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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) a. "It helps to maintain the temperature of the fetus." b. "It serves as a mechanism for metabolic exchange." c. "It helps in maintaining fluid and electrolyte balance." d. "It helps in the expansion of airspaces in fetal lungs." e. "It helps in the detection of fetal development."
a, c ,e 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. Unlike the placenta, the amniotic fluid does not serve as a mechanism for the metabolic exchange of nutrients. Expansion of air spaces in the fetal lungs is done by fetal lung fluid secreted by 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? a. The fetus is at risk for Down syndrome. b. The woman is at high risk for developing preterm labor. c. The lung maturity of the fetus d. Meconium is present in the amniotic fluid.
c. 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 presence of surface-active phospholipids is not an indication of Down syndrome. This result reveals that the fetal lungs are mature and in no way indicates risk for preterm labor. Meconium should not be present in the amniotic fluid.
The nurse should teach a pregnant woman that which substances are teratogens? (select all that apply) a. Cigarette smoke b. Isotretinoin (Retin A) c. Vitamin C d. Salicylic acid e. Rubella
a, b, e.
What time span in lunar months, calendar months, weeks, and days indicates the appropriate length for a normal pregnancy? a. 10 lunar months, 9 calendar months, 40 weeks, 280 days b. 9 lunar months, 9 calendar months, 39 weeks, 260 days c. 9 lunar months, 10 calendar months, 40 weeks, 280 days d. 10 lunar months, 10 calendar months, 39 weeks, 260 days
a. 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.
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? a. Retardation of fetal lung maturity b. Retardation of fetal brain maturity c. Retardation of immune system maturity d. Retardation of fetal tubular heart maturity
a. 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. Retardation of fetal brain maturity can cause motor, sensory, or cognitive disorders in the fetus after birth. Retardation of immune system maturity makes the fetus more susceptible to infections. Retardation of the fetal tubular heart maturity causes congenital heart diseases in the fetus after birth.
What is the rationale behind encouraging postpartum clients to nurse when they are producing colostrum? a. Colostrum is rich in immunoglobulin G (IgG). b. Colostrum is rich in immunoglobulin A (IgA). c. Colostrum is rich in immunoglobulin D (IgD). d. Colostrum is rich in immunoglobulin M (IgM).
b. 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.
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? a. Increased maternal blood pressure b. Prolonged contractions c. Impaired fetal respiratory movement d. Slow decrease in progesterone levels
b. 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. Increased maternal blood pressure does not affect the placental blood flow. Fetal respiratory movements are not associated with the placental circulation. Progesterone levels are usually high during pregnancy; they do not affect the blood flow to placenta.
The nurse is providing preconception counseling to a client who is taking carbamazepine (Tegretol) for seizures. What instruction should the nurse) provide with respect to this drug? a. Take carbamazepine (Tegretol) with alcohol. b. Stop taking carbamazepine (Tegretol) and contact your neurologist for alternative medication. c. Increase the dose of carbamazepine (Tegretol). d. Decrease the dose of carbamazepine (Tegretol).
b. Stop taking carbamazepine (Tegretol) and contact your neurologist for alternative medication. Carbamazepine (Tegretol) is an anticonvulsant drug that is a teratogen to the developing embryo and fetus, so clients who are pregnant or are planning to get pregnant should abstain from using it. Administering carbamazepine (Tegretol) with alcohol may synergize the lethal affects and is therefore prohibited. Increasing the dose of the drug may increase the adverse effects and may be lethal to the fetus. Decreasing the dose of the drug may not ensure safety of the client or the fetus.
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? a. "We don't really know when such defects occur." b. "It depends on what caused the defect." c. "They occur between the third and fifth weeks of development." d. "They usually occur in the first 2 weeks of development."
c. "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.
The student nurse is giving a presentation about milestones in embryonic development. Which information should the student include? a. At 8 weeks of gestation, primary lung and urethral buds appear. b. At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. c. At 20 weeks of gestation, the vernix caseosa and lanugo appear. d. At 24 weeks of gestation, the skin is smooth, and subcutaneous fat is beginning to collect.
c. At 20 weeks of gestation, the vernix caseosa and lanugo appear. Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks.
A 35-year-old African-American client informs the nurse of her desire to become pregnant. Based on the client's racial background, what risks should the nurse discuss with the client? a. Triplet pregnancy b. Single fetus pregnancy c. Dizygotic twin pregnancy d. Monozygotic twin pregnancy
c. Dizygotic twin pregnancy African-American women have an increased chance of having dizygotic twins. When the client produces two mature ova in the same ovulation cycle, they both have a chance of being fertilized by different sperm. This results in two fetuses that are not identical, or dizygotic twins. The incidence of dizygotic twinning increases with maternal age up to 35 years, with parity, and with the use of fertility drugs. The occurrences of multifetal pregnancies with three fetuses or triplets have increased with the use of fertility drugs and in vitro fertilization. A single-fetus pregnancy is a normal pregnancy, and it is not associated with race or fertility drugs. There is no association of monozygotic twinning with race, heredity, maternal age, or parity. Fertility drugs increase the incidence of monozygotic twinning.
A pregnant woman has been diagnosed with oligohydramnios. Which presentation would the nurse suspect to find on physical examination? a. Fetus is in a breech position b. FHR baseline is within normal range c. Fetus may have renal problems d. Increased fundal height
c. 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 position of the fetus is due to gestational age and the maternal uterine environment. FHR may be within normal range. FHR is affected by gestational age and fetal well-being. An increase in fundal height would be associated with polyhydramnios and/or gestational age assessment.
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? a. "You are not pregnant if you have any bleeding." b. "You should try to conceive again." c. "You should get a vaginal ultrasound scan done." d. "You should take a pregnancy test after a week."
d. "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. The client is likely to be pregnant and thus the nurse should not ask the client to try conceiving this time. Pregnancy cannot be detected through vaginal ultrasound in early pregnancy.
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? a. 4 weeks b. 8 weeks c. 12 weeks d. 20 weeks
d. 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. In a 4-week-old fetus,there is only a well-marked midbrain flexure; no hindbrain or cervical flexures, and the neural groove is closed. In an 8-week-old fetus, the cerebral cortex begins to acquire typical cells. The cerebral cortex, meninges, and ventricular foramina begin to differentiate, and the cerebrospinal fluid begins to circulate. The spinal cord extends the entire length of the spine. In a 12-week-old fetus, brain structural configuration is almost complete, and the spinal cord shows cervical and lumbar enlargements. The fourth ventricle foramina are developed and sucking is present
The nurse suspects that a client is pregnant and asks the client to take a pregnancy test. What finding would indicate that the test result is positive? a. Presence of cortisol in the serum b. Presence of estrogen in the serum c. Presence of progesterone in the serum d. Presence of human chorionic gonadotropin (hCG) in the serum
d. Presence of human chorionic gonadotropin (hCG) in the serum One of the early functions of a placenta is to act as an endocrine gland and produce a proteinaceous hormone called human chorionic gonadotropin (hCG), whichcan be detected by blood tests as early as 8 to 10 days after conception. Pregnancy tests specifically test for the presence of this hormone. Cortisol is produced by the adrenal glands in both men and women and has no impact on pregnancy. Progesterone and estrogen are found in female patients regardless of pregnancy. These levels fluctuate depending on the ovulation cycle. During pregnancy, levels of estrogen and progesterone may fluctuate depending on the gestation period.
