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Final Exam: NSG 432/ NSG432 (Latest 202 5 / 202 6
Update) Nursing Care of the Childbearing Family
Complete | Questions & Answers | 100% Correct|
Grade A (Verified Solutions) – GCU
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 (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, and BMI b. Drug/alcohol use, age, and family history c. Family history, blood pressure, and BMI d. Family history, BMI, and drug/alcohol abuse Family history, BMI, and drug/alcohol abuse Her family history of NTD, low BMI, and substance abuse all 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 would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. 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.
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) Ultrasound examination 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 MSAFP screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if fetal/maternal anomalies are detected. NST is performed to assess fetal well-being in the third trimester. The 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 growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts Doppler blood flow analysis
fetuses, detection of fetal infection, determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time? a. Biophysical profile (BPP) b. Amniocentesis c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Transvaginal ultrasound Transvaginal ultrasound Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the 14th week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal). A patient 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 isn't 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. ―Don't worry about it. Everything is fine.‖ 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.‖ An accurate and appropriate response is, ―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.‖ Although ―Your placenta isn't working properly, and your baby is in danger‖ may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the patient. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response ―Don't worry about it. Everything is fine‖ is not appropriate and discredits the patient's concerns. 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. negative.
c. initially the transvaginal examination can be painful. d. the transvaginal examination allows pelvic anatomy to be evaluated in greater detail. the transvaginal examination allows pelvic anatomy to be evaluated in greater detail. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty bladder. 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 feels pressure as the probe is moved. In the first trimester, ultrasonography can be used to gain information on a. amniotic fluid volume. b. location of gestational sacs. c. placental location and maturity. d. cervical length. location of gestational sacs. During the first trimester, ultrasound examination is performed to obtain information regarding the number, size, and location of gestational sacs; the presence or absence of fetal cardiac and body movements; the presences or absence of uterine abnormalities (e.g., bicornuate uterus or fibroids) or adnexal masses (e.g., ovarian cysts or an ectopic pregnancy); and pregnancy dating.
Nurses should be aware that the biophysical profile (BPP) a. is an accurate indicator of impending fetal death. 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 ultrasound examination. is an accurate indicator of impending fetal death. An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure. Compared with contraction stress test (CST), 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. has no known contraindications. CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive.
intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities. A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is a. ―The test results are within normal limits.‖ b. ―Immediate delivery by cesarean birth is being considered.‖ c. ―Further testing will be performed to determine the meaning of this score.‖ d. ―An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.‖ ―The test results are within normal limits.‖ The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?
a. Multiple-marker screening b. Lecithin/sphingomyelin [L/S] ratio c. Biophysical profile d. Type and crossmatch of maternal and fetal serum Multiple-marker screening Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch would not predict chromosomal defects in the fetus. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at a. 4 weeks. b. 8 weeks. c. 10 weeks. d. 14 weeks. 10 weeks CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, the risk of limb reduction is no greater than in the general population
uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term. Intrauterine growth restriction (IUGR) is associated with numerous pregnancy- related risk factors. (Select all that apply.) a. Poor material weight gain b. Chronic maternal infections c. Gestational hypertension d. Premature rupture of membranes e. Smoking A, B, C, E Poor material weight gain, chronic infections disease, gestational hypertension, and smoking are all risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR. Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations. (Select all that apply.) a. Establish gestational age b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy A, B, C, E
Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. ―I will need to increase my insulin dosage during the first 3 months of pregnancy.‖ b. ―Insulin dosage will likely need to be increased during the second and third trimesters.‖ c. ―Episodes of hypoglycemia are more likely to occur during the first 3 months.‖ d. ―Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.‖ ―I will need to increase my insulin dosage during the first 3 months of pregnancy.‖ Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. ―Insulin dosage will likely need to be increased during the second and third trimesters,‖ ―Episodes of hypoglycemia are more likely to occur during the first 3 months,‖ and ―Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding‖ are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy
Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight. macrosomia Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 lbs less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time? a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern Imbalanced nutrition: less than body requirements This patient's clinical cues include weight loss, which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume. This patient reports weight loss, not weight gain. Imbalanced nutrition: more than body requirements is not an appropriate nursing diagnosis. Although the patient reports nervousness based on the patient's other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements. Maternal phenylalanine hydroxylase deficiency (PAH) is an important health concern during pregnancy because a. it is a recognized cause of preterm labor. b. the fetus may develop neurologic problems. c. a pregnant woman is more likely to die without dietary control. d. women with PKU are usually retarded and should not reproduce. the fetus may develop neurologic problems. Children born to women with untreated PAH are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PAH has no effect on labor. Women without dietary control of PAH are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PAH at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of uncertain etiology, or who have given birth to microcephalic infants.
during the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own insulin around the 10th week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that a. diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. hydramnios occurs approximately twice as often in diabetic pregnancies. c. infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being. diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild-to- moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.
The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc a. is now done for all pregnant women, not just those with or likely to have diabetes. b. is a snapshot of glucose control at the moment. c. would be considered evidence of good diabetes control with a result of 5% to 6%. d. is done on the patient's urine, not her blood. would be considered evidence of good diabetes control with a result of 5% to 6%. A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood. A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)? a. 75 mg/dL before lunch. This is low; better eat now. b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin. d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
