Chapter 12 EAQs

A maternity nurse should be aware of which fact about the amniotic fluid?

It serves as a source of oral fluid and as a repository for waste from the fetus. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (polyhydramnios) is associated with gastrointestinal and other abnormalities.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate?

"A baby in utero does respond to the mother's voice." Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice.

A client in the twentieth week of pregnancy visits a clinic to learn about the development of the fetus. The client says to the nurse, "I am excited and I want to know what has developed in my child so far." What information should the nurse be able to tell to the client about the fetus?

"The fetus has hair on their scalp." Scalp hair appears after the 16th week of pregnancy along with the eyes, ear and nose. However, scalp hair is still in the developmental stage and is observed upon gross examination of the fetus. Sweat glands are formed at the 24th week of pregnancy. Nasal cartilage is observed after 40 weeks of pregnancy. Sebaceous glands are formed after 20 weeks of pregnancy.

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate?

"They occur between the third and fifth weeks of development." Blood vessel and blood formation begin in the third week, and the heart is developmentally complete in the fifth week. The nurse would be aware of when such defects occur. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begin in the third week, and the heart is developmentally complete in the fifth week.

A client tells the nurse, "I have been trying to conceive for the past two months. I missed my period this month but I had slight red spotting at the time I would usually have my period." What is the nurse's best response?

"You should take a pregnancy test after a week." The client is trying to conceive and has missed her period, which could indicate that she may be pregnant. Slight red spotting at the time of a missed menstrual period is normal and may be indicative of implantation bleeding or of a menstrual period, so a pregnancy test should be taken when the timing is right. Because it takes some time to detect hCG levels in the urine, the nurse should ask the client to take the pregnancy test after a week

A 20-week pregnant client visits the clinic for a regular health checkup. The client asks the nurse about the importance of the amniotic fluid in fetal development. What response should the nurse give to the client? Select all that apply.

1. "It helps to maintain the temperature of the fetus." 3. "It helps in maintaining fluid and electrolyte balance." 5. "It helps in the detection of fetal development." The amniotic fluid helps to maintain a constant body temperature, and fluid and electrolyte balances in the fetus. It acts like a shock absorber and cushioning material, due to which it protects the fetus against mechanical shocks. Fetal development is determined by estimating the lecithin/sphingnomyelin (L/S ratio) in the fetal cells present in the amniotic fluid. This helps in the early detection of any fetal disorders.

The nursing instructor is educating a student nurse about the hormone human chorionic somatomammotropin (hCS). What points should the instructor teach the student nurse? Select all that apply.

1. It facilitates glucose transport across the placental membrane. 4. It stimulates breast development in order to prepare for lactation. 5. It stimulates maternal metabolism to supply nutrients to the fetus. Human chorionic somatomammotropin (hCS) is a protein hormone produced by the placenta.

The student nurse asks the clinical coordinator about the physiologic process of conception. Which statements should the clinical coordinator include in the teaching? Select all that apply.

1. It is the first phase in the process of a woman becoming pregnant. 3. It is the fusion of the sperm cell and the egg cell to form a zygote. Conception is the very first step and involves the fusion of the sperm and the egg cell to form a zygote. This is considered the beginning of pregnancy.

What time span in lunar months, calendar months, weeks, and days indicates the appropriate length for a normal pregnancy?

10 lunar months, 9 calendar months, 40 weeks, 280 days Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth.

Which fetal heart rate indicates that there is normal growth and development?

150 beats/minute The normal fetal heart rate is found to be 110 to 160 beats/minute. Usually, the fetal heart rate is higher than normal healthy adults in order to meet the high oxygen demand of the fetus. If the fetal heart rate is 150 beats/minute, it indicates that the fetus is healthy and is receiving sufficient oxygen, as required for fetal growth. If the fetal heart rate is less than 110 beats/minute it indicates an insufficient supply of oxygen to the fetus. If the fetal heart rate is more than 160 beats/minute it indicates that the fetus is at risk of hypertension.

The nurse is regularly checking the ultrasound diagnostic reports of a pregnant client. In which week of the pregnancy can the nurse see the grossly-formed brain?

20 weeks At 20 weeks of pregnancy, one can observe the brain of the fetus, which is grossly formed. It is at this time that spinal cord myelination begins. The spinal cord ends at the level of first sacral vertebra (S1) in this stage of fetal development.

The ultrasound reports of a pregnant client indicate that the fetal nose and ears are ossified. At what gestational age would this information become apparent?

20 weeks In the ultrasound reports of a fetus at the 20-week gestation period, the nose and the sternum are ossified.

The nurse educator is teaching the student nurse about the viability of a 23-week preterm infant. Which factors would limit the survival of this infant? Select all that apply.

3. Lung oxygenation capability 4. Central nervous system (CNS) function Viability refers to the capability of the fetus to survive outside the uterus. With modern technology and advancements in maternal and neonatal care, infants who are 22 to 25 weeks of gestation are now considered to be on the threshold of viability. The factors that limit survival outside the uterus when an infant is born at this early stage are based on the oxygenation capability of the lungs and the CNS function.

The nurse should teach a pregnant woman that which substances are teratogens? Select all that apply.

Cigarette smoke Isotretinoin (Retin A) Rubella

What is the rationale behind encouraging postpartum clients to nurse when they are producing colostrum?

Colostrum is rich in immunoglobulin A (IgA). A newborn baby does not have any IgA. However, colostrum, which is the precursor to breast milk, is rich in IgA. This substance provides passive immunity to the neonate. The antibody cannot pass placental barriers and, therefore, the fetus lacks this immunoglobulin. IgG provides passive acquired immunity against bacterial toxins and can cross placental barriers. IgD is produced in very low amounts and is seen in blood serum. IgD is not present in breast milk and passes through placental barriers. IgM can pass through the maternal placenta and reach the fetus. This antibody aids in response to the blood group antigens.

Which hormone produced by the fetus is believed to initiate labor?

Cortisol The adrenal cortex is formed during the 6th week of the gestational period and produces hormones by the 8th or 9th week. The fetus produces higher amounts of cortisol as the due date gets closer. This is believed to aid in initiating labor by decreasing the maternal progesterone and stimulating prostaglandin production. Insulin, which helps regulate glucose in the fetus, is produced by the islets of Langerhans of the pancreas. Estriol is a type of estrogen hormone secreted by the placenta that stimulates uteroplacental growth. Thyroxine is a thyroid hormone produced in the fetus; thyroxine does not easily cross the placenta.

The nurse is caring for an infant who has meconium ileus. For what other condition should the nurse assess the child?

Cystic fibrosis As the fetus nears the birth date, fetal waste products begin to accumulate in the fetal intestines as dark green to black, tarry meconium. Normally this substance is passed through the rectum within 24 hours of birth. An imperforate anus, or meconium ileus, is the condition in which a firm meconium plug blocks the anal passage. This condition is seen in infants with cystic fibrosis.

While reviewing the ultrasound results of a pregnant client, the nurse observes the presence of two embryos. Both embryos have a common amnion and common chorion with one placenta. What complications might the nurse anticipate in the fetuses?

Decreased circulation of blood in the fetuses Rarely, division of the ovum occurs after the eighth day of fertilization. This leads to the formation of two embryos within a common amnion and a common chorion, and one placenta. Circulatory problems can occur if the umbilical cords become tangled. This can lead to fetal death of one or both babies.

The nurse is caring for a preterm infant with low levels of glucuronyl transferase enzyme. What disease risk may be increased in the infant?

Hyperbilirubinemia Glucuronyl transferase enzyme is responsible for the clearance of unconjugated bilirubin. Low levels of glucuronyl transferase enzyme would result in hyperbilirubinemia in the child.

A pregnant woman has been diagnosed with oligohydramnios. Which presentation would the nurse suspect to find on physical examination?

Fetus may have renal problems Oligohydramnios reflects a decrease in the amount of amniotic fluid and is associated with renal abnormalities in the fetus and compromised fetal well-being.

The nurse observes that the newborn has milky secretions from the nipples. What is the reason for this finding?

High levels of maternal estrogen High levels of maternal estrogen stimulate mammary engorgement and cause secretion of fluid, called "witch's milk" in newborns of both sexes.

The nurse is caring for a diabetic pregnant client. Which conditions should the nurse expect to find in the client's newborn?

Hypoglycemic and overweight Maternal hyperglycemia produces fetal hyperglycemia by stimulating hyperinsulinemia and islet cell hyperplasia. This results in the impaired regulation of the hormone insulin in the fetus. Therefore, the newborn of a diabetic pregnant client may be hypoglycemic and overweight. This happens from the loss of a maternal glucose source after birth.

The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping what way?

In a side-lying position Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. It is now known that either side-lying position enhances uteroplacental blood flow.

How many veins and arteries are present between the maternal and the fetal circulatory system by the 5th week of pregnancy?

One vein and two arteries The fetal heart starts beating by the end of the 5th week. Two arteries carry blood from the embryo to the chorionic villi and one vein returns the blood to the embryo. Deoxygenated blood leaves the fetus through the umbilical arteries and enters the placenta, where it is oxygenated. Oxygenated blood leaves placenta through the umbilical vein, which enters the fetus via the umbilical cord. It is rare for there to be one vein and one artery. Approximately 1% of umbilical cords contain only two vessels: one artery and one vein. This occurrence is sometimes associated with congenital malformations. Therefore, the presence of two veins and one artery and two veins and two arteries is inappropriate.

The blood pressure of a pregnant client becomes low when the client lies on the back. What would be the best nursing intervention to maintain normal blood pressure in the client?

Position the client to lie on the left side and rest.

The nurse is assisting the health care provider with a client in labor. The nurse concludes that the placental blood flow is reduced. What assessment finding would lead the nurse to conclude this?

Prolonged contractions Braxton Hicks contractions generally enhance blood flow to the placenta. However, if the contractions are prolonged, the blood flow to the placenta can become restricted.

Upon reviewing the reports of a 12-week pregnant client, the nurse finds that the client has a low amniotic fluid volume. Which system does the nurse suspect to be affected in the fetus?

Renal system The amniotic fluid serves many functions and the volume of amniotic fluid is an important factor in the assessment of fetal well-being. Amniotic fluid volume of less than 300 ml (oligohydramnios) at term is associated with fetal renal abnormalities. Amniotic fluid volume of more than 2 L (hydramnios) near term is associated with malformations in the respiratory, cardiovascular, and gastrointestinal systems.

Upon reviewing the health history of a pregnant client, the nurse finds that the client has chronic glomerulonephritis. Which complication could occur if the client and fetus are not managed effectively?

Retardation of fetal lung maturity The presence of pulmonary surfactants is used to determine the degree of fetal lung maturity. When a client with a history of gestational diabetes or chronic glomerulonephritis becomes pregnant, this can slow down the development of the lungs of the fetus.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates what?

The lung maturity of the fetus The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation.

The results of the three-dimensional ultrasound showed the presence of conjoined twins in the womb of a pregnant client. Which instruction should be given by the primary health care provider to the nurse during the delivery of the client's infant?

To plan for a cesarean section to deliver the client Cesarean section is recommended for the client having conjoined twins, because it minimizes the trauma in both the mother and the fetus.

Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that what?

Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing

Which pulmonary surfactant ratio confirms the maturity of the infant's lungs?

When the ratio of lecithin to sphingomyelin is 2:1 Lecithin (L) is the most critical alveolar surfactant, and it is required for postnatal lung expansion. Another alveolar surfactant, sphingomyelin (S), remains constant in its amount. The measure of lecithin in relation to sphingomyelin, or the L/S ratio, is used to determine fetal lung maturity. When the L/S ratio reaches 2:1, the infant's lungs are considered to be mature. This occurs approximately in the middle of the third trimester. The 3:1 ratio of lecithin to sphingomyelin would indicate that the fetal lungs are immature. If the ratio of sphingomyelin to lecithin were 1:1 or 2:1, it would also indicate impaired function of fetal lungs.