Chapter 26: Assessment for Risk Factors in Pregnancy My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 26: Assessment for Risk Factors in 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 with 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 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 (BP), BMI

d.

Family history, BMI, drug/alcohol abuse

ANS: D

Her family history of NTD, low BMI, and substance 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.

The womans drug/alcohol (ETOH) use and family history put her in a high risk category, but her age does not.

The womans family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which is high risk. Her BP is normal.

DIF: Cognitive Level: Comprehension REF: 637, 638

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 (MSAFP) screening

c.

Amniocentesis

d.

Nonstress test (NST)

ANS: A

An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus.

It is too early in the pregnancy to perform an MSAFP screening; it is performed at 16 to 18 weeks of gestation.

An amniocentesis is performed if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected. This procedure is not performed until 16 to 18 weeks of gestation.

An NST is performed to assess fetal well-being in the third trimester.

DIF: Cognitive Level: Comprehension REF: 641

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

3. A nurse sees a woman for the first time when she is 30 weeks pregnant. The woman 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: Analysis REF: 643

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

4. 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 yields more detailed information about the fetus?

a.

Ultrasound for fetal anomalies

b.

Biophysical profile (BPP)

c.

Maternal serum alpha-fetoprotein (MSAFP) screening

d.

Percutaneous umbilical blood sampling (PUBS)

ANS: 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.

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 intrauterine growth restriction (IUGR), and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

DIF: Cognitive Level: Comprehension REF: 643, 644

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

5. 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 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.

Nonstress test (NST)

ANS: C

Amniocentesis is performed to assess fetal lung maturity in the event of a preterm birth.

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 (IUGR), and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

Determination of fetal size by ultrasound typically is done 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: Comprehension REF: 645, 647

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

6. A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. What screening test should be suggested to her?

a.

Biophysical profile

b.

Chorionic villi sampling

c.

Maternal serum alpha-fetoprotein (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 biophysical profile 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 tenth to twelfth weeks of gestation.

Screening for diabetes mellitus begins with the first prenatal visit.

DIF: Cognitive Level: Comprehension REF: 648

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

7. A maternal serum alpha-fetoprotein (MSAFP) test indicates an elevated level. It is repeated and again 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 for fetal anomalies

c.

Biophysical profile (BPP) for fetal well-being

d.

Amniocentesis for genetic anomalies

ANS: B

If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect (NTD), repeated AFP, ultrasound examination, and possibly amniocentesis.

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 (IUGR), and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

A BPP is a method of assessing fetal well-being in the third trimester.

Prior to an amniocentesis, the client would have an ultrasound for direct visualization of the fetus.

DIF: Cognitive Level: Application REF: 649

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

8. A client 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

Calcium deposits are of significance in postterm pregnancies. Ultrasonography can be used to determine placental aging.

Although stating that the clients placenta isnt working properly and the baby is in danger may be a valid response, it does not reflect therapeutic communication techniques and is likely to alarm the client.

An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation.

Telling the client not to worry is not appropriate and discredits her concerns.

DIF: Cognitive Level: Application REF: 642

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

9. 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

Adequate uterine activity necessary for a CST consists of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative.

A positive CST indicates the presence of repetitive later FHR decelerations.

The term satisfactory is not applicable.

The term unsatisfactory is not applicable.

DIF: Cognitive Level: Analysis REF: 652

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

10. 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, sociodemographic factors place both the mother and baby at risk

c.

High risk pregnancy status extends from first confirmation of pregnancy to birth

d.

High risk pregnancy is less critical a medical concern because of the reduction in family size and the decrease in unwanted pregnancies

ANS: B

Sociodemographic risks include lack of prenatal care, low income, marital status, and ethnicity.

Approximately 500,000 of the 4 million births (12.5%) in the United States are categorized as high risk.

The high risk status for the mother extends through 30 days after childbirth.

The reduction in family size and the decrease in unwanted pregnancies, along with technologic advances that facilitate pregnancies in previously infertile couples and advance the potential of care, have enhanced emphasis on delivering babies safely.

DIF: Cognitive Level: Comprehension REF: 637

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

11. With regard to maternal, fetal, and neonatal health problems, nurses should be aware that:

a.

Infection has replaced pulmonary embolism as one of the three top causes of maternal death attributable to pregnancy

b.

The leading cause of death in the neonatal period is disorders related to short gestation and low birth weight

c.

Factors related to the maternal death rate include age and marital status but not race

d.

Antepartum fetal deaths can best be prevented by better recognizing and responding to abnormalities of pregnancy and labor

ANS: D

Medical teams need to be alert to signs of trouble. Race is a factor. African-American maternal mortality rates are more than three times higher than those for Caucasian women.

Infection used to be an important cause of maternal death; it has been replaced by pulmonary embolism.

The leading cause of death in the neonatal period is congenital anomalies.

Race is a factor. African-American maternal mortality rates are more than three times higher than those for Caucasian women.

DIF: Cognitive Level: Comprehension REF: 638

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

12. Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?

a.

Moderate coffee consumption

b.

Moderate alcohol consumption

c.

Cigarette smoke

d.

Emotional distress

ANS: A

Birth defects in humans have not been related to caffeine consumption. Pregnant women who consume more than 300 mg of caffeine daily may be at increased risk for miscarriage or intrauterine growth restriction (IUGR).

Although the exact effects of alcohol in pregnancy have not been quantified, it exerts adverse effects on the fetus including fetal alcohol syndrome, fetal alcohol effects, learning disabilities, and hyperactivity.

A strong, consistent, causal relation has been established between maternal smoking and reduced birth weight.

Childbearing triggers profound and complex physiologic and psychologic changes. Evidence suggests a relationship between emotional distress and birth complications.

DIF: Cognitive Level: Analysis REF: 638

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

13. When nurses help their expectant mothers assess the daily fetal movement counts (DFMCs) they should be aware that:

a.

Alcohol or cigarette smoke can irritate the fetus into 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-sized women

ANS: C

No movement in a 12-hour period is cause for investigation and possibly intervention.

Alcohol and cigarette smoke temporarily reduce fetal movement.

The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time.

Obese women have a harder time assessing fetal movement.

DIF: Cognitive Level: Comprehension REF: 640

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

14. In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their clients 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

The transvaginal examination also allows intrauterine pregnancies to be diagnosed earlier.

The abdominal examination requires a full bladder; the transvaginal examination requires an empty one.

The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester.

Neither method should be painful, although with the transvaginal examination the woman will feel pressure as the probe is moved.

DIF: Cognitive Level: Knowledge REF: 640

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

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

a.

Amniotic fluid volume

b.

The presence of maternal abnormalities

c.

Placental location and maturity

d.

Cervical length

ANS: B

Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and ovarian cysts.

Amniotic fluid volume is not available via ultrasonography until the second or third trimester.

Placental location and maturity are not available via ultrasonography until the second or third trimester.

Cervical length is not available via ultrasonography until the second or third trimester.

DIF: Cognitive Level: Knowledge REF: 641

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

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

a.

Is an accurate indicator of impending 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 (AFI)

d.

Involves an invasive form of ultrasonic examination

ANS: A

An abnormal BPP score is one indication that labor should be induced.

The BPP evaluates the health of the fetus.

The BPP requires many different measures.

The BPP is a noninvasive procedure.

DIF: Cognitive Level: Comprehension REF: 643

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

17. With regard to amniocentesis, nurses should be aware that:

a.

Because of new imaging techniques, it is now possible in the first trimester

b.

Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases

c.

Administration of RhoD immunoglobulin may be necessary

d.

The presence of meconium in the amniotic fluid is always cause for concern

ANS: C

Due to the possibility of fetomaternal hemorrhage, administration of RhoD immunoglobulin is the standard of practice after amniocentesis for women who are Rh negative.

Amniocentesis is possible after the fourteenth week of pregnancy when the uterus becomes an abdominal organ.

Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography.

Meconium in the amniotic fluid before the beginning of labor is not usually a problem.

DIF: Cognitive Level: Comprehension REF: 645

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

18. 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

The CST has several contraindications.

The NST has a high rate of false-positive results.

The NST is less sensitive than the CST.

The NST is relatively inexpensive.

DIF: Cognitive Level: Comprehension REF: 651

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

19. Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client 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

Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in diabetic rather than nondiabetic pregnancies. This puts the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage.

Prolonged rupture of membranes, intrauterine growth restriction (IUGR), intrauterine fetal death, and renal agenesis (Potter syndrome) put the client at risk for developing oligohydramnios.

Anencephaly, placental insufficiency, and perinatal hypoxia contribute to the risk for postterm pregnancy.

Maternal age greater than 35 and balanced translocation (maternal and paternal) are risk factors for chromosomal abnormalities.

DIF: Cognitive Level: Application REF: 639

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Intrauterine growth restriction (IUGR) 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

Poor nutrition, maternal collagen disease, gestational hypertension, and smoking are risk factors associated with the occurrence of IUGR.

Premature rupture of membranes is associated with preterm labor, not IUGR.

DIF: Cognitive Level: Analysis REF: 639

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

2. Which assessment is not included in the fetal biophysical profile (BPP)?

a.

Fetal movement

b.

Fetal tone

c.

Fetal heart rate

d.

Amniotic fluid index

e.

Placental grade

ANS: E

Fetal movement, tone, heart rate, and amniotic fluid index are all assessed in a BPP.

The placental grade is determined by ultrasound (as is a BPP), but it is not included in the criteria of assessment factors for a BPP.

DIF: Cognitive Level: Analysis REF: 643

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

COMPLETION

1. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for ______________________________ in pregnancy.

ANS:

Neural tube defects (NTDs)

Through the technique of MSAFP levels, approximately 80% to 85% of all open NTDs and open abdominal wall defects can be detected early in pregnancy. Screening is recommended for all pregnant women.

DIF: Cognitive Level: Comprehension REF: 648

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

TRUE/FALSE

1. The timing of childbirth for women at risk for uteroplacental insufficiency (UPI) is often determined by magnetic resonance imaging (MRI). Is this statement true or false?

ANS: F

MRI evaluates fetal structures, the placenta, and the amniotic fluid volume.

UPI is assessed using electronic fetal monitoring.

DIF: Cognitive Level: Knowledge REF: 645

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. Assessment of risk to the mother and fetus should include environmental factors such as noxious chemicals and pollutants. Is this statement true or false?

ANS: T

Hazards in the womans workplace and general environment create a risk to the mother and fetus. Such hazards include noxious chemicals, radiation, infections, and pollutants.

DIF: Cognitive Level: Knowledge REF: 637

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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