Deck 9: Assessment for Risk Factors

Question 1

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy,including that:

A)Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis.
B)Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects.
C)Percutaneous umbilical blood sampling (PUBS) is one of the triple-marker tests for Down syndrome.
D)MSAFP is a screening tool only;it identifies candidates for more definitive procedures.

Answer 1

MSAFP is a screening tool only;it identifies candidates for more definitive procedures.

Question 2

In the past factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader,more comprehensive approach to high risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:

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

Answer 2

Geographic.

Question 3

Nurses should be aware that the biophysical profile (BPP):

A)Is an accurate indicator of impending fetal death.
B)Is a compilation of health risk factors of the mother during the later stages of pregnancy.
C)Consists of a Doppler blood flow analysis and an amniotic fluid index.
D)Involves an invasive form of ultrasonic examination.

Answer 3

Is an accurate indicator of impending fetal death.

Question 4

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 screening (MSAFP)
D)Percutaneous umbilical blood sampling (PUBS)

Question 5

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?" The best response by the nurse is:

A)"Your placenta changes as your pregnancy progresses,and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits,the higher the grade,or number,that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby."
B)"Your placenta isn't working properly,and your baby is in danger."
C)"This means that we will need to perform an amniocentesis to detect if you have any placental damage."
D)"Don't worry about it. Everything is fine."

Question 6

A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion,showing declining interest. The nurse can best help the couple by:

A)Telling her that the physician will isolate the problem with more tests.
B)Encouraging her and urging her to continue with childbirth classes.
C)Becoming assertive and laying out the decisions the couple needs to make.
D)Downplaying her risks by citing success rate studies.

Question 7

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 would be 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 8

In comparing the abdominal and transvaginal methods of ultrasound examination,nurses should explain to their clients that:

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 9

With regard to amniocentesis,nurses should be aware that:

A)Because of new imaging techniques,it is now possible 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)The shake test,or bubble stability test,is a quick means of determining fetal maturity.
D)The presence of meconium in the amniotic fluid is always cause for concern.

Question 10

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,BMI
B)Drug/alcohol use,age,family history
C)Family history,blood pressure,BMI
D)Family history,BMI,drug/alcohol abuse

Question 11

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?

A)Biophysical profile
B)Amniocentesis
C)Maternal serum alpha-fetoprotein (MSAFP)
D)Transvaginal ultrasound

Question 12

A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?

A)Percutaneous umbilical blood sampling (PUBS)
B)Ultrasound for fetal anomalies
C)Biophysical profile (BPP) for fetal well-being
D)Amniocentesis for genetic anomalies

Question 13

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 screening (MSAFP)
C)Amniocentesis
D)Nonstress test (NST)

Question 14

The nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

A)Sometimes uses vibroacoustic stimulation.
B)Is an invasive test;however,contractions are stimulated.
C)Is considered negative if no late decelerations are observed with the contractions.
D)Is more effective than the nonstress test (NST) if the membranes have already been ruptured.

Question 15

At 35 weeks of pregnancy a woman experiences preterm labor. Although tocolytics 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 would be an important test for fetal well-being at this time?

A)Percutaneous umbilical blood sampling (PUBS)
B)Ultrasound for fetal size
C)Amniocentesis for fetal lung maturity
D)Nonstress test

Question 16

In comparison to contraction stress tests (CSTs),the nonstress test (NST) for antepartum fetal assessment:

A)Has no known contraindications.
B)Has fewer false-positive results.
C)Is more sensitive in detecting fetal compromise.
D)Is slightly more expensive.

Question 17

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:

A)Negative.
B)Positive.
C)Satisfactory.
D)Unsatisfactory.

Question 18

In the United States today:

A)More than 20% of pregnancies meet the definition of high risk to either the mother or the infant.
B)Other than biophysical criteria,the chief factor in high risk pregnancies is the number of women who have no access to prenatal care.
C)High risk pregnancy status extends from first confirmation of pregnancy to birth.
D)High risk pregnancy is less critical a medical concern because of the reduction in family size and the decrease in unwanted pregnancies.

Question 19

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.

Question 20

In the first trimester,ultrasonography can be used to gain information on:

A)Amniotic fluid volume.
B)The presence and location of an intrauterine contraceptive device.
C)Placental location and maturity.
D)Cervical length.

Question 21

MSAFP levels have been used as a screening tool for ________________ in pregnancy.

Question 22

Intrauterine growth restriction is associated with what pregnancy-related risk factors? Choose all that apply.

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

Question 23

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus,the nurse is aware that he or she is at a greater risk for:

A)Oligohydramnios.
B)Polyhydramnios.
C)Postterm pregnancy.
D)Chromosomal abnormalities.