Deck 26: Assessment of High Risk Pregnancy

Question 1

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)

Answer 1

Biophysical profile (BPP)

Question 2

A pregnant woman's BPP score is 8.She asks the nurse to explain the results.How should the nurse respond at this time?

A) "The test results are within normal limits."
B) "Immediate delivery by cesarean birth is being considered."
C) "Further testing will be performed to determine the meaning of this score."
D) "An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery."

Answer 2

"The test results are within normal limits."

Question 3

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 nurse's 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 isn't working properly, and your baby is in danger."
C) "We need to perform an amniocentesis to detect if you have any placental damage."
D) "Don't worry about it. Everything is fine."

Answer 3

"Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning."

Question 4

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.

Question 5

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy.Which statement regarding monitoring techniques is the most accurate?

A) Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis.
B) MSAFP screening is recommended only for women at risk for NTDs.
C) PUBS is one of the triple-marker tests for Down syndrome.
D) MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.

Question 6

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.

Question 7

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.

Question 8

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

Question 9

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

Question 10

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

Question 11

In the past,factors to determine whether a woman was likely to develop a high-risk pregnancy were primarily evaluated from a medical point of view.A broader,more comprehensive approach to high-risk pregnancy has been adopted today.Four categories have now been established,based on the threats to the health of the woman and the outcome of pregnancy.Which category should not be included in this group?

A) Biophysical
B) Psychosocial
C) Geographic
D) Environmental

Question 12

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.

Question 13

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

Question 14

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

Question 15

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

Question 16

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

Question 17

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

Question 18

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

Question 19

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)

Question 20

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 ½ 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.

Question 21

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor.

Smoking,alcohol,and illicit drug use

A)Polyhydramnios
B)IUGR (maternal cause)
C)Oligohydramnios
D)Chromosomal abnormalities
E)IUGR (fetoplacental cause)

Question 22

The indirect Coombs' test is a screening tool for Rh incompatibility.If the titer is greater than ______,amniocentesis may be a necessary next step.

A) 1:2
B) 1:4
C) 1:8
D) 1:12

Question 23

While working with the pregnant client in her first trimester,what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)?

A) 4
B) 8
C) 10
D) 14

Question 24

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor.

Premature rupture of membranes

A)Polyhydramnios
B)IUGR (maternal cause)
C)Oligohydramnios
D)Chromosomal abnormalities
E)IUGR (fetoplacental cause)

Question 25

Cell-free deoxyribonucleic acid (DNA)screening is a new method of noninvasive prenatal testing (NIPT)that has recently become available in the clinical setting.This technology can provide a definitive diagnosis of which findings?

A) Fetal Rh status
B) Fetal gender
C) Maternally transmitted gene disorder
D) Paternally transmitted gene disorder
E) Trisomy 21

Question 26

Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?

A) Place the woman on nothing by mouth (nil per os [NPO]) for 12 hours.
B) Instruct the woman to drink 1 to 2 quarts of water.
C) Administer an enema.
D) Perform an abdominal preparation.

Question 27

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor.

Advanced maternal age

A)Polyhydramnios
B)IUGR (maternal cause)
C)Oligohydramnios
D)Chromosomal abnormalities
E)IUGR (fetoplacental cause)

Question 28

IUGR is associated with which pregnancy-related risk factors?

A) Poor nutrition
B) Maternal collagen disease
C) Gestational hypertension
D) Premature rupture of membranes
E) Smoking

Question 29

How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period?

A) Nonreactive
B) Positive
C) Negative
D) Reactive

Question 30

Transvaginal ultrasonography is often performed during the first trimester.While preparing a 6-week gestational client for this procedure,she expresses concerns over the necessity for this test.The nurse should explain that this diagnostic test may be indicated for which situations?

A) Multifetal gestation
B) Obesity
C) Fetal abnormalities
D) Amniotic fluid volume
E) Ectopic pregnancy

Question 31

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor.

Fetal congenital anomalies

A)Polyhydramnios
B)IUGR (maternal cause)
C)Oligohydramnios
D)Chromosomal abnormalities
E)IUGR (fetoplacental cause)

Question 32

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor.

Abnormal placenta development

A)Polyhydramnios
B)IUGR (maternal cause)
C)Oligohydramnios
D)Chromosomal abnormalities
E)IUGR (fetoplacental cause)

Question 33

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?

A) Multiple-marker screening
B) L/S ratio
C) BPP
D) Blood type and crossmatch of maternal and fetal serum

Question 34

Which assessments are included in the fetal BPP?

A) Fetal movement
B) Fetal tone
C) Fetal heart rate
D) AFI
E) Placental grade