E. Antepartal Fetal testing
During a contraction stress test, the nurse notices late decelerations with three out of the six contractions. These results are classified as: negative. positive. equivocal. unsatisfactory.
positive. Positive results are when late decelerations accompany at least 50% of the contractions.
A woman tells the nurse she is 16 weeks' pregnant. During the assessment, the nurse measures the fundus of the uterus to be at the umbilicus. The nurse correctly interprets the comparison of the dates with the measurements to be Not comparable Congruent Incongruent Irrelevant
Incongruent
What is an indicator for performing a contraction stress test? Increased fetal movement and small for gestational age Maternal diabetes mellitus and postmaturity Adolescent pregnancy and poor prenatal care History of preterm labor and intrauterine growth restriction
Maternal diabetes mellitus and postmaturity Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Intrauterine growth restriction is an indicator; but history of a previous stillbirth, not preterm labor, is the other indicator.
A woman who is 10 weeks' pregnant is complaining of nausea and vomiting every morning. Which action can the nurse suggest to the woman to alleviate the nausea? Eat dry crackers before arising in the morning. Eat only three meals a day. Drink plenty of fluids with meals. Eat mostly protein foods and very little carbohydrates.
Eat dry crackers before arising in the morning.
The purpose of initiating contractions in a contraction stress test is to Determine the degree of fetal activity Apply a stressful stimulus to the fetus Identify fetal acceleration patterns Increase placental blood flow
Apply a stressful stimulus to the fetus The contraction stress test involves recording the response of the fetal heart rate to stress induced by uterine contractions.
A client is to have an ultrasound to in order to do a general survey of the fetus, placenta, and amniotic fluid. This type of ultrasound level is termed ______________.
Basic
When is the most accurate time to determine gestational age through ultrasound? First trimester Second trimester Third trimester There is no difference in accuracy between the trimesters
First trimester A. During the first trimester, measurement of the crown-rump length of the embryo is the most reliable indicator of gestational age. . B. Gestational age determination by ultrasonography is increasingly less accurate after the first trimester. C. Estimating fetal age by ultrasound after 32 weeks is subject to major error. D. Gestational age determination by ultrasonography is increasingly less accurate after the first trimester.
An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: Intercourse should be avoided if any spotting from the vagina occurs afterward. Intercourse is safe until the third trimester. Safer-sex practices should be used once the membranes rupture. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.
A woman is concerned that she has developed numerous nosebleeds during this pregnancy. She feels this is a sign of leukemia and wants to be screened. The nurse's response to the woman should be based on the fact that Leukemia is a major concern during pregnancy Nose bleeds are a common occurrence during pregnancy Nose bleeds are rare in pregnancy; therefore further assessment is necessary Platelet count decreases significantly during pregnancy
Nose bleeds are a common occurrence during pregnancy
The nurse notes that the hemoglobin level of a woman at 35 weeks of gestation is 11.5 g/dL. The nurses next action should be to Note that this is within the normal range for pregnancy Note that this is within the normal range for an average adult Call the physician; this shows mild anemia Recall that the RBC count increases slightly during pregnancy
Note that this is within the normal range for pregnancy The normal range of hemoglobin for pregnancy is greater than 11 g/dL in the first and third trimesters and greater than 10.5 g/dL in the second trimester.
Select all of the conditions that are associated with elevated levels of serum alpha-fetoprotein. Open neural tube defects Threatened abortion Chromosomal trisomies Gestational trophoblastic disease Fetal demise
Open neural tube defects Threatened abortion Fetal demise
A woman who is 6 weeks' pregnant is scheduled for an ultrasound. She asks the nurse what can be seen at this stage of the pregnant. The nurse would be correct if she responded: The sex of the baby The baby's heartbeat Characteristics of the baby's face Fetal presentation
The baby's heartbeat A. The sex of the baby cannot be determined until about 12 weeks. B. The heartbeat is visible when the embryo is 5 mm in length. Fetal sex and details about the baby cannot be seen until later in the pregnancy. C. Characteristics of the baby's face can be seen on a three-dimensional sonogram later in the pregnancy. D. Fetal presentation is determined during the second and third trimester
The client has a biophysical profile done. The nurse notes that the NST test was reactive, the fetal breathing movements were absent, the gross body movements numbered one in 30 minutes, the fetal tone showed fetal extremity extension and return to flexion and one pocket of amniotic fluid that measures 3 cm. The nurse anticipates that next action by the physician will be: further study because a score of 6 is not normal. no further study because a score of 9 is normal. further study because a score of 3 is not normal. no further study because a score of 10 is perfect.
further study because a score of 6 is not normal. A score of 8 to 10 is normal for a biophysical profile. To score, five categories are used. The reactive NST gives a score of 2; absent fetal breathing movements is a 0; one gross body movement is a score of 0; the fetal tone of extension and flexion is a 2; and one pocket of amniotic fluid is a score of 2. This gives a total of 6, which is not within normal limits and further studies are indicated.
An ultrasound is done prior to an amniocentesis in order to: determine fetal age. locate fetal and placental position. determine maternal blood pressure. determine amount of fetal movement.
locate fetal and placental position. Determining fetal and placental position is important prior to amniocentesis in order to prevent damage by the needle.
An ultrasound is ordered for a client that is 8½ months pregnant. It is important for the nurse to: instruct the client to drink several glasses of clear fluid 1 hour before the examination and not void. place a wedge under one hip when placing her on the examination table. place the client in the lithotomy position for the examination. instruct the client to bring someone with her to the examination to drive her home.
place a wedge under one hip when placing her on the examination table. When lying supine, the client is at risk for supine hypotension. Placing a wedge or rolled blanket under one hip will move the gravid uterus over to the side away from the vena cava and aorta. Drinking several glasses of clear fluid is needed during the second trimester prior to an ultrasound. A vaginal ultrasound is done during the first trimester.
The nurse notices that during the nonstress test the fetal heart accelerated 20 beats per minute above baseline three times with fetal movement. The acceleration each lasted about 15 seconds before returning to baseline. This result is classified as: reactive. nonreactive.
reactive. A reactive (reassuring) nonstress test shows at least two fetal heart accelerations, with or without fetal movement within a 20-minute period. The accelerations peak at least 15 beats per minute above the baseline and last 15 seconds from baseline to baseline.
During the first trimester the pregnant woman would be most motivated to learn about: Fetal development. Impact of a new baby on family members. Measures to reduce nausea and fatigue so she can feel better. Location of childbirth preparation and breastfeeding classes.
Measures to reduce nausea and fatigue so she can feel better. During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy.
A woman who is 8 months pregnant has been advised to have an amniocentesis. She asked the nurse the reason for the procedure. The usual reason for an amniocentesis during this period of pregnancy is to determine _________________________.
fetal lung maturity
An amniocentesis is ordered for an 8-month-pregnant client. The nurse is aware that the most common reason for this test at this time is to test for: fetal demise. fetal chromosome abnormalities. fetal lung maturity. amniotic fluid amount.
fetal lung maturity. One common indication for amniocentesis during the third trimester is to determine fetal lung maturity. Amniocentesis may be done midtrimester to determine chromosomal abnormalities. Amniocentesis is not done to determine fetal demise or amniotic fluid amount.
A woman is 35 weeks' pregnant during her clinic visit. She complains of numerous vaginal infections during the pregnancy. She tells the nurse, "I'm afraid I have diabetes, because I have some infections." The best response by the nurse would be "Diabetes is a possibility. I will set you up for testing." "A vaginal infection is a symptom of diabetes, but it also is a problem with normal pregnancies due to the changes in your vaginal area." "Itching is a problem with pregnancies and it makes you think you have an infection. The physician can order you some cream to help with the itching and pain." "This seems to be a concern with all of our patients today."
"A vaginal infection is a symptom of diabetes, but it also is a problem with normal pregnancies due to the changes in your vaginal area."
The nurse understands that additional patient teaching is needed about the signs of pregnancy when the patient states "The nurse heard the heartbeat of the baby, so I finally know I am pregnant." "I think I felt the baby move last night, so I may be pregnant." "I know I am pregnant because I have missed two periods." "I think I am pregnant because I am vomiting every morning after breakfast."
"I know I am pregnant because I have missed two periods."
An 8-month-pregnant client comes to the clinic complaining that she has not felt the baby move for the past 48 hours. Other than checking the fetal heart tones, the nurse can also anticipate which fetal study? Amniocentesis Multiple-marker study Blood flow assessment Ultrasonography
Ultrasonography Ultrasonography is used in the last two trimesters to confirm fetal viability.
The nurse is teaching a woman in her second trimester about an upcoming ultrasonography exam. The nurse knows her teaching has been successful when the woman states "I will drink several glasses of water about an hour before I come in for the test." "I will empty my bladder just before the test." "I will not eat or drink anything for 8 hours prior to coming in for the test." "I will plan on staying at the doctor's office for about 2 hours after the test so you can check to make sure the baby was not harmed during the procedure."
"I will drink several glasses of water about an hour before I come in for the test." A. Drinking several glasses of clear fluid 1 hour before the time of the examination will produce a full bladder. The bladder will displace the intestines and elevate the uterus for better visibility. B. The woman needs a full bladder prior to the exam in order to displace the intestines and elevate the uterus for better visibility. C. It is not necessary to be NPO for 8 hours prior to this exam. D. No fetal postprocedure assessments are necessary.
The nurse is explaining the results of a maternal serum alpha-fetoprotein screening test to the woman. The nurse knows the woman does not understand the teaching if she says "Since the levels were within normal limits, I know the baby does not have any anomalies." "I know that the levels are high, but that does not always mean something is wrong with the baby." "Since I am not sure about the date of my last menstrual period, the test results cannot be accurately interpreted." "Since the levels are low, my baby may have Down syndrome."
"Since the levels were within normal limits, I know the baby does not have any anomalies." A. Alpha-fetoprotein levels are a screening test. Some fetal defects are covered by skin and do not produce elevated levels of AFP. B. MSAFP levels are a screening test and must be viewed as the first step in a series of diagnostic procedures that are indicated if abnormal concentrations are found. C. Inaccurate estimation of gestational age can result in false-positive or false-negative results. D. Low levels are an indication of Down syndrome; more testing is indicated.
An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response would be: "This is normal behavior and should begin to subside by the second trimester." "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." "This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." "You seem impatient with her. Perhaps this is precipitating her behavior."
"This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." This is the most appropriate response since it gives an explanation and a time frame for when the mood swings may stop.
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test? "I will need to have a full bladder for the test to be done accurately." "I should have my husband drive me home after the test because I may be nauseous." "This test will help to determine if the baby has Down syndrome or a neural tube defect." "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
"This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome. An amniocentesis would be the test that a pregnant woman should be driven home afterward. An ultrasound is the test that requires a full bladder.
The physician has ordered a chorionic villus sampling to be done on a client. The nurse knows to schedule the test to be done between which weeks of gestation? 4 and 6 weeks 6 and 8 weeks 8 and 10 weeks 10 and 12 weeks
10 and 12 weeks CVS is usually performed between 10 and 12 weeks of gestation. At this time the chorionic villi are formed significantly in order to obtain adequate samplings.
A woman who is 10 weeks' pregnant asks the nurse about the multiple marker screen testing that the nurse-midwife has ordered. The nurse should base her ANSwer on the knowledge that A multiple marker screen test will test for three types of sexual trANSmitted diseases so that Patsy can be treated if necessary A multiple marker screen test will screen for fetal anomalies A triple screen test will test for gestational diabetes so treatment can be started early in the pregnancy A multiple marker screen test will test Patsy's blood and the fetal blood for compatibility
A multiple marker screen test will screen for fetal anomalies
In preparing a pregnant client for a nonstress test, the nurse should: ask the client if she smokes and when was her last cigarette. have the client drink four glasses of water. ask the client when was the last time she had anything to eat or drink. ask the client for a urine sample to check for glucose levels.
ask the client if she smokes and when was her last cigarette. For the greatest accuracy of a nonstress test the woman should not have smoked recently. This produces vasoconstriction, which may alter the results.
A 36-year-old primigravid is in the clinic for her first prenatal appointment. The nurse can anticipate that the multiple-marker screening may be done on this client to screen for: gestational diabetes. hypertensive disease of pregnancy. trisomy disorders. placental previa.
trisomy disorders. The multiple-marker screening test (MSAFP, hCG, unconjugated estriol, inhibin A) is used to screen for trisomies in the fetus. Older primigravids are at higher risk for these defects.
A client's maternal serum alpha-fetoprotein (MSAFP) levels are elevated. The nurse can anticipate that the next test done will be: amniocentesis. ultrasound. biophysical profile. chorionic villus sampling.
ultrasound. The MSAFP is a screening test, not a diagnostic test. If the levels are elevated an ultrasound is offered to determine whether the abnormal concentration results from inaccurate gestational age, multifetal gestation, or fetal demise.
During prenatal teaching it is important for the nurse to inform the patient about danger signs in pregnancy. Which sign need to be reported immediately to the health care provider? Clear mucous vaginal discharge Frequent urination Vaginal bleeding Backache that occurs after standing for a long period
vag. bleeding
During a prenatal visit at 36 weeks of gestation, the nurse tested a woman's urine for glucose and protein. The results indicated a trace amount of glucose. The nurse's next action should be to Retest the urine for accuracy Have the woman give another sample for retesting Report the results immediately to the physician so further testing can be preformed Consider this as a normal result for this stage of pregnancy
Consider this as a normal result for this stage of pregnancy
If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner's first pregnancy? Views pregnancy with pride as a confirmation of his virility Consistently changes the subject when the topic of the fetus/newborn is raised Expresses concern that he might faint at the birth of his baby Experiences nausea and fatigue, along with his partner, during the first trimester
Consistently changes the subject when the topic of the fetus/newborn is raised Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further.
A pregnant client has a 2-year history of uncontrolled hypertension. The nurse can anticipate which fetal study to be ordered? Amniocentesis Chorionic villus sampling Doppler ultrasound blood flow assessment
Doppler ultrasound blood flow assessment Pregnancies complicated by hypertension may have a Doppler ultrasound assessment of blood flow through the umbilical artery done to identify abnormalities in the diastolic flow.
A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: Wiggles and points her toes during the cramp. Applies cold compresses to the affected leg. Extends her leg and dorsiflexes her foot during the cramp. Avoids weight bearing on the affected leg during the cramp.
Extends her leg and dorsiflexes her foot during the cramp. Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp.
While the vital signs of a pregnant woman in her third trimester are being assessment, the woman, who is lying supine, complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? Have the patient stand up; retake her blood pressure. Have the patient sit down and hold her arm in a dependent position. Have the patient lie supine for 5 minutes; recheck her blood pressure on both arms. Have the patient turn to her left side; recheck her blood pressure in 5 minutes.
Have the patient turn to her left side; recheck her blood pressure in 5 minutes.
A pregnant woman's last menstrual period began on April 8, 2009, and ended on April 13. Using Nägele's rule, her estimated date of birth would be: January 15, 2010. January 20, 2010. December 15, 2009. November 5, 2009.
January 15, 2010. Nägele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period. When this rule is used with April 8, 2009, the estimated date of birth is January 15, 2010.
What laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy? Hematocrit 38%, hemoglobin 13 g/dl White blood cell count 6000/mm3 Platelets 300,000/mm3 Rubella titre 1:6
Rubella titre 1:6 A rubella titer of less than 1:10 indicates a lack of immunity to rubella, a viral infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period since administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months.
A maternal serum alpha-fetoprotein (MsAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with: Down syndrome. Sickle cell anemia. Cardiac defects. Open neural tube defects such as spina bifida.
Open neural tube defects such as spina bifida. A triple marker test determines the levels of MsAFP along with serum levels of estriol and human chorionic gonadotropin; an elevated level is associated with open neural tube defects.
On which aspect of fetal diagnostic testing do parents usually place the most importance? Safety of the fetus Duration of the test Cost of the procedure Physical discomfort caused by the procedure
Safety of the fetus A. Although all of these are considerations, parents are usually most concerned about the safety of the fetus. B. Duration of the test is a consideration; however, parents are usually most concerned about the safety of the fetus. C. Cost of the procedure is a consideration; however, parents are usually most concerned about the safety of the fetus. D. Physical discomfort caused by the procedure is a consideration; however, parents are usually most concerned about the safety of the fetus.
The results of a nonstress test shows three fetal heart rate accelerations with fetal movement that peak at 15 beats per minute above baseline and last 15 seconds. The nurses next action should be to Apply acoustic stimulation for one second for further testing This is a reassuring sign and no other testing is necessary at this time Continue to test for 40 additional minutes Prepare the woman for a contraction stress test
This is a reassuring sign and no other testing is necessary at this time A. Acoustic stimulation can be used if the fetus is not active. The results given in the base of the question are reassuring, and no other testing is necessary. B. A reactive sign is at least two fetal heart rate accelerations with or without fetal movement, occurring within a 20-minute period, peaking at least 15 beats per minute about the baseline, and lasting 15 seconds. This is reassuring, and no further testing is necessary. C. The test results are reassuring, and there is no need to continue the test. D. The test results are reassuring, and no further testing is necessary at this time.
A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: Assess the woman's blood pressure and pulse. Have the woman breathe into a paper bag. Raise the woman's legs. Turn the woman on her side.
Turn the woman on her side. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure.
A woman had a chorionic villus sampling procedure. Prior to discharge the nurse should teach her to report what symptom that may be an indication of a complication? Lack of fetal movement Frequent urination Nausea and vomiting Vaginal bleeding or passage of amniotic fluid
Vaginal bleeding or passage of amniotic fluid B. Frequent urination is a common symptom of pregnancy during the first trimester. It is not an indication of procedural complications. C. Nausea and vomiting are a common symptom of pregnancy during the first trimester and not an indication of procedural complications. D. Vaginal bleeding or passage of amniotic fluid suggests possible miscarriage and should be reported.
After a percutaneous umbilical blood sampling (PUBS) on a client, the nurse notes a fetal heart rate of 100. The nurse is aware that this indicates a: major complication, and interventions are necessary immediately. common complication and is usually brief. minor complication that needs to be monitored for the next 2 weeks.
common complication and is usually brief. Fetal bradycardia is the most common complication after PUBS, is usually brief, and has no long-term consequence.
A woman who is 8 months pregnant had a biophysical profile test done. The results give a score of 4/10. The nurse can anticipate that the next plan of action may be to ______________.
consider delivery
A client comes to the clinic requesting an ultrasound to confirm a pregnancy. Her last menstrual period was 15 days ago. The nurse's best response would be to: make an appointment. ask the reason for needing a confirmation this soon in the pregnancy. inform her that an ultrasound can not confirm a pregnancy this early. refer her to a specialist who is trained in confirming early pregnancies.
inform her that an ultrasound can not confirm a pregnancy this early. The gestational sac can be seen about 25 days after the last menstrual period. Therefore, this client may not be able to use an ultrasound for confirmation.
