Chapter 19: Assessment of High Risk Pregnancy My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 19: Assessment of High Risk Pregnancy

Test Bank 

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 and has a body mass index (BMI) of 17.5. She admits to having used cocaine several times during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. 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 place the woman in a high risk category?

a. Blood pressure, age, BMI
b. Drug/alcohol use, age, family history
c. Family history, blood pressure, BMI
d. Family history, BMI, drug/alcohol abuse

ANS: D

Feedback
A 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 would be a high risk.
B The womans drug/alcohol use and family history put her in a high risk category, but her age does not.
C The womans family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal.
D Her family history of NTD, low BMI, and substance abuse are all high risk factors of pregnancy.

DIF:Cognitive Level: ComprehensionREF:561

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

2. A 39-year-old primigravida thinks that she is about 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, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?

a. Ultrasound examination
b. Maternal serum alpha-fetoprotein screening (MSAFP)
c. Amniocentesis
d. Nonstress test (NST)

ANS: A

Feedback
A An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus.
B It is too early in the pregnancy to perform this test. The MSAFP is performed at 16 to 18 weeks of gestation, followed by amniocentesis if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected.
C It is too early in the pregnancy to perform this test. The MSAFP is performed at 16 to 18 weeks of gestation, followed by amniocentesis if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected.
D It is too early in the pregnancy to perform this test. An NST is performed to assess fetal well-being in the third trimester.

DIF:Cognitive Level: ComprehensionREF:565

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

3. A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?

a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein screening (MSAFP)
d. Percutaneous umbilical blood sampling (PUBS)

ANS: B

Feedback
A An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy.
B Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and 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.
C It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being.
D 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: ComprehensionREF:568

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Assessment, Diagnosis

4. At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytics 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 would be 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. Nonstress test

ANS: C

Feedback
A 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 intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
B Typically fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario.
C Amniocentesis would be performed to assess fetal lung maturity in the event of a preterm birth.
D A nonstress test measures the fetal response to fetal movement in a noncontracting mother.

DIF:Cognitive Level: ComprehensionREF:568

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

5. A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?

a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal anomalies
c. Biophysical profile (BPP) for fetal well-being
d. Amniocentesis for genetic anomalies

ANS: B

Feedback
A Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
B If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated AFP, ultrasound examination, and possibly amniocentesis.
C A BPP is a method of assessing fetal well-being in the third trimester.
D Before an amniocentesis is considered, the woman first would have an ultrasound for direct visualization of the fetus.

DIF:Cognitive Level: ApplicationREF:566

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

6. A woman asks her nurse, My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean? The best response by the nurse is:

a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.
b. Your placenta isnt working properly, and your baby is in danger.
c. This means that we will need to perform an amniocentesis to detect if you have any placental damage.
d. Dont worry about it. Everything is fine.

ANS: A

Feedback
A This is an accurate and appropriate statement.
B Although this statement may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the woman.
C An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation.
D This statement is not appropriate and discredits the womans concerns.

DIF:Cognitive Level: ApplicationREF:567

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

7. A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:

a. Negative.
b. Positive.
c. Satisfactory.
d. Unsatisfactory.

ANS: A

Feedback
A Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute timeframe. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative.
B A positive CST indicates the presence of repetitive later FHR decelerations.
C This term is not applicable.
D This term is not applicable.

DIF:Cognitive Level: AnalysisREF:578

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Assessment, Diagnosis

8. In the United States today:

a. More than 20% of pregnancies meet the definition of high risk to either the mother or the infant.
b. Other than biophysical criteria, the greatest socioeconomic risk factor in high risk pregnancies is the inability to access prenatal care.
c. High risk pregnancy status extends from first confirmation of pregnancy to birth.
d. High risk pregnancy is a less critical medical concern because of the reduction in family size and the decrease in unwanted pregnancies.

ANS: B

Feedback
A Approximately 500,000 of the four million births (12.5%) in the United States will be categorized as high risk.
B Lack of access to prenatal care poses the greatest socioeconomic risk to these patients. Other factors include low income, marital status, and ethnicity.
C The high risk status for the mother extends through 30 days after childbirth.
D These factors, along with technologic advances that both facilitate pregnancies in previously infertile couples and advance the potential of care, have enhanced emphasis on delivering babies safely.

DIF:Cognitive Level: ComprehensionREF:561

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

9. When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that:

a. Alcohol or cigarette smoke can irritate the fetus, causing greater activity.
b. Kick counts should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off.
c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
d. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women can.

ANS: C

Feedback
A Alcohol and cigarette smoke temporarily reduce fetal movement.
B The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time.
C No movement in a 12-hour period is cause for investigation and possibly intervention.
D Obese women have a harder time assessing fetal movement.

DIF:Cognitive Level: ComprehensionREF:564

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

10. In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that:

a. Both require the woman to have a full bladder.
b. The abdominal examination is more useful in the first trimester.
c. Initially the transvaginal examination can be painful.
d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

ANS: D

Feedback
A The abdominal examination requires a full bladder; the transvaginal examination requires an empty one.
B The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester.
C Neither method should be painful, although with the transvaginal examination the woman will feel pressure as the probe is moved.
D It also allows intrauterine pregnancies to be diagnosed earlier.

DIF:Cognitive Level: KnowledgeREF:564

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

11. In the first trimester, ultrasonography can be used to gain information on:

a. Amniotic fluid volume.
b. Uterine abnormalities.
c. Placental location and maturity.
d. Cervical length.

ANS: B

Feedback
A This information would not be available via ultrasonography until the second or third trimester.
B Ultrasonography can detect certain uterine abnormalities such as bicornate uterus and fibroids.
C This information would not be available via ultrasonography until the second or third trimester.
D This information would not be available via ultrasonography until the second or third trimester.

DIF:Cognitive Level: KnowledgeREF:565

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

12. Nurses should be aware that the biophysical profile (BPP):

a. Is an accurate indicator of fetal well-being.
b. Is a compilation of health risk factors of the mother during the later stages of pregnancy.
c. Consists of a Doppler blood flow analysis and an amniotic fluid index.
d. Involves an invasive form of ultrasonic examination.

ANS: A

Feedback
A An abnormal BPP score is one indication that labor should be induced.
B The BPP evaluates the health of the fetus.
C The BPP requires many different measures.
D The BPP is a noninvasive procedure.

DIF:Cognitive Level: ComprehensionREF:568

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

13. In comparison to contraction stress tests (CSTs), the nonstress test (NST) for antepartum fetal assessment:

a. Has no known contraindications.
b. Has fewer false-positive results.
c. Is more sensitive in detecting fetal compromise.
d. Is slightly more expensive.

ANS: A

Feedback
A The NST is noninvasive, inexpensive, and has no known contraindications.
B The NST has a high rate of false-positive results.
C The NST is less sensitive than the CST.
D The NST is relatively inexpensive.

DIF:Cognitive Level: ComprehensionREF:575

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

14. Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring woman with diabetes mellitus, the nurse is aware that she is at a greater risk for:

a. Oligohydramnios.
b. Polyhydramnios.
c. Postterm pregnancy.
d. Chromosomal abnormalities.

ANS: B

Feedback
A Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios.
B Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in diabetic rather than nondiabetic pregnancies. This will put the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage.
C Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy.
D Maternal age greater than 35 and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.

DIF:Cognitive Level: ApplicationREF:563

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Intrauterine growth restriction is associated with what pregnancy-related risk factors? Choose all that apply.

a. Poor nutrition
b. Maternal collagen disease
c. Gestational hypertension
d. Premature rupture of membranes
e. Smoking

ANS: A, B, C, E

Feedback
Correct These risk factors are associated with the occurrence of intrauterine growth restriction (IUGR).
Incorrect Premature rupture of membranes is associated with preterm labor, not IUGR.

DIF:Cognitive Level: AnalysisREF:563

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

Leave a Reply