Deck 12: Pregnancy Risk Factors and Assessment: Maternal and Fetal

Question 1

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

Answer 1

Transvaginal ultrasound

Question 2

Which of the following statements is true?

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 2

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

Question 3

At 35 weeks of pregnancy,a woman experiences preterm labour.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

Answer 3

Amniocentesis for fetal lung maturity

Question 4

With regard to amniocentesis,what should the nurse be aware of?

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 a cause for concern.

Question 5

Which of the following factors is strongly related to maternal mortality in Canada?

A) Obesity
B) Ethnicity
C) Age greater than 35 years
D) Decreased number of births per family

Question 6

Which of the following is true in relation to the nonstress test (NST)for antepartum fetal assessment?

A) It has no known contraindications.
B) It has fewer false-positive results than the contraction stress test (CST).
C) It is more sensitive than the CST in detecting fetal compromise.
D) It is slightly more expensive than the CST.

Question 7

When nurses help expectant mothers assess the daily fetal movement counts,they should be aware of which of the following?

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 continue non-stop for 24 hours.
D) If 6 movements are not felt in 2 hours, further evaluation is required.

Question 8

Which of the following statements is accurate in relation to the contraction stress test (CST)?

A) The CST sometimes uses vibroacoustic stimulation.
B) The CST is an invasive test no matter how contractions are stimulated.
C) The CST is considered negative if no late decelerations are observed with the contractions.
D) The CST is more effective than the nonstress test (NST) if the membranes have already been ruptured.

Question 9

In the first trimester,ultrasonography can be used to gain information on which of the following?

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

Question 10

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 useful in confirming the diagnosis?

A) Doppler blood flow analysis
B) Contraction stress test (CST)
C) Amniocentesis
D) Daily fetal movement counts

Question 11

A patient asks her nurse,"My doctor told me that he is concerned about the grade of my placenta because I am overdue.What does that mean?" What is the best response from the nurse?

A) "Your placenta is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade."
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 will be fine. This is very normal."

Question 12

A 41-week pregnant multigravida presents in the labour 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 13

Which of the following statements is true?

A) More than 20% of pregnancies meet the definition of high risk to either the mother or the infant.
B) 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 14

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.How would the nurse document the interpretation of this test?

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

Question 15

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 16

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 17

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.How can the nurse best help the couple?

A) Tell her that the physician will isolate the problem with more tests.
B) Encourage her and urge her to continue with childbirth classes.
C) Become assertive and lay out the decisions the couple needs to make.
D) Downplay her risks by citing success rate studies.

Question 18

In comparing the abdominal and transvaginal methods of ultrasound examination,what should the nurse explain to the patient?

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 19

What should the nurse be aware of in relation to the biophysical profile (BPP)?

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

Question 20

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 and alcohol use, age, family history
C) Family history, blood pressure, respiratory rate
D) Family history, BMI, drug and alcohol use

Question 21

Intrauterine growth restriction is associated with what pregnancy-related risk factors?

A) Excessive weight gain
B) Maternal collagen disease
C) Polyhydramnios
D) Premature rupture of membranes

Question 22

Risk factors tend to be interrelated and cumulative in their effect.While planning the care for a labouring patient with diabetes mellitus,the nurse is aware that the woman is at a greater risk for which of the following?

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