Chapter 26: Assessment of High Risk Pregnancy
MULTIPLE CHOICE
1. 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 woman’s family history of an NTD, her low BMI, and her drug and alcohol use abuse
are high risk factors of pregnancy. The woman’s 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.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant,
although she has had irreguNlaU
rR enIstN
mS ruGalTpBer.ioCdO
s aMll 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 woman’s 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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
,3. 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 woman’s
pregnancy, it is not used to diagnose IUGR.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment | Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
4. A 41-week pregnant multigravida arrives at the labor and delivery unit after testing
indicated that her fetus couN
ld bR
e exI
perG
iencB
in.
gCsomMe difficulties in utero. Which diagnostic
U S N T
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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment | Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
, 5. 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. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. Non stress test (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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
6. 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. Biophysical profile (BPP)
b. Chorionic villi samplinN
g URSINGTB.COM
c. Maternal Serum Alpha-Fetoprotein Screening (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.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
7. An Maternal Serum Alpha-Fetoprotein Screening (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. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound
c. Biophysical profile (BPP)
d. Amniocentesis
MULTIPLE CHOICE
1. 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 woman’s family history of an NTD, her low BMI, and her drug and alcohol use abuse
are high risk factors of pregnancy. The woman’s 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.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant,
although she has had irreguNlaU
rR enIstN
mS ruGalTpBer.ioCdO
s aMll 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 woman’s 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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
,3. 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 woman’s
pregnancy, it is not used to diagnose IUGR.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment | Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
4. A 41-week pregnant multigravida arrives at the labor and delivery unit after testing
indicated that her fetus couN
ld bR
e exI
perG
iencB
in.
gCsomMe difficulties in utero. Which diagnostic
U S N T
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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment | Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
, 5. 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. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. Non stress test (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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
6. 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. Biophysical profile (BPP)
b. Chorionic villi samplinN
g URSINGTB.COM
c. Maternal Serum Alpha-Fetoprotein Screening (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.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
7. An Maternal Serum Alpha-Fetoprotein Screening (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. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound
c. Biophysical profile (BPP)
d. Amniocentesis
