Deck 26: Assessment of High Risk Pregnancy

Question 1

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

Answer 1

Presence of maternal abnormalities

Question 2

How does the nurse document a non-stress test (NST)during which two or more fetal heart rate (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

Answer 2

Reactive

Question 3

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) Percutaneous umbilical blood sampling (PUBS)
B) Ultrasound for fetal size
C) Amniocentesis for fetal lung maturity
D) Non stress test (NST)

Answer 3

Amniocentesis for fetal lung maturity

Question 4

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

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

Question 5

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

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

Question 6

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 7

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 8

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 Rh_o(D)immunoglobulin may be necessary.
D) The presence of meconium in the amniotic fluid is always a cause for concern.

Question 9

A pregnant woman's biophysical profile (BPP)score is 8.She asks the nurse to explain the results.How should the nurse respond initially?

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."

Question 10

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 11

Which information is an important consideration when comparing the contraction stress test (CST)with the nonstress test (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 12

Which information is the highest priority for the nurse to comprehend regarding the biophysical profile (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

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 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 14

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 15

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) Biophysical profile (BPP)
B) Chorionic villi sampling
C) Maternal Serum Alpha-Fetoprotein Screening (MSAFP)screening
D) Screening for diabetes mellitus

Question 16

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 17

An Maternal Serum Alpha-Fetoprotein Screening (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) Percutaneous umbilical blood sampling (PUBS)
B) Ultrasound
C) Biophysical profile (BPP)
D) Amniocentesis

Question 18

A 41-week pregnant multigravida arrives at the labor and delivery unit after testing 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)

Question 19

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 20

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) Maternal serum AFP (MSAFP)screening is recommended only for women at risk for neural tube defects (NTDs).
C) Percutaneous umbilical blood sampling (PUBS)is one of the triple-marker tests for Down syndrome.
D) Maternal serum AFP (MSAFP)is a screening tool only;it identifies candidates for more definitive diagnostic procedures.

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.

Advanced maternal age

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

Question 22

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 23

The indirect Coombs' test is a screening tool for Rh incompatibility.An amniocentesis may be a necessary next step it the titer is greater than what?

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

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.

Fetal congenital anomalies

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

Question 25

Cell-free deoxyribonucleic acid (cfDNA)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? (Select all that apply. )

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

Question 26

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 27

Which assessments are included in the fetal biophysical profile (BPP)? (Select all that apply. )

A) Fetal movement
B) Fetal tone
C) Fetal heart rate
D) Amniotic fluid index (AFI)
E) Placental grade

Question 28

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 29

Intrauterine growth restriction (IUGR)is associated with which pregnancy-related risk factors? (Select all that apply. )

A) Poor nutrition
B) Multifetal pregnancy
C) Gestational hypertension
D) Premature rupture of membranes
E) Smoking