Chapter 19 Assessment of High Risk Pregnancy

Chapter 19  Assessment of High Risk Pregnancy

Complete Chapter Questions And Answers
 

Sample Questions

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 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 would be a high risk.
B
The woman’s drug/alcohol use and family history put her in a high risk category, but her age does not.
C
The woman’s 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: Comprehension REF: 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: Comprehension REF: 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: Comprehension REF: 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: Comprehension REF: 568
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation