
smoked throughout the pregnancy, and her fundal height measurements now are suggestive of
growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be
another tool that is useful in confirming the diagnosis?
a.
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement counts
ANS: A Do
ppler 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 pregnancies that are high risk
because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or
preterm labour. Because of the potential risk of inducing labour 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 the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick-count monitoring is
MULTIPLE CHOICE
1. 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 indicates
that she has 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, BMI
b. Drug and alcohol use, age, family history
c. Family history, blood pressure, respiratory
rate
d. Family history, BMI, drug and alcohol
use
ANS: D
Her family history of NTD, low BMI, and substance use are all 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 and alcohol use and
family history also put her in a high-risk category.
DIF: Cognitive Level: ComprehensionREF: p. 293 | p. 295 OBJ:
Nursing Process: Assessment
2. 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.
b.
screening (MSAFP)
c. Amniocentesis
d. Nonstress test (NST)
ANS: A
Ultrasound examination
Maternal serum alpha-fetoprotein
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 the MSAFP, an
amniocentesis, or an NST. The MSAFP is performed at 16 to 18 weeks of gestation, followed by
amniocentesis if the MSAFP levels are abnormal or if fetal or maternal anomalies are detected.
An NST is performed to assess fetal well-being in the third trimester.
DIF: Cognitive Level: Comprehension REF: p. 297 | Box 13-4
OBJ: Nursing Process: Assessment
3. The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has
smoked throughout the pregnancy, and her fundal height measurements now are suggestive of
growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be
another tool that is useful in confirming the diagnosis?
a.
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement counts
ANS: A Do
ppler 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 pregnancies that are high risk
because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or
preterm labour. Because of the potential risk of inducing labour 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 the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick-count monitoring is
