Deck 21: Assessment of Fetal Well-Being

Question 1

The nurse is returning phone calls from patients. Which patient does the nurse anticipate would not require a serum beta hCG?

A) A patient with a risk of ectopic pregnancy
B) A patient with spotting during pregnancy
C) A patient with previous pelvic inflammatory disease
D) A patient with a previous history of twins

Answer 1

A patient with a previous history of twins

Question 2

The patient is being seen for her first prenatal appointment at 14 weeks' gestation. She is sure of her last menstrual period (LMP). The fundal height is measured at 20 centimeters. Which test would the nurse anticipate that the certified nurse-midwife will order for this patient?

A) Amniocentesis for fetal genetic anomaly
B) Ultrasound to determine the number of fetuses
C) Beta hCG to detect the location of the pregnancy
D) Maternal serum alpha-fetoprotein for Down syndrome

Answer 2

Ultrasound to determine the number of fetuses

Question 3

The prenatal clinic nurse is explaining test results to a patient who has had an assessment for fetal well-being. Which statement indicates that the patient understands the test result?

A) "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby."
B) "The reactive nonstress test means that my baby is not growing because of a lack of oxygen."
C) "Because my contraction stress test was positive, we know that my baby will tolerate labor well."
D) "My biophysical profile score of 6 points to everything being normal and healthy for my baby."

Answer 3

"The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby."

Question 4

A pregnant woman is having a nipple-stimulated contraction stress test. Which result indicates hyperstimulation?

A) The fetal heart rate decelerates when three contractions occur within a 10-minute period.
B) The fetal heart rate accelerates when contractions last up to 60 seconds.
C) There are more than five fetal movements in a 10-minute period.
D) There are more than three uterine contractions in a 6-minute period.

Question 5

A patient at 37 weeks' gestation has a mildly elevated blood pressure. Her antenatal testing demonstrates a fetal heart rate baseline of 150 with three contractions in 10 minutes, no decelerations, and accelerations four times in 1 hour. This test would be considered a:

A) Positive nonstress test.
B) Negative contraction stress test.
C) Positive contraction stress test.
D) Negative nonstress test.

Question 6

During a nonstress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test, and last 20 seconds each. The nurse realizes these results will be interpreted as:

A) A negative test.
B) A reactive test.
C) A nonreactive test.
D) An equivocal test.

Question 7

Of all the patients who have been scheduled to have a biophysical profile, the nurse should check with the physician and clarify the order for which patient?

A) A gravida with intrauterine growth restriction
B) A gravida with mild hypertension of pregnancy
C) A gravida who is postterm
D) A gravida who complains of decreased fetal movement for 2 days

Question 8

The patient at 24 weeks' gestation is experiencing painless vaginal bleeding after intercourse. The physician has ordered a transvaginal ultrasound examination. Which statements by the patient indicate an understanding of why this exam has been requested? "This ultrasound: ()

A) "Will show the baby's gender."
B) "Might cause the miscarriage of my baby."
C) "Carries a risk of creating a uterine infection."
D) "Can determine the location of my placenta."
E) "Might detect whether the placenta is detaching prematurely."

Question 9

Each of the following pregnant women is scheduled for a 14-week antepartal visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (AFP) screening to which patient?

A) 28-year-old with history of rheumatic heart disease
B) 18-year-old with exposure to HIV
C) 20-year-old with a history of preterm labor
D) 35-year-old with a child with spina bifida

Question 10

When assisting with an abdominal ultrasound procedure to determine fetal age, the nurse:

A) Asks the woman to sign an operative consent form prior to the procedure.
B) Has the woman empty her bladder before the test begins.
C) Assists the woman into a supine position on the examining table.
D) Instructs the woman to eat a fat-free meal 2 hours before the scheduled test time.

Question 11

The nurse is preparing a patient in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching has been effective?

A) "If the ultrasound is normal, it means my baby has no abnormalities."
B) "The nuchal translucency measurement will diagnose Down syndrome."
C) "I might be able to see who the baby looks like with the ultrasound."
D) "Measuring the length of my cervix will determine whether I will deliver early."

Question 12

A type 1 diabetic who is at 32 weeks' gestation is having a nonstress test for fetal well-being because she has been having problems with glucose control. Which of the following meets the criteria for her test to be considered reactive?

A) Fetal heart rate baseline of 150 with two accelerations to 160 for 10 seconds within 20 minutes
B) Fetal heart rate baseline of 140 with one acceleration to 160 for 15 seconds within 30 minutes
C) Fetal heart rate baseline of 140 with two accelerations to 155 for 15 seconds within 20 minutes
D) Fetal heart rate baseline of 130 with two accelerations to 140 for 15 seconds within 20 minutes

Question 13

The nurse is responding to phone calls. Whose call should the nurse return first?

A) A patient at 37 weeks' gestation reports no fetal movement for 24 hours.
B) A patient at 29 weeks' gestation reports increased fetal movement.
C) A patient at 32 weeks' gestation reports decreased fetal movement X 2 days.
D) A patient at 35 weeks' gestation reports decreased fetal movement X 4 hours.

Question 14

A woman at 28 weeks' gestation is asked to keep a fetal activity diary and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for more than 30 minutes. The most appropriate initial comment by the nurse would be:

A) "You need to come to the clinic right away for further evaluation."
B) "Have you been smoking?"
C) "When did you eat last?"
D) "Your baby might be asleep."

Question 15

The nurse is preparing a patient for amniocentesis. Which statement would indicate that the patient clearly understands the risks of an amniocentesis?

A) "I might go into labor early."
B) "It could produce a congenital defect in my baby."
C) "Actually, there are no real risks to this procedure."
D) "The test could stunt my baby's growth."

Question 16

At 32 weeks' gestation, a woman is scheduled for a second nonstress test (following one she had at 28 weeks' gestation). Which statement by the patient would indicate an adequate understanding of this procedure?

A) "I can't get up and walk around during the test."
B) "I'll have an IV started before the test."
C) "I must avoid drinks containing caffeine for 24 hours before the test."
D) "I need to have a full bladder for this test."

Question 17

The nurse is reviewing amniocentesis results. Care was appropriate if the patient:

A) Who is Rh-positive received RhoGAM after the amniocentesis.
B) Was monitored for 30 minutes after completion of the test.
C) Began vaginal spotting before leaving for home after the test.
D) Identified that she takes insulin before each meal and at bedtime.

Question 18

The patient with an abnormal quadruple screen is scheduled for an ultrasound. Which statement indicates that the patient understands the need for this additional antepartal fetal surveillance?

A) "After the ultrasound, my partner and I will decide how to decorate the nursery."
B) "During the ultrasound we will see which of us the baby looks like most."
C) "The ultrasound will show whether there are abnormalities with the baby's spine."
D) "The blood test wasn't run correctly, and now we need to have the sonogram."

Question 19

The nurse is working in an outpatient clinic. Which patient's indications most warrant fetal monitoring in the third trimester?

A) Gravida 4, para 3, 39 weeks, with a history of one spontaneous abortion at 8 weeks
B) Gravida 1, para 0, 40 weeks, with a history of endometriosis and a prior appendectomy
C) Gravida 3, para 2, with a history of gestational diabetes controlled by diet
D) Gravida 2, para 1, 36 weeks, with hypertension disorder of pregnancy

Question 20

A woman is at 32 weeks' gestation. Her fundal height measurement at this clinic appointment is 26 centimeters. After reviewing her ultrasound results, the healthcare provider asks the nurse to schedule the patient for a series of sonograms to be done every 2 weeks. The nurse should make sure that the patient understands that the main purpose for this is to:

A) Assess for congenital anomalies.
B) Evaluate fetal growth.
C) Determine fetal presentation.
D) Rule out a suspected hydatidiform mole.

Question 21

The patient at 14 weeks' gestation has undergone a transvaginal ultrasound to assess cervical length. The ultrasound revealed cervical funneling. How should the nurse explain these findings to the patient? "Your cervix:

A) "Has become cone-shaped and more open at the end near the baby."
B) "Is shortened, and you will deliver your baby prematurely."
C) "Is short, and has become wider at the end that extends into the vagina."
D) "Was beginning to open but now is starting to close up again."

Question 22

The nurse knows that a lecithin/sphingomyelin (L/S) ratio finding of 2:1 on amniotic fluid means:

A) Fetal lungs are still immature.
B) The fetus has a congenital anomaly.
C) Fetal lungs are mature.
D) The fetus is small for gestational age.

Question 23

The pregnant patient and her partner are both 40 years old. The nurse is explaining the options of chorionic villus sampling (CVS) and amniocentesis for genetic testing. The nurse should correct the patient if she states:

A) "Amniocentesis results are available sooner than CVS results are."
B) "CVS carries a higher risk of limb abnormalities."
C) "Amniocentesis cannot detect a neural tube defect."
D) "CVS is performed through my belly or my cervix."

Question 24

The nurse anticipates that the physician will most likely order a cervico-vaginal fetal fibronectin test for which patient?

A) The patient at 34 weeks' gestation with gestational diabetes
B) The patient at 32 weeks' gestation with regular uterine contractions
C) The patient at 37 weeks' multi-fetal gestation
D) The patient at 20 weeks' gestation with ruptured amniotic membranes

Question 25

The patient and her partner are carriers of sickle-cell disease. They are considering prenatal diagnosis with either amniocentesis or chorionic villus sampling (CVS). Which statements indicate that further teaching is needed on these two diagnostic procedures?

A) "Chorionic villus sampling carries a lower risk of miscarriage."
B) "Amniocentesis can be done earlier in my pregnancy than CVS."
C) "Neither test will conclusively diagnose sickle-cell disease in our baby."
D) "The diagnosis comes sooner if we have CVS, not amniocentesis."
E) "Amniocentesis is more accurate in diagnosis than the CVS."

Question 26

A 28-year-old woman has been an insulin-dependent diabetic for 10 years. At 36 weeks' gestation, she has an amniocentesis. A lecithin/sphingomyelin (L/S) ratio test is performed on the sample of her amniotic fluid. Since she is a diabetic, the 2:1 ratio obtained indicates that the fetus:

A) May or may not have immature lungs.
B) Has an intrauterine infection.
C) Has a neural tube defect.
D) Is at risk for hyperglycemia.