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Maternal Child Nursing Care 4th Edition Perry Lowdermilk Test Bank

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Maternal Child Nursing Care 4th Edition Perry Lowdermilk Test Bank

ISBN-13: 978-0323057202

ISBN-10: 0323057209

 

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Maternal Child Nursing Care 4th Edition Perry Lowdermilk Test Bank

ISBN-13: 978-0323057202

ISBN-10: 0323057209

 

 

 

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Perry: Maternal Child Nursing Care, 4th Edition

 

Chapter 9: Assessment for Risk Factors

 

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 (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

Her family history of NTD, low BMI, and substance abuse are all 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.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    192

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

 

  1. 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

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 the MSAFP, an amniocentesis, or an NST. 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. An NST is performed to assess fetal well-being in the third trimester.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    194

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment

 

  1. 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 would be another tool useful in confirming the diagnosis?
a. Doppler blood flow analysis c. Amniocentesis
b. Contraction stress test (CST) 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 intrauterine growth restriction (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: Analysis                  REF:    198

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment, Diagnosis

 

  1. 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

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

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    198, 199

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment, Diagnosis

 

  1. 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

Amniocentesis would be 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, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Typically fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario. A nonstress test measures the fetal response to fetal movement in a noncontracting mother.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    202

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Evaluation

 

  1. 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
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP)
d. Transvaginal ultrasound

 

 

ANS:   D

An ultrasound is the method of biophysical assessment of the infant that would be performed at this gestational age. A biophysical profile would be a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. An MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    194

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Planning

 

  1. 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

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. 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. A BPP is a method of assessing fetal well-being in the third trimester. Before an amniocentesis is considered, the client first would have an ultrasound for direct visualization of the fetus.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    204

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

 

  1. 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 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.”

 

 

ANS:   A

An accurate and appropriate statement 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 client. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. “Don’t worry about it. Everything is fine” is not appropriate and discredits the client’s concerns.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    197

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Planning

 

  1. 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. c. Satisfactory.
b. Positive. d. Unsatisfactory.

 

 

ANS:   A

Adequate uterine activity necessary for a CST consists of the presence 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. Satisfactory and unsatisfactory are not applicable terms.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    206

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment, Diagnosis

 

  1. 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 chief factor in high risk pregnancies is the number of women who have no access to prenatal care.
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

In addition to women without access to prenatal care, lifestyles that pose health risks also are a concern. Approximately 500,000 of the four million births (12.5%) in the United States will be categorized as high risk. The high risk status for the mother extends through 30 days after childbirth. High risk pregnancy is less critical a medical concern because of the reduction in family size and the decrease in unwanted pregnancies., 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.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    189

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment

 

  1. 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 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-size 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.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    192

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Planning

 

  1. 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 allows pelvic anatomy to be evaluated in greater detail and 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.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    194

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Planning

 

  1. In the first trimester, ultrasonography can be used to gain information on:
a. Amniotic fluid volume.
b. The presence and location of an intrauterine contraceptive device.
c. Placental location and maturity.
d. Cervical length.

 

 

ANS:   B

In the first trimester, ultrasonography can be used to gain information on the presence and location of an intrauterine contraceptive device and can also detect certain uterine abnormalities. Information about amniotic fluid volume, placental location and maturity, and cervical length would not be available via ultrasonography until the second or third trimester.

 

PTS:    1                      DIF:    Cognitive Level: Knowledge             REF:    196

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

 

  1. 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 ultrasonic examination.

 

 

ANS:   A

An abnormal BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    199

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment

 

  1. 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. The shake test, or bubble stability test, is a quick means of determining fetal maturity.
d. The presence of meconium in the amniotic fluid is always cause for concern.

 

 

ANS:   C

Diluted fluid is mixed with ethanol and shaken. After 15 minutes the bubbles tell the story. 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.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    202

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment

 

  1. Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:
a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis.
b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects.
c. Percutaneous umbilical blood sampling (PUBS) is one of the triple-marker tests for Down syndrome.
d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

 

 

ANS:   D

MSAFP is a screening tool, not a diagnostic tool. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the triple-marker tests for Down syndrome.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    204

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Planning

 

  1. 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, is less sensitive than the CST, and is relatively inexpensive.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    205

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment

 

  1. The nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
a. Sometimes uses vibroacoustic stimulation.
b. Is an invasive test; however, contractions are stimulated.
c. Is considered negative if no late decelerations are observed with the contractions.
d. Is more effective than the nonstress test (NST) if the membranes have already been ruptured.

 

 

ANS:   C

No late decelerations is good news. Vibroacoustic stimulation is sometimes used with the NST. The CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    206

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Assessment

 

  1. A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion, showing declining interest. The nurse can best help the couple by:
a. Telling her that the physician will isolate the problem with more tests.
b. Encouraging her and urging her to continue with childbirth classes.
c. Becoming assertive and laying out the decisions the couple needs to make.
d. Downplaying her risks by citing success rate studies.

 

 

ANS:   B

The nurse can best help the woman and her family regain a sense of control in their lives by providing support and encouragement (including active involvement in preparations and classes). The nurse can try to present opportunities for the couple to make as many choices as possible in prenatal care.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    207, 208

OBJ:    Client Needs: Psychosocial Integrity

TOP:    Nursing Process: Planning

 

  1. In the past factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:
a. Biophysical. c. Geographic.
b. Psychosocial. d. Environmental.

 

 

ANS:   C

This category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are those that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    190

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Diagnosis

 

  1. 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 he or she is at a greater risk for:
a. Oligohydramnios. c. Postterm pregnancy.
b. Polyhydramnios. 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 will put the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age greater than 35 and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.

 

PTS:    1                      DIF:    Cognitive Level: Application             REF:    192

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

Poor nutrition, maternal collagen disease, gestational hypertension, and smoking are all risk factors associated with the occurrence of intrauterine growth restriction (IUGR). Premature rupture of membranes is associated with preterm labor, not IUGR.

 

PTS:    1                      DIF:    Cognitive Level: Analysis                  REF:    192

OBJ:    Client Needs: Health Promotion and Maintenance

TOP:    Nursing Process: Diagnosis

 

COMPLETION

 

  1. MSAFP levels have been used as a screening tool for ________________ in pregnancy.

 

ANS:   Neural tube defects

 

PTS:    1                      DIF:    Cognitive Level: Comprehension      REF:    203

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

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