Assessment of High Risk Pregnancy
A client at 36 weeks' gestation is scheduled for a routine ultrasound prior to an amniocentesis. After teaching 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." Before amniocentesis, a routine ultrasound is valuable in locating the placenta, locating a pool of amniotic fluid, and showing the primary care provider where to insert the needle. Color Doppler imaging ultrasonography identifies blood flow through the umbilical cord. A routine ultrasound does not accomplish this.
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."
When teaching a primigravid client about the diagnostic tests used in pregnancy, the nurse should include which information?
A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity
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?
Asses 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. After a molar pregnancy, the client should receive follow-up care, including regular hCG testing, for 1 year because of the risk of developing chorionic carcinoma. After removal of a hydatidiform mole, the hCG level gradually falls to a negative reading unless chorionic carcinoma is developing, in which case the hCG level rises. A Pap test isn't an effective indicator of a hydatidiform mole. A follow-up examination would be scheduled within weeks of the client's discharge. The client must not become pregnant during follow-up care because pregnancy causes the hCG level to rise, making it indistinguishable from this early sign of chorionic carcinoma.
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 Because of the client's age, the amniocentesis is most likely being done to evaluate for Down syndrome (trisomy 21). Women older than 35 years are at higher risk for having a child with Down syndrome. Cri-du-chat syndrome is a genetic disorder involving a short arm on chromosome 5. This disorder is not associated with mothers who are older than 35 years. The client is AB-positive, so the amniocentesis is not being done for ABO incompatibility, in which the mother is type O and the fetus is type A, B, or AB. The amniocentesis is not being done to detect erythroblastosis fetalis because the mother is Rh-positive.
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.
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.
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
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 client is scheduled for amniocentesis. When preparing the client for the procedure, the nurse should:
ask patient to void
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
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
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?
butt
A nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To help determine whether the client is at risk for a TORCH infection, the nurse should ask which question?
do you have cats at home
When performing Leopold's maneuvers, which action would the nurse ask the client to perform to ensure optimal comfort and accuracy?
emptying her bladder
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?
evidence of fetal well being
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? Select all that apply.
fetal tone fetal breathing movements amniotic fluid volume
A nulligravid client with gestational diabetes tells the nurse that she had a reactive nonstress test 3 days ago and asks, "What does that mean?" The nurse explains that a reactive nonstress test indicates which of the following about the fetus?
fetal well being at this pint in the pregnancy
A client has her first prenatal visit at 15 weeks' gestation. The client weighs 144 lb (65.5kg) and states this is a 4-pound weight gain. Which assessment finding requires further investigation?
fundal height of 18 cm Fundal height (in centimeters) should roughly equal the number of weeks' gestation. This client should have a fundal height of 15 to 16 cm. A height of 18 cm could be indicative of many things, including multiples or polyhydramnios. The blood pressure, urine, and weight findings are within normal limits for this client. During the first trimester, weight gain should average between 1 and 4.5 pounds (0.5-2 kg).
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
Following an eclamptic seizure, the nurse should assess the client for which complication?
uterine contractions After an eclamptic seizure, the client commonly falls into a deep sleep or coma. The nurse must continually monitor the client for signs of impending labor because the client will not be able to verbalize that contractions are occurring. Oliguria is more common than polyuria after an eclamptic seizure. Facial flushing is not common unless it is caused by a reaction to a medication. Typically, the client remains hypertensive unless medications such as magnesium sulfate are administered
A client at 36 weeks' gestation with type 1 diabetes is scheduled for a contraction stress test. After explaining the purpose of the test, the nurse determines that the client understands the instruction when she states that the test is done to detect which problem?
uteroplacental sufficiency
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 she says that she will report which problem?
vaginal bleeding
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 Fetal acoustic stimulation involves the use of an instrument that emits sound levels of approximately 80 dB at a frequency of 80 Hz. The sharp sound startles and awakens the fetus and is used with nonstress testing as a method to evaluate fetal well-being.
A multigravid client visits the clinic because she suspects that she is pregnant but is unable to tell the nurse when her 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
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 are associated with neural tube defects. increased alpha fetoprotein (AFP) is one of the four laboratory values in a maternal quad screen. The labs are human chorionic gonadotropin, estriol, and inhibin-A. Increased AFP levels are associated with neural tube defects, such as spina bifida, anencephaly, and encephalocele. Ultrasonography is used to confirm a neural tube defect only when AFP levels are increased. Because AFP levels are usually highest at 15 to 18 weeks' gestation, this is the optimum time for testing. Performing the test after this time leads to inaccurate results. The client's blood, not urine, is used for the sample.
The nurse is assessing fetal presentation in a multiparous client. The figure here indicates which presentation?: foot is dangling out of birth canal
footling breech
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 Maternal fetal activity count is the least invasive and demanding method for assessing fetal well-being. To use this method, the client simply counts, records, and reports the number of times the fetus kicks during a designated period each day. Chorionic villi sampling is invasive and expensive and should be reserved for pregnant clients at risk for genetic defects. Ultrasonography and nonstress testing, although noninvasive, are expensive and require the use of medical facilities, which may place extra demands on the client's finances.
