MIDTERM REVIEW:Lowdermilk:
Maternity & Womens Health Care,
11th Edition 100% ACCURATE
A woman arrives at the clinic seeking confirmation that she is
pregnant. The following information is obtained: She is 24 years old
with a body mass index (BMI) of 17.5. She admits to having used
cocaine several times during the past year and occasionally drinks
alcohol. Her blood pressure is 108/70 mm Hg. The family history is
positive for diabetes mellitus and cancer. Her sister recently gave
birth to an infant with a neural tube defect (NTD). Which
characteristics places this client in a high-risk category?
a.
Blood pressure, age, BMI
b.
Drug and alcohol use, age, family history
c.
Family history, blood pressure (BP), BMI
d.
Family history, BMI, drug and alcohol abuse
ANS: D
The womans family history of an NTD, her low BMI, and her drug and
alcohol use abuse are high risk factors of pregnancy. The womans BP
is normal, and her age does not put her at risk. Her BMI is low and
may indicate poor nutritional status, which is a high risk.
DIF: Cognitive Level: Analyze REF: p. 633
A 39-year-old primigravida woman believes that she is approximately 8
weeks pregnant, although she has had irregular menstrual periods all
her life. She has a history of smoking approximately one pack of
cigarettes a day; however, she tells the nurse that she is trying to
cut down. Her laboratory data are within normal limits. What
diagnostic technique would be useful at this time?
a.
Ultrasound examination
b.
Maternal serum alpha-fetoprotein (MSAFP) screening
c.
Amniocentesis
,d.
Nonstress test (NST)
ANS: A
An ultrasound examination could be performed to confirm the pregnancy
and to determine the gestational age of the fetus. An MSAFP screening
is performed at 16 to 18 weeks of gestation; therefore, it is too
early in the womans pregnancy to perform this diagnostic test. An
amniocentesis is performed if the MSAFP levels are abnormal or if
fetal or maternal anomalies are detected. An NST is performed to
assess fetal well-being in the third trimester.
DIF: Cognitive Level: Understand REF: p. 635
Brainpower
The nurse sees a woman for the first time when she is 30 weeks
pregnant. The client has smoked throughout the pregnancy, and fundal
height measurements now are suggestive of intrauterine growth
restriction (IUGR) in the fetus. In addition to ultrasound to measure
fetal size, what is another tool useful in confirming the diagnosis?
a.
Doppler blood flow analysis
b.
Contraction stress test (CST)
c.
Amniocentesis
d.
Daily fetal movement counts
ANS: A
Doppler blood flow analysis allows the examiner to study the blood
flow noninvasively in the fetus and the placenta. It is a helpful
tool in the management of high-risk pregnancies because of IUGR,
diabetes mellitus, multiple fetuses, or preterm labor. Because of the
potential risk of inducing labor and causing fetal distress, a CST is
not performed on a woman whose fetus is preterm. Indications for an
amniocentesis include diagnosis of genetic disorders or congenital
anomalies, assessment of pulmonary maturity, and the diagnosis of
fetal hemolytic disease, not IUGR. Fetal kick count monitoring is
performed to monitor the fetus in pregnancies complicated by
conditions that may affect fetal oxygenation. Although this may be a
useful tool at some point later in this womans pregnancy, it is not
used to diagnose IUGR.
DIF: Cognitive Level: Analyze REF: p. 639
A 41-week pregnant multigravida arrives at the labor and delivery
unit after a NST indicated that her fetus could be experiencing some
,difficulties in utero. Which diagnostic tool yields more detailed
information about the condition of the fetus?
a.
Ultrasound for fetal anomalies
b.
Biophysical profile (BPP)
c.
MSAFP screening
d.
Percutaneous umbilical blood sampling (PUBS)
ANS: B
Real-time ultrasound permits a detailed assessment of the physical
and physiologic characteristics of the developing fetus and a
cataloging of normal and abnormal biophysical responses to stimuli.
The BPP is a noninvasive, dynamic assessment of a fetus that is based
on acute and chronic markers of fetal disease. An ultrasound for
fetal anomalies would most likely have occurred earlier in the
pregnancy. It is too late in the pregnancy to perform an MSAFP.
Furthermore, it does not provide information related to fetal well-
being. Indications for PUBS include prenatal diagnosis or inherited
blood disorders, karyotyping of malformed fetuses, detection of fetal
infection, determination of the acid-base status of the fetus with
IUGR, and assessment and treatment of isoimmunization and
thrombocytopenia in the fetus.
DIF: Cognitive Level: Understand REF: p. 640
At 35 weeks of pregnancy, a woman experiences preterm labor. Although
tocolytic medications are administered and she is placed on bed rest,
she continues to experience regular uterine contractions and her
cervix is beginning to dilate and efface. What is an important test
for fetal well-being at this time?
a.
PUBS
b.
Ultrasound for fetal size
c.
Amniocentesis for fetal lung maturity
d.
NST
ANS: C
Amniocentesis is performed to assess fetal lung maturity in the event
of a preterm birth. The fluid is examined to determine the lecithin
to sphingomyelin (L/S) ratio. Indications for PUBS include prenatal
diagnosis or inherited blood disorders, karyotyping of malformed
, fetuses, detection of fetal infection, determination of the acid-base
status of the fetus with IUGR, and assessment and treatment of
isoimmunization and thrombocytopenia in the fetus. Determination of
fetal size by ultrasound is typically performed during the second
trimester and is not indicated in this scenario. An NST measures the
fetal response to fetal movement in a noncontracting mother.
DIF: Cognitive Level: Understand REF: p. 642 TOP: Nursing Process:
Evaluation
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation.
Which screening test should the nurse recommend be ordered for this
client?
a.
BPP
b.
Chorionic villi sampling
c.
MSAFP screening
d.
Screening for diabetes mellitus
ANS: C
The biochemical assessment MSAFP test is performed from week 15 to
week 20 of gestation (weeks 16 to 18 are ideal). A BPP is a method of
biophysical assessment of fetal well-being in the third trimester.
Chorionic villi sampling is a biochemical assessment of the fetus
that should be performed from the 10th to 12th weeks of gestation.
Screening for diabetes mellitus begins with the first prenatal visit.
DIF: Cognitive Level: Apply REF: p. 645 TOP: Nursing Process:
Planning
An MSAFP screening indicates an elevated level of alpha-fetoprotein.
The test is repeated, and again the level is reported as higher than
normal. What is the next step in the assessment sequence to determine
the well-being of the fetus?
a.
PUBS
b.
Ultrasound for fetal anomalies
c.
BPP for fetal well-being
d.
Amniocentesis for genetic anomalies
ANS: B
If MSAFP findings are abnormal, then follow-up procedures include
Maternity & Womens Health Care,
11th Edition 100% ACCURATE
A woman arrives at the clinic seeking confirmation that she is
pregnant. The following information is obtained: She is 24 years old
with a body mass index (BMI) of 17.5. She admits to having used
cocaine several times during the past year and occasionally drinks
alcohol. Her blood pressure is 108/70 mm Hg. The family history is
positive for diabetes mellitus and cancer. Her sister recently gave
birth to an infant with a neural tube defect (NTD). Which
characteristics places this client in a high-risk category?
a.
Blood pressure, age, BMI
b.
Drug and alcohol use, age, family history
c.
Family history, blood pressure (BP), BMI
d.
Family history, BMI, drug and alcohol abuse
ANS: D
The womans family history of an NTD, her low BMI, and her drug and
alcohol use abuse are high risk factors of pregnancy. The womans BP
is normal, and her age does not put her at risk. Her BMI is low and
may indicate poor nutritional status, which is a high risk.
DIF: Cognitive Level: Analyze REF: p. 633
A 39-year-old primigravida woman believes that she is approximately 8
weeks pregnant, although she has had irregular menstrual periods all
her life. She has a history of smoking approximately one pack of
cigarettes a day; however, she tells the nurse that she is trying to
cut down. Her laboratory data are within normal limits. What
diagnostic technique would be useful at this time?
a.
Ultrasound examination
b.
Maternal serum alpha-fetoprotein (MSAFP) screening
c.
Amniocentesis
,d.
Nonstress test (NST)
ANS: A
An ultrasound examination could be performed to confirm the pregnancy
and to determine the gestational age of the fetus. An MSAFP screening
is performed at 16 to 18 weeks of gestation; therefore, it is too
early in the womans pregnancy to perform this diagnostic test. An
amniocentesis is performed if the MSAFP levels are abnormal or if
fetal or maternal anomalies are detected. An NST is performed to
assess fetal well-being in the third trimester.
DIF: Cognitive Level: Understand REF: p. 635
Brainpower
The nurse sees a woman for the first time when she is 30 weeks
pregnant. The client has smoked throughout the pregnancy, and fundal
height measurements now are suggestive of intrauterine growth
restriction (IUGR) in the fetus. In addition to ultrasound to measure
fetal size, what is another tool useful in confirming the diagnosis?
a.
Doppler blood flow analysis
b.
Contraction stress test (CST)
c.
Amniocentesis
d.
Daily fetal movement counts
ANS: A
Doppler blood flow analysis allows the examiner to study the blood
flow noninvasively in the fetus and the placenta. It is a helpful
tool in the management of high-risk pregnancies because of IUGR,
diabetes mellitus, multiple fetuses, or preterm labor. Because of the
potential risk of inducing labor and causing fetal distress, a CST is
not performed on a woman whose fetus is preterm. Indications for an
amniocentesis include diagnosis of genetic disorders or congenital
anomalies, assessment of pulmonary maturity, and the diagnosis of
fetal hemolytic disease, not IUGR. Fetal kick count monitoring is
performed to monitor the fetus in pregnancies complicated by
conditions that may affect fetal oxygenation. Although this may be a
useful tool at some point later in this womans pregnancy, it is not
used to diagnose IUGR.
DIF: Cognitive Level: Analyze REF: p. 639
A 41-week pregnant multigravida arrives at the labor and delivery
unit after a NST indicated that her fetus could be experiencing some
,difficulties in utero. Which diagnostic tool yields more detailed
information about the condition of the fetus?
a.
Ultrasound for fetal anomalies
b.
Biophysical profile (BPP)
c.
MSAFP screening
d.
Percutaneous umbilical blood sampling (PUBS)
ANS: B
Real-time ultrasound permits a detailed assessment of the physical
and physiologic characteristics of the developing fetus and a
cataloging of normal and abnormal biophysical responses to stimuli.
The BPP is a noninvasive, dynamic assessment of a fetus that is based
on acute and chronic markers of fetal disease. An ultrasound for
fetal anomalies would most likely have occurred earlier in the
pregnancy. It is too late in the pregnancy to perform an MSAFP.
Furthermore, it does not provide information related to fetal well-
being. Indications for PUBS include prenatal diagnosis or inherited
blood disorders, karyotyping of malformed fetuses, detection of fetal
infection, determination of the acid-base status of the fetus with
IUGR, and assessment and treatment of isoimmunization and
thrombocytopenia in the fetus.
DIF: Cognitive Level: Understand REF: p. 640
At 35 weeks of pregnancy, a woman experiences preterm labor. Although
tocolytic medications are administered and she is placed on bed rest,
she continues to experience regular uterine contractions and her
cervix is beginning to dilate and efface. What is an important test
for fetal well-being at this time?
a.
PUBS
b.
Ultrasound for fetal size
c.
Amniocentesis for fetal lung maturity
d.
NST
ANS: C
Amniocentesis is performed to assess fetal lung maturity in the event
of a preterm birth. The fluid is examined to determine the lecithin
to sphingomyelin (L/S) ratio. Indications for PUBS include prenatal
diagnosis or inherited blood disorders, karyotyping of malformed
, fetuses, detection of fetal infection, determination of the acid-base
status of the fetus with IUGR, and assessment and treatment of
isoimmunization and thrombocytopenia in the fetus. Determination of
fetal size by ultrasound is typically performed during the second
trimester and is not indicated in this scenario. An NST measures the
fetal response to fetal movement in a noncontracting mother.
DIF: Cognitive Level: Understand REF: p. 642 TOP: Nursing Process:
Evaluation
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation.
Which screening test should the nurse recommend be ordered for this
client?
a.
BPP
b.
Chorionic villi sampling
c.
MSAFP screening
d.
Screening for diabetes mellitus
ANS: C
The biochemical assessment MSAFP test is performed from week 15 to
week 20 of gestation (weeks 16 to 18 are ideal). A BPP is a method of
biophysical assessment of fetal well-being in the third trimester.
Chorionic villi sampling is a biochemical assessment of the fetus
that should be performed from the 10th to 12th weeks of gestation.
Screening for diabetes mellitus begins with the first prenatal visit.
DIF: Cognitive Level: Apply REF: p. 645 TOP: Nursing Process:
Planning
An MSAFP screening indicates an elevated level of alpha-fetoprotein.
The test is repeated, and again the level is reported as higher than
normal. What is the next step in the assessment sequence to determine
the well-being of the fetus?
a.
PUBS
b.
Ultrasound for fetal anomalies
c.
BPP for fetal well-being
d.
Amniocentesis for genetic anomalies
ANS: B
If MSAFP findings are abnormal, then follow-up procedures include
