Question 1

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that:&#10;A) Both require the woman to have a full bladder.&#10;B) The abdominal examination is more useful in the first trimester.&#10;C) Initially the transvaginal examination can be painful.&#10;D) The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

Accepted Answer

The transvaginal examination allows for better evaluation of the pelvic anatomy compared to the abdominal examination. While some women may experience discomfort during the first transvaginal examination, it is generally not painful. A full bladder is only necessary for the abdominal examination. The usefulness of each examination may vary depending on the stage of pregnancy and the reason for the ultrasound.

Question 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) Ultrasound examination
B) Maternal serum alpha-fetoprotein screening (MSAFP)
C) Amniocentesis
D) Nonstress test (NST)

Ultrasound examination

Accepted Answer

Ultrasound examination is the most appropriate diagnostic technique to confirm the gestational age and viability of the fetus, especially in this case of irregular menstrual periods. It can also detect any abnormalities in the fetus and identify the number of fetuses. MSAFP, amniocentesis, and NST are usually performed later in the pregnancy to screen for chromosomal abnormalities, neural tube defects, and fetal distress. Additionally, smoking cessation counseling and support should be provided to the patient.

Question 3

In the first trimester, ultrasonography can be used to gain information on:&#10;A) Amniotic fluid volume.&#10;B) Uterine abnormalities.&#10;C) Placental location and maturity.&#10;D) Cervical length.

Accepted Answer

Ultrasonography in the first trimester is primarily used to assess uterine abnormalities, confirm intrauterine pregnancy, and determine gestational age. Other options like amniotic fluid volume, placental location, and cervical length are typically assessed in later trimesters.

Question 4

In the United States today:&#10;A) More than 20% of pregnancies meet the definition of high risk to either the mother or the infant.&#10;B) Other than biophysical criteria, the greatest socioeconomic risk factor in high risk pregnancies is the inability to access prenatal care.&#10;C) High risk pregnancy status extends from first confirmation of pregnancy to birth.&#10;D) High risk pregnancy is a less critical medical concern because of the reduction in family size and the decrease in unwanted pregnancies.

Accepted Answer

The answer of In the United States today:&#10;A) More than...

Question 5

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

Accepted Answer

An elevated maternal serum AFP level can indicate a neural tube defect or other fetal anomalies. The next step would be to perform an ultrasound to visualize the fetus and assess for any structural abnormalities. This would help determine the well-being of the fetus and guide further diagnostic testing if necessary. PUBS and amniocentesis would be reserved for more invasive testing if abnormalities are found on the ultrasound or if there are other risk factors present. A BPP may also be performed, but the ultrasound for fetal anomalies would be the first step.

Question 6

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.

Accepted Answer

A nipple-stimulated contraction stress test (CST) is considered negative if there are no late decelerations of the fetal heart rate (FHR) over a 10-minute period of contractions. In this case, the FHR has a baseline of approximately 120 beats/min without any decelerations, indicating a negative result.

Question 7

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old and has 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

Accepted Answer

The woman's family history of NTD, BMI of 17.5, and admission of cocaine and alcohol use place her in a high-risk category for pregnancy complications. The other factors such as age, blood pressure, and family history of diabetes mellitus and cancer do not significantly increase her risk for complications during pregnancy.

Question 8

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring woman with diabetes mellitus, the nurse is aware that she is at a greater risk for:&#10;A) Oligohydramnios.&#10;B) Polyhydramnios.&#10;C) Postterm pregnancy.&#10;D) Chromosomal abnormalities.

Accepted Answer

Women with diabetes mellitus are at a higher risk of polyhydramnios, which is characterized by excessive amniotic fluid. This is due to increased fetal urine production caused by hyperinsulinemia in the fetus. Oligohydramnios, postterm pregnancy, and chromosomal abnormalities are not directly associated with diabetes mellitus.

Question 9

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that:&#10;A) Alcohol or cigarette smoke can irritate the fetus, causing greater activity.&#10;B) &#34;Kick counts&#34; should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off.&#10;C) The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.&#10;D) Obese mothers familiar with their bodies can assess fetal movement as well as average-size women can.

Accepted Answer

The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. This is because a significant decrease or complete lack of fetal movement may indicate fetal distress, and immediate medical attention is necessary. Taking "kick counts" every half hour is not necessary and can cause unnecessary anxiety for the mother. Similarly, averaging the counts every 6 hours may lead to missed episodes of decreased fetal movement. It is true that alcohol and cigarette smoke can irritate the fetus, but they are not relevant to the assessment of fetal movement. Obese mothers may have difficulty assessing fetal movement due to increased layers of adipose tissue.

Question 10

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

Accepted Answer

Amniocentesis for fetal lung maturity is important at 35 weeks to assess if the fetus's lungs are developed enough for delivery, as preterm labor is occurring.

Question 11

Nurses should be aware that the biophysical profile (BPP):&#10;A) Is an accurate indicator of fetal well-being.&#10;B) Is a compilation of health risk factors of the mother during the later stages of pregnancy.&#10;C) Consists of a Doppler blood flow analysis and an amniotic fluid index.&#10;D) Involves an invasive form of ultrasonic examination.

Accepted Answer

The answer of Nurses should be aware that the biophysical...

Question 12

A woman asks her nurse, &#34;My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?&#34; The best response by the nurse is:&#10;A) &#34;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.&#34;&#10;B) &#34;Your placenta isn't working properly, and your baby is in danger.&#34;&#10;C) &#34;This means that we will need to perform an amniocentesis to detect if you have any placental damage.&#34;&#10;D) &#34;Don't worry about it. Everything is fine.&#34;

Accepted Answer

The answer of A woman asks her nurse, &#34;My doctor...

Question 13

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)

Accepted Answer

The answer of A 41-week pregnant multigravida presents in the...

Question 14

Intrauterine growth restriction is associated with what pregnancy-related risk factors? Choose all that apply.&#10;A) Poor nutrition&#10;B) Maternal collagen disease&#10;C) Gestational hypertension&#10;D) Premature rupture of membranes&#10;E) Smoking

Accepted Answer

The answer of Intrauterine growth restriction is associated with what...

Question 15

In comparison to contraction stress tests (CSTs), the nonstress test (NST) for antepartum fetal assessment:&#10;A) Has no known contraindications.&#10;B) Has fewer false-positive results.&#10;C) Is more sensitive in detecting fetal compromise.&#10;D) Is slightly more expensive.

Accepted Answer

The answer of In comparison to contraction stress tests (CSTs),...

Deck 19: Assessment of High Risk Pregnancy