NSG 312 Exam 2 Lippincott: Assessment of Pregnancy

Types of breech

Although breech presentations are rare, footling breech occurs when there is an extension of the fetal knees and one or both feet protrude through the pelvis. In frank breech, there is flexion of the fetal thighs and extension of the knees. The feet rest at the sides of the fetal head. In complete breech, there is flexion of the fetal thighs and knees; the fetus appears to be squatting. Vertex position occurs in 95% of births; in such cases, the head is engaged in the pelvis

A 24-year-old nulligravid client with a history of irregular menstrual cycles visits the clinic because she suspects that she is "about 6 weeks pregnant." An ultrasound is scheduled in 2 weeks. What should the nurse tell the client that the primary purpose of the test is?

Assess gestational age.

A client who is pregnant with her second child comes to the clinic complaining of a pulling and tightening sensation over her pubic bone every 15 minutes. She reports no vaginal fluid leakage. Because she has just entered her 36th week of pregnancy, she is apprehensive about her symptoms. Vaginal examination discloses a closed, thick, posterior cervix. These findings suggest that the client is experiencing:

Braxton Hicks contractions.

A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform mole. Which expected outcome takes highest priority for this client?

Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative.

To determine if a client is at risk for a TORCH infection, what question should the nurse ask?

Do you have any cats at home?

A primigravid adolescent client at approximately 15 weeks' gestation is visiting the prenatal clinic to undergo maternal quad screening. What information should the nurse include in the teaching plan for this client?

Increased levels of alpha-fetoprotein (AFP) are associated with neural tube defects.

During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 20 beats/minute, each lasting 20 seconds. These increases occur only with fetal movement. What does this finding suggest?

The fetus is not in distress at this time.

What is the purpose of a maternal blood test for alpha-fetoprotein?

To detect neural tube defects.

What procedure can be used to estimate the gestational age of a fetus?

Ultrasonography

A client is scheduled for amniocentesis. When preparing the client for the procedure, the nurse should:

ask the client to void.

A nurse is assessing a client who's 29 weeks pregnant. What is the most cost-effective method for assessing fetal well-being?

maternal fetal activity count

A primigravid client with diabetes at 38 weeks' gestation asks the nurse why she had a fetal acoustic stimulation during her last nonstress test. Which should the nurse include as the rationale for this test?

to startle and awaken the fetus

A multigravid client visits the clinic because they suspect that they are pregnant. The client, however, is unable to tell the nurse when their last menstrual period began. The client has a history of preterm birth. The nurse instructs the client that the gestational age of the fetus can be estimated by which procedure?

ultrasonography

Following an eclamptic seizure, the nurse should assess the client for which complication?

uterine contractions

After teaching a pregnant client about potential complications of amniocentesis that must be reported immediately, the nurse determines that the client understands the instruction when they say that they will report which problem?

vaginal bleeding

An obstetric ultrasound reveals that the client's fetus has spina bifida. The mother is concerned about raising a child with a congenital abnormality and she starts to cry. Which response by the nurse is best?

Sit at her bedside and allow the client to express her feelings.

A multigravid client at 38 weeks' gestation is scheduled to undergo a contraction stress test. What should the nurse include in the explanation as the purpose of this test?

assessment of fetal ability to tolerate labor

When performing Leopold maneuvers, the nurse would ask the client to perform which action to ensure optimal comfort and accuracy?

emptying their bladder.

What assessment finding requires further investigation in a client with a 4-pound weight gain at 15 weeks' gestation?

Fundal height of 18 cm.

A client is told that she needs to have a nonstress test to determine fetal well-being. After 20 minutes of monitoring, the nurse reviews the strip and finds two 15-beat accelerations that lasted for 15 seconds. What should the nurse do next?

Inform the physician and prepare for discharge; this client has a normal strip.

The health care provider prescribes a maternal blood test for alpha-fetoprotein for a nulligravid client at 16 weeks' gestation. When developing the teaching plan, the nurse bases the explanations on the understanding that this test is used to detect which condition?

neural tube defects

A client at 36 weeks' gestation with type 1 diabetes has an abnormal biophysical profile and is scheduled for a contraction stress test. After explaining the purpose of the test, the nurse determines that the client understands the instruction when they state that the test is done to detect which problem?

uteroplacental sufficiency

What information should be included when teaching a primigravid client about diagnostic tests used in pregnancy?

A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity.

A 40-year-old primigravid client with AB-positive blood visits the outpatient clinic for an amniocentesis at 16 weeks' gestation. The nurse determines that the most likely reason for the client's amniocentesis is to determine if the fetus has which problem?

Down syndrome

What does a reactive nonstress test indicate about the fetus?

Fetal well-being at this point in the pregnancy.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of the fetus. The client's BPP score is 8. What does this score indicate?

The fetus isn't in distress at this time.

A 27-year-old primigravid client with insulin-dependent diabetes at 34 weeks' gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate?

There is evidence of fetal well-being.

During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, a nurse should instruct the client to push the control button at which time?

at the beginning of each fetal movement

A client at 36 weeks' gestation is scheduled for a routine ultrasound prior to an amniocentesis. After the nurse teaches the client about the purpose of the ultrasound, which client statement would indicate to the nurse that the client needs further instruction?

"The ultrasound identifies blood flow through the umbilical cord."

During routine prenatal screening, a nurse tells a client that her blood sample will be used for alpha fetoprotein (AFP) testing. Which statement best describes what AFP testing indicates?

"This test will screen for spina bifida, Down syndrome, or other genetic defects."

The fetus of a multigravid client at 38 weeks' gestation is determined to be in a frank breech presentation. The nurse describes this presentation to the client as which fetal part coming in contact with the cervix?

buttocks

A nurse is caring for a post-term client at 41 weeks of gestation who is about to undergo a biophysical profile (BPP) to evaluate her fetus's well-being. The client asks, "What will be able to be determined from this test?" The nurse is correct to answer which?

fetal tone fetal breathing movements amniotic fluid volume