Ch 12
The nurse is caring for a client who is having a high risk pregnancy and requires genetic studies. Which procedures will the nurse anticipate? Select all that apply. Amniocentesis Maternal serum alpha-fetoprotein screening Chorionic villus sampling Percutaneous umbilical blood sampling Ultrasonography
Amniocentesis Chorionic villus sampling Percutaneous umbilical blood sampling Explanation: The nurse is most correct to anticipate either an amniocentesis or chorionic villus sampling as the primary tests for genetic testing. Percutaneous umbilical blood sampling can also be used to determine genetically linked blood diseases such as von Willebrand disease. Maternal serum alpha-fetoprotein screen is completed to screen for neural tube defects. Ultrasonography is a noninvasive procedure showing fetal images and movement.
In which situation is the nurse correct to document a reactive nonstress test? Select all that apply. At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip Decelerations in the fetal heart rate every 15 minutes The mother noting fetal movement and/or fetal kicks A lack of fetal movement over a 20 minute period
At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip The mother noting fetal movement and/or fetal kicks Explanation: It is a reassuring factor to have a reactive nonstress test. A reactive test shows at least 2 accelerations of the fetal heart rate, variability of the heart rate noted in the monitor strip and the mother notes (which should be seen on the monitor strip as well) the fetus moving and/or kicking. Decelerations and a lack of fetal movement are concerning and will need to have further follow-up.
A 38-year-old client and partner are carriers of the Tay-Sachs gene, have one child with Tay-Sachs, and are concerned to learn she is pregnant again. The nurse predicts the health care provider will order which test if the couple wants to know if this baby will also be born with Tay-Sachs? A multiple marker screening test Amniocentesis Chorionic villus sampling Percutaneous umbilical blood sampling
Chorionic villus sampling Explanation: Chorionic villus sampling (CVS) is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood and is not the best source for chromosomal studies.
Leading a discussion among couples who are thinking about getting pregnant, the nurse stresses that preconception counseling helps to identify risks and encourages modification by the couple before conception. The nurse considers the discussion successful when the couples realize that the greatest risk to the embryo is: between 17 and 56 days after conception. between 4 and 17 days after conception. between 4 and 17 hours after conception. between 17 and 56 hours after conception.
between 17 and 56 days after conception. Explanation: 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 young couple are concerned that their fetus may be born with sickle cell anemia. The nurse explains that the recessive traits of sickle-cell anemia can be determined by using which test? chorionic villus sampling amniocentesis blood typing percutaneous umbilical blood sampling
chorionic villus sampling Explanation: 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 client is in her second trimester, and the health care provider has recommended she undergo an amniocentesis. The nurse explains that the procedure is used to diagnose which conditions? Select all that apply. chromosomal abnormalities inborn errors of metabolism neural tube defects Rh incompatibility HIV
chromosomal abnormalities inborn errors of metabolism neural tube defects Explanation: 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.
Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply. measles mumps influenza rubella Tdap vaccine (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis)
measles mumps rubella Explanation: Live virus vaccines, such as measles, HPV, mumps, rubella, and poliomyelitis (Sabin type), are contraindicated during pregnancy because they may transmit a viral infection to a fetus. Women are advised to be vaccinated against influenza before/during pregnancy. Tetanus is also treated the same in pregnant women as in others by Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) injection.
Which occupation may expose a fetus to environmental hazards? Select all that apply. nurse anesthetist working in a busy oral surgeon's office oncology nurse working in an outpatient chemotherapy unit short-order cook for a busy deli nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client population preschool teacher who has 20 children in the classroom throughout the day
nurse anesthetist working in a busy oral surgeon's office oncology nurse working in an outpatient chemotherapy unit nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client population Explanation: Some occupations are hazardous during pregnancy and should be discontinued because they bring women into contact with harmful substances. For example, nurses working with anesthetic gases in operating rooms or dental offices are reported to have a higher incidence of spontaneous miscarriage and, possibly, congenital anomalies in children than nurses working in other locales, probably because of exposure to nitrous oxide. Nurses working with chemotherapy agents may also be at risk and should wear gloves to protect themselves from exposure to these drugs. Ribavirin, an antiviral formerly used to treat respiratory syncytial virus (RSV) infections, is also apparently teratogenic. It is administered by inhalation to individuals with RSV in hematopoietic cell or heart and lung transplant recipients.
A woman arrives in the emergency department in active labor. She has not received any prenatal care and reports spending a lot of time in a hot tub to relax. The nurse caring for this woman should prepare for which possible birth defect related to the fetus being exposed to prolonged hyperthermia in a hot tub? Select all that apply. white, frothy bubbles in baby's mouth coughing or choking during feedings intestines located outside the abdominal wall large opening in the baby's face and mouth swallowing problems with liquids coming out the baby's nose
white, frothy bubbles in baby's mouth coughing or choking during feedings intestines located outside the abdominal wall Explanation: The common symptoms of esophageal astresia include frothy white bubbles in the baby's mouth and coughing or choking when feeding. An omphalocele is manifested by intestines being located outside the abdominal wall. A large opening in baby's face/mouth and milk coming out of the baby's nose because of swallowing problems are findings associated with cleft lip and palate.
A 35-year-old client has been told to keep her pulse rate below 140 bpm during workouts because she pregnant. This means that the client will be working roughly what percentage of the suggested pulse rate? 60% 65% 70% 75%
75% Explanation: 220 - 35 = 185 x 0.75 = 138.75 (round to 139)
A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which action should the nurse suggest? Select all that apply. Eat some saltine crackers before rising in the morning. Suck on sour candies. Delay breakfast until 10 or 11 AM. Try eating a snack before bedtime Eat two regular meals later in the day. Use a scopolamine patch.
Eat some saltine crackers before rising in the morning. Suck on sour candies. Delay breakfast until 10 or 11 AM. Try eating a snack before bedtime
The pregnant mother and her partner ask the nurse why the health care provider chose a chorionic villus sampling (CVS) procedure over an amniocentesis. The nurse is correct to highlight which benefits of CVS over amniocentesis. Select all that apply. Less cost Quicker results Less procedural discomfort Able to be completed earlier in pregnancy Less potential complications
Quicker results Able to be completed earlier in pregnancy Explanation: Chorionic villus sampling is a procedure similar to amniocentesis that provides chromosomal studies of fetal cells. CVS can be completed earlier in pregnancy with the results returning earlier, in 7 to 10 days. Cost factors are similar. Both procedures may have some associated discomfort.
While triaging messages from the answering machine from clients with the following symptoms, which client would obtain the first visit of the day? The client at 37 weeks' gestation experiencing shortness of breath The client at 11 weeks' gestation experiencing abdominal cramping The client at 24 weeks' gestation experiencing frequent heartburn The client at 6 weeks' gestation experiencing nausea and vomiting
The client at 11 weeks' gestation experiencing abdominal cramping Explanation: The nurse is correct to have the client with the most acute symptom to have the earliest appointment. The client with the most acute symptom is the client in the first trimester experiencing abdominal cramping. The other clients are experiencing common discomforts of pregnancy.
When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used? anterior surface of the sacral prominence and the anterior surface of the symphysis pubis medial surface of the ischial tuberosities interior surface of the sacral prominence and the posterior surface of the symphysis pubis posterior surface of sacrum and the axis of the ischial tuberosities
anterior surface of the sacral prominence and the anterior surface of the symphysis pubis
A pregnant client in her 12th week of gestation has come to a health care center for a physical examination of her abdomen. Where should the nurse palpate for the fundus in this client?
at the symphysis pubis Explanation: In the 12th week of gestation, the nurse should palpate the fundus at the symphysis pubis. The nurse should palpate for the fundus below the ensiform cartilage when the client is in the 36th week of gestation; midway between symphysis and umbilicus in the 16th week of gestation; and at the umbilicus in the 20th week of gestation.
The nurse is reviewing all of the documentation on determining estimated date of delivery. Which objective data is included? Select all that apply. sonogram CT Scan fundal height last day of menstrual period calculating Naegele rule Pelvic exam findings
sonogram fundal height calculating Naegele rule Explanation: The following provide objective data on the estimated date of delivery (EDD). The sonogram (a gold standard) provides detailed fetal measurements confirming the gestational age. The fundal height provides growth data, and Nagele rule calculates the estimated date of delivery using the first day of the last menstrual period. A CT scan is not ordered. Pelvic exam findings provide data that the client is pregnant and can also provide data that true labor has begun.
Which strategies is the nurse correct to utilize when attempting to awaken a potentially sleeping fetus? Select all that apply. Lay the mother on the left side Clap near the mother's abdomen Provide the mother a cold beverage Place hands on the abdomen to move the fetus Use vibroacoustic stimulation
Clap near the mother's abdomen Provide the mother a cold beverage Place hands on the abdomen to move the fetus Use vibroacoustic stimulation
As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month-old daughter, born 2 days after her estimated date of birth; a 3-year-old son born at 35 weeks' gestation; and two lost pregnancies, one at 12 weeks and one at 21 weeks. How should the nurse document this history?
G5 T1 P2 A1 L2 Explanation: The G represents the total number of pregnancies, which is 5. The T represents term deliveries that ended at or beyond 38 weeks' gestation, which is 1. The P refers to preterm deliveries (ended after 20 weeks and before end of 37 weeks), which is 2. The A refers to abortions or the number of pregnancies that ended before 20 weeks' gestation, which is 1. The L refers to living children, which is 2. Thus the nurse will document G5 T1 P2 A1 L2 for this client.
A nurse at the health care facility assesses a client in the 20th week of gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?
at the level of the umbilicus Explanation: In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.
