Chapter 26 Flashcards
- 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
ANS: D
The woman’s family history of an NTD, her low BMI, and her drug and alcohol use abuse are high risk factors of pregnancy. The woman’s BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which is a high risk.
- 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)
ANS: A
An ultrasound examination could be performed to confirm the pregnancy and to determine the gestational age of the fetus. An MSAFP screening is performed at 16 to 18 weeks of gestation; therefore, it is too early in the woman’s pregnancy to perform this diagnostic test. An amniocentesis is performed if the MSAFP levels are abnormal or if fetal or maternal anomalies are detected. An NST is performed to assess fetal well-being in the third trimester.
- 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
ANS: A
Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies because of IUGR, diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman’s pregnancy, it is not used to diagnose IUGR.
- 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)
ANS: B
Real-time ultrasound permits a detailed assessment of the physical and physiologic characteristics of the developing fetus and a cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
- 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
ANS: C
Amniocentesis is performed to assess fetal lung maturity in the event of a preterm birth. The fluid is examined to determine the lecithin to sphingomyelin (L/S) ratio. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Determination of fetal size by ultrasound is typically performed during the second trimester and is not indicated in this scenario. An NST measures the fetal response to fetal movement in a noncontracting mother.
- 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
ANS: C
The biochemical assessment MSAFP test is performed from week 15 to week 20 of gestation (weeks 16 to 18 are ideal). A BPP is a method of biophysical assessment of fetal well-being in the third trimester. Chorionic villi sampling is a biochemical assessment of the fetus that should be performed from the 10th to 12th weeks of gestation. Screening for diabetes mellitus begins with the first prenatal visit.
- 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
ANS: B
If MSAFP findings are abnormal, then follow-up procedures include genetic counseling for families with a history of NTD, repeated MSAFP screenings, an ultrasound examination, and possibly amniocentesis. Indications for the use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A BPP is a method of assessing fetal well-being in the third trimester. Before an amniocentesis, the client would have an ultrasound for direct visualization of the fetus.
- 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.”
ANS: A
An explanation of what is meant by the “grade of my placenta” is the most appropriate response. If the client desires further information, the nurse can explain that calcium deposits are significant in postterm pregnancies, and ultrasonography can also be used to determine placental aging. Although stating that the client’s placenta is not working properly and that the baby is in danger may be a valid response, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not amniocentesis, is the method of assessment used to determine placental maturation. Telling the client not to worry is not appropriate and discredits her concerns.
- 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
ANS: A
Adequate uterine activity necessary for a CST consists of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, then the findings are considered to be negative. A positive CST indicates the presence of repetitive late FHR decelerations. The terms satisfactory or unsatisfactory are not applicable.
- 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
ANS: A
Birth defects in humans have not been related to caffeine consumption. Pregnant women who consume more than 300 mg of caffeine daily may be at increased risk for miscarriage or IUGR. Although the exact effects of alcohol in pregnancy have not been quantified, it exerts adverse effects on the fetus including fetal alcohol syndrome, fetal alcohol effects, learning disabilities, and hyperactivity. A strong, consistent, causal relation has been established between maternal smoking and reduced birth weight. Childbearing triggers profound and complex physiologic and psychologic changes on the mother. Evidence suggests a relationship between emotional distress and birth complications.
- 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 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.
ANS: C
No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time. A count of less than 3 in 1 hour warrants further evaluation by a NST.
- 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.
ANS: D
The transvaginal examination allows pelvic anatomy to be evaluated in greater detail than the abdominal method and also allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither the abdominal nor the transvaginal method of ultrasound examination should be painful, although the woman will feel pressure as the probe is moved during the transvaginal examination.
- 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
ANS: B
Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and ovarian cysts. Amniotic fluid volume, placental location and maturity, and cervical length are not available via ultrasonography until the second or third trimester.
- 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.
ANS: A
An abnormal BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.
- 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.
ANS: C
As a result of the possibility of fetomaternal hemorrhage, administration of Rho(D) immunoglobulin is the standard of practice after amniocentesis for women who are Rh negative. Amniocentesis is possible after the 14th week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.
