OB Ch 12
A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A) 9 B) 7 C) 5 D) 3
A
A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that: A) It is safe to have intercourse at this time. B) Intercourse at this time is likely to cause rupture of membranes. C) There are other ways that the couple can satisfy their needs. D) Intercourse at this time is likely to result in premature labor.
A
There is a concern that your client is not obtaining enough folic acid. Which test can be used to evaluate the fetus for potential neural tube defects? A. Alpha-fetoprotein analysis B. Doppler flow study C. Amniocentesis D. Triple-marker screen
A Alpha-fetoprotein is a substance produced by the fetus. AFP enters the maternal circulation by crossing the placenta. If there is a developmental defect, more AFP escapes into amniotic fluid from the fetus. The optimal time for AFP screening is 16 to 18 weeks. The triple marker screens for AFP, hCG, and unconjugated estriol. This screens for neural defects and Down syndrome. The Doppler flow study evaluates the blood flow and amniocentesis evaluates the contents of the amniotic fluid looking for chromosomal defects.
After teaching a group of students about the discomforts of pregnancy, the students demonstrate understanding of the information when they identify which as common during the first trimester? (Select all that apply.) A) Urinary frequency B) Breast tenderness C) Cravings D) Backache E) Leg cramps
A,B,C
Your client is in her second trimester and the health care provider has recommended she undergo an amniocentesis. You explain the procedure is used to diagnose which of the following? (Select all that apply.) A. Inborn errors of metabolism B. Neural tube defects C. Rh incompatibility D. Chromosomal abnormalities E. HIV
A,B,D Amniocentesis is performed in the second trimester, usually between 15 and 18 weeks gestation. Over 40 different chromosomal abnormalities, inborn errors of metabolism, and neural tube defects can be diagnosed with amniocentesis. It can replace a genetic probability with a diagnostic certainty, allowing the woman and her partner to make an informed decision about their options. Rh incompatibility and HIV status are both evaluated by blood tests.
The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which of the following would the nurse include? (Select all that apply.) A. Sudden leakage of fluid during the second trimester B. Headache with visual changes in the third trimester C. Nausea with vomiting during the first trimester D. Lower abdominal pain with shoulder pain in the first trimester E. Urinary frequency in the third trimester
A,B,D Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester, and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.
A pregnant woman is scheduled to undergo percutaneous umbilical blood sampling. When discussing this test with the woman, the nurse reviews what can be evaluated with the specimens collected. Which of the following would the nurse include? (Select all that apply.) A) Rh incompatibility B) Fetal acid-base status C) Sex-linked disorders D) Enzyme deficiencies E) Coagulation studies
A,B,E
A client's last menstrual period was April 11. Using Nagele's rule, her expected date of birth (EDB. would be: A) January 4 B) January 18 C) January 25 D) February 24
B
A client's maternal serum alpha-fetoprotein (MSAFP. level was unusually elevated at 17 weeks. The nurse suspects which of the following? A) Fetal hypoxia B) Open spinal defects C) Down syndrome D) Maternal hypertension
B
A nurse is reviewing the medical record of a pregnant woman and notes that she is gravid II. The nurse interprets this to indicate the number of: A) Deliveries B) Pregnancies C) Spontaneous abortions D) Pre-term births
B
After teaching a group of students about the different perinatal education methods, the instructor determines that the teaching was successful when the students identify which of the following as the Bradley method? A) Psychoprophylactic method B) Partner-coached method C) Natural childbirth method D) Mind prevention method
B
When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes that the primary goal of these classes is to: A) Equip a couple with the knowledge to experience a pain-free childbirth B) Provide knowledge and skills to actively participate in birth and parenting C) Eliminate anxiety so that they can have an uncomplicated birth D) Empower the couple to totally control the birth process
B
Which of the following would the nurse include when teaching a pregnant woman about chorionic villus sampling? A) "The results should be available in about a week." B) "You'll have an ultrasound first and then the test." C) "Afterwards, you can resume your exercise program." D) "This test is very helpful for identifying spinal defects."
B
A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks gestation, a 2-year old son born at 39 weeks gestation, and a spontaneous abortion 1 year ago at 6 weeks gestation. Using the GTPAL method, the nurse would document her obstetric history as: A) 3 2 1 0 3 B) 3 1 2 2 3 C) 4 1 1 1 3 D) 4 2 1 3 1
C
Your client is anxious to have an ultrasound at each visit. You explain that it isn't necessary and schedule a second ultrasound to be performed when she is about: A. 18 to 20 weeks pregnant B. 15 to 17 weeks pregnant C. 21 to 23 weeks pregnant D. 24 to 26 weeks pregnant
C There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.
A pregnant woman needs an update in her immunizations. Which of the following vaccinations would the nurse ensure that the woman receives? A) Measles B) Mumps C) Rubella D) Hepatitis B
D
After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was successful when the client states which of the following? A) "I won't expect more than three movements to happen in an hour." B) "I'll do the counts while I'm sitting and watching my son's basketball game." C)"I'll do the count once a week on a morning that I'm not rushed for work." D) "I'll sit comfortably in a recliner or lie on my side when I do the counts."
D The client should perform the counts in a relaxed environment and a comfortable position, such as a semi-Fowler's or side-lying position. The woman needs to do fetal movement counts consistently, at approximately the same time each day. A woman should report a count of fewer than three fetal movements in an hour. A relaxed environment, a comfortable position, and consistency in performing the counts are important to identify changes.
A potential complication for the mother and fetus is Rh incompatibility; therefore assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with RhoGAM is indicated, when should it be given? A. At 28 weeks B. At 36 weeks C. Only at birth D. At 32 weeks
If indicated, RhoGAM should be given at 28 weeks for prophylaxis and again following birth if the infant is Rh+.
You are preparing to release a client who underwent a percutaneous umbilical blood sampling earlier in the day. You remind the client about the signs to watch for that could indicate an infection and you remind the client for the need to: A.Sleep sitting up for one night B.Soak in a tub of warm water if cramping occurs C. Remain on bed rest for 48 hours D. Count fetal movements as instructed
Prior to discharge, instruct the woman to report signs of infection, an increase in contractions or a change in fetal activity level from normal. Reinforce the need to count fetal movements, and review the technique so she can assess them when she is discharged home. Bed rest for 48 hours would be recommended only if there were other concerns. The client needs to report any continued cramping, and sleeping sitting upright would not be indicated.
A young couple are concerned that their fetus may be born with sickle cell anemia. You explain that the recessive traits of sickle-cell anemia can be determined by using which test? A.Chorionic villus sampling B. Amniocentesis C. Blood typing D. Percutaneous umbilical blood sampling
A Chorionic villus sampling (CVS) is a procedure for obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, fetal gender determination, and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay-Sachs disease. Amniocentesis is used to evaluate for neural tube defects, chromosomal disorders, and inborn errors of metabolism. Blood typing is performed via a blood sample. Percutaneous umbilical blood sampling allows for rapid chromosomal analysis.
A pregnant woman in her second trimester tells the nurse, "I've been passing a lot of gas and feel bloated." Which of the following suggestions would be helpful for the woman? A) "Watch how much beans and onions you eat." B) "Limit the amount of fluid you drink with meals" C) "Try exercising a little more." D) "Some say that eating mints can help." E) "Cut down on your intake of cheeses."
A,C,D
Your client is complaining at her prenatal visit that she cannot find any shoes that are comfortable. Assessment of her legs reveals dependent edema. You suggest she attempt to do the following to help reduce the edema: (Select all that apply.) A. Elevate feet and legs when sitting or lying. B. When lying down, lie on the right side. C. Avoid foods high in sodium, sugar, and fats. D. Drink 6 to 8 glasses of water each day. E. Wear knee-high support stockings.
A,C,D Dependent edema is usually the result of pressure put on the veins preventing adequate blood flow to return to the heart. Appropriate suggestions to reduce dependent edema include elevating feet and legs when sitting or lying down; avoiding foods that are high in sodium, sugar, and fats; drinking at least 6 to 8 glasses of water per day; avoid wearing knee-high stockings; and lying on the left side to keep the gravid uterus off the vena cava to return blood to the heart.
A pregnant woman who is 26 weeks pregnant arrives for a follow-up visit. Which of the following assessments, in addition to measuring fundal height and fetal heart rate, would the nurse expect to complete? (Select all that apply.) A. Blood glucose level B. Edema C. Blood pressure D. Weight E. Urine testing
A,C,D,E Up to 28 weeks' gestation, follow-up visits involve assessment of the client's blood pressure and weight, urine testing for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a blood glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks' gestation.
When assessing a woman at follow-up prenatal visits, the nurse would anticipate which of the following to be performed? A) Hemoglobin and hematocrit B) Urine for culture C) Fetal ultrasound D) Fundal height measurement
D
During a routine prenatal visit, a client, 36 weeks pregnant, states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute. and irregular, with bilateral crackles in the lower lung bases. Which nursing diagnosis would be the priority for this client? A) Ineffective tissue perfusion related to supine hypotensive syndrome B) Impaired gas exchange related to pulmonary congestion C) Activity intolerance related to increased metabolic requirements D) Anxiety related to fear of pregnancy outcome
B
A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations? A) Just below the ensiform cartilage B) At the umbilicus C) Between the symphysis and umbilicus D) Symphysis pubis
B At 20 weeks' gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage.
When describing the role of a doula to a group of pregnant women, which of the following would the nurse include? A)The doula is capable of handling high-risk births and emergencies. B) The doula primarily focuses on providing continuous labor support. C)The doula can perform any necessary clinical procedures. D) The doula is a professionally trained nurse hired to provide physical and emotional support.
B Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.
After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching? A) "I'll stay away from foods like cabbage and brussels sprouts." B)"I'll switch to chewing gum instead of using mints." C)"I'll increase my time spent on walking each day." D) "I'll try to drink more fluids to help move things along."
B Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing
After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching? A. "I'll stay away from foods like cabbage and brussels sprouts." B."I'll switch to chewing gum instead of using mints." C. "I'll increase my time spent on walking each day." D. "I'll try to drink more fluids to help move things along."
B Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.
The initial prenatal visit should be a complete assessment of the client's past and present history. Part of this assessment should include the immunization history. You inform the client to avoid which of the following types of vaccines while she is pregnant? A. Live virus vaccine B. Bacterial vaccine C. Toxoid vaccine D. Inactivated virus vaccine
B Routine immunizations are not usually indicated during pregnancy. However, no evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. A number of other vaccines have not been adequately studied. Advise pregnant women to avoid live virus vaccines (MMR and varicella) and to avoid becoming pregnant within one month of having received one of these vaccines because of the theoretical risk of transmission to the fetus.
The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would suggest a potential problem? A) 12.5cm B) 12.0 C) 13.5cm D) 13.0
B The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: A. 2 weeks B. 4 weeks C. 3 weeks D. 1 week
B The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.
At the first prenatal visit, the client reports her LMP was November 16, 2011. You determine the estimated date of birth (EDB) to be: A. September 1, 2012 B. August 23, 2012 C. August 3, 2012 D. August 13, 2012
B There are several methods to determine the EDB. Nagele's rule can be used, which involves subtracting 3 months and then adding 7 days to the first day of the LMP. Then correct the year by adding 1 where necessary. Another method is to add 7 days and then add 9 months and add 1 to the year where needed. Thus the client reports her LMP was Nov 16, 2011, subtract 3 months (August), add 7 days (23), and add 1 year (2012). This client's EDB is August 23, 2012.
A nurse is working with a pregnancy woman to schedule follow-up visits for her pregnancy. Which statement by the woman indicates that she understands the scheduling? A) "I need to make visits every 2 months until I'm 36 weeks pregnant." B) "Once I get to 28 weeks, I have to come twice a month." C) "From now until I'm 28 weeks, I'll be coming once a month." D) "I'll make sure to get a day off every 2 weeks to make my visits."
C
A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate which of the following? A) 14 weeks' gestation B) 20 weeks' gestation C) 28 weeks' gestation D) 36 weeks' gestation
C
A pregnant woman has a rubella titer drawn on her first prenatal visit. The nurse explains that this test measures which of the following? A) Platelet level B) Rh status C) Immunity to German measles D) Red blood cell count
C
A pregnant woman in the 36th week of gestation complains that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention would be most appropriate for the nurse to suggest? A) "Limit your intake of fluids." B) "Eliminate salt from your diet." C) "Try elevating your legs when you sit." D) "Wear Spandex-type full-length pants."
C
On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse records this finding as: Hegar's sign B) Goodell's sign C) Chadwick's sign D) Homans' sign
C
When preparing a woman for an amniocentesis, the nurse would instruct her to do which of the following? A) Shower with an antiseptic scrub. B) Swallow the preprocedure sedative. C) Empty her bladder. D) Lie on her left side.
C
pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful? A) "I'll sit in a window seat so I can focus on the sky to help relax me." B) "I won't drink too much fluid so I don't have to urinate so often." C) "I'll get up and walk around the airplane about every 2 hours." D) "I'll do some upper arm stretches while sitting in my seat."
C
The use of real-time ultrasonography allows the health care provider to obtain what type of information about the fetus? A. Chromosomal abnormalities B. The size and shape of placenta C. Biophysical profile D. The effectiveness of neural tube defect treatment
C A biophysical profile uses real-time ultrasound to allow assessment of various parameters of fetal well-being. This may include fetal movements, fetal tone, and fetal breathing, as well as assessment of amniotic fluid volume with or without assessment of fetal heart rate. Chromosomal abnormalities are detected via amniocentesis. Neural tube defect treatment is not evaluated via biophysical profile, and although the placenta may be observed, it is not the focus of this procedure.
A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which of the following? A. Treatment can be started once the test results are back. B. The blood tests are definitive. C. Further testing will be required to confirm any diagnosis. D. A second set of screening tests can be obtained to confirm results.
C Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.
A nursing instructor is describing the various childbirth methods. Which of the following would the instructor include as part of the Lamaze method? A) Focus on the pleasurable sensations of childbirth B) Concentration on sensations while turning on to own bodies C) Interruption of the fear-tension-pain cycle D) Use of specific breathing and relaxation techniques
D
In preparing for a preconception class, it will be important to include a discussion of potential risk factors. Which of the following would be included? A. Importance of taking adequate vitamin and mineral supplements B. The importance of healthy lifestyle C. The use of OTC drugs with teratogens D. Family history of pregnancy complications
C Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.
You are leading a discussion among couples who are thinking about getting pregnant. As the nurse you stress that preconception counseling helps to identify risks and encourages modification by the couple before conception. You consider the discussion successful when the couples realize that the greatest risk to the embryo is: A.Between 17 and 56 hours after conception B. Between 4 and 17 hours after conception C. Between 4 and 17 days after conception D. Between 17 and 56 days after conception
C The period of greatest environmental sensitivity and consequent risk for the developing embryo is between days 17 and 56 after conception. The first prenatal visit, which is usually a month or later after a missed menstrual period, may occur too late to affect reproductive outcomes associated with abnormal organogenesis secondary to poor lifestyle choices.
A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as: A. 31021 B. 21212 C. 30111 D. 20111
C The woman's obstetric history would be documented as 30111, G (gravida) = 3 (current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability) = 1, and L (number of living children) = 1.
During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: A) Variable decelerations B) Fetal tachycardia C) A nonreactive pattern D) Reactive pattern
D
When assessing a pregnant woman in her last trimester, which question would be most appropriate to use to gather information about weight gain and fluid retention? A) "What's your usual dietary intake for a typical day?" B) "What size maternity clothes are you wearing now?" C) "How puffy does your face look by the end of a day?" D) "How swollen do your ankles appear before you go to bed?
D
At the first prenatal visit of all clients who come to your clinic, appropriate blood screenings are obtained. You realize that a hemoglobin A1c above which level is concerning for diabetes and warrants further testing? A. 5.0% B. 6.0% C. 5.5% D. 6.5%
D A hemoglobin A1c level of at least 6.5% is concerning for overt diabetes and further testing should be conducted to ensure the client is not diabetic. If glucose testing is not diagnostic of overt diabetes, the woman should be tested for gestational diabetes from 24 to 28 weeks of gestation with a 75-gm oral glucose tolerance test.
When providing preconception care to a client, which medication would the nurse identify as being safe to continue during pregnancy? A) Warfarin B) Lithium C) Accutane D) Famotidine
D Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause major birth defects or other fetal problems. Accutane and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and
Encouraging routine prenatal visits is an important function for nurses to ensure the clients avoid complications or difficulties throughout the pregnancy and delivery. All clients should be screened for gestational diabetes at which time during the pregnancy? A. Between 20 and 24 weeks' gestation B. Between 15 and 19 weeks' gestation C. Between 29 and 32 weeks' gestation D. Between 24 and 28 weeks' gestation
D Screening for gestational diabetes is best done between 24 and 28 weeks' gestation, unless screening is warranted in the first trimester for high-risk reasons. If the initial screening is elevated, then further testing should be conducted to confirm the diagnosis.