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Maternal Child Nursing Care Perry Hockenberry Lowdermilk 5th Edition Test Bank
Maternal Child Nursing Care Perry Hockenberry Lowdermilk 5th Edition Test Bank
Maternal Child Nursing Care Perry Hockenberry Lowdermilk 5th Edition 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 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.
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 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.
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 would yield 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. 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 been performed earlier in the pregnancy. It is too late in the pregnancy to
perform MSAFP screening. Also, MSAFP screening 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 a fetus with IUGR, and assessment and treatment of
isoimmunization and thrombocytopenia in the fetus.
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 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 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 client. 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 client’s concerns.
10. 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.
11. 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
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.
12. 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.
ANS: B
During the first trimester, ultrasound examination is performed to obtain information
regarding the number, size, and location of gestatials 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.
15. 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. Maternal serum alpha-fetoprotein (MSAFP) screening 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 provides 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 screening, not PUBS, is part
of the triple-marker tests for Down syndrome.
16. 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.
ANS: A
CST has several contraindications. NST has a high rate of false-positive results, is less
sensitive than the CST, and is relatively inexpensive.
17. The nurse providing care for the antepartum woman should understand that 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 nonstress test (NST) if the membranes have already been
ruptured.
ANS: C
No late decelerations is good news. Vibroacoustic stimulation is sometimes used with
NST. CST is invasive if stimulation is by intravenous oxytocin but not if by nipple
stimulation and is contraindicated if the membranes have ruptured.
19. 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.
Which of the following is not one of these categories?
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 risks that can affect both fertility and fetal
development. These include infections, chemicals, radiation, pesticides, illicit drugs, and
industrial pollutants.
20. 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. c. Postterm pregnancy.
b. Polyhydramnios. d. Chromosomal abnormalities.
ANS: B
Polyhydramnios (amniotic fluid >2000 mL) is 10 times more likely to occur in diabetic
compared with nondiabetic pregnancies. Polyhydramnios puts 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 older than 35 and balanced translocation (maternal and
paternal) are risk factors for chromosome abnormalities.
21. 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.”
ANS: A
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.
22. 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
ANS: A
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.
23. 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 c. 10 weeks
b. 8 weeks d. 14 weeks
ANS: C
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.
25. The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate
(FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute
period is:
a. Nonreactive c. Negative
b. Positive d. Reactive
ANS: D
The NST is reactive (normal) when two or more FHR accelerations of at least 15
beats/min (each with a duration of at least 15 seconds) occur in a 20-minute period. A
nonreactive result means that the heart rate did not accelerate during fetal movement. A
positive result is not used with NST. Contraction stress test (CST) uses positive as a result
term. A negative result is not used with NST. CST uses negative as a result term.
MULTIPLE RESPONSE
26. Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk
factors (Select 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 all are
risk factors associated with IUGR. Premature rupture of membranes is associated with
preterm labor, not IUGR.
27. 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. Multifetal gestation
b. Obesity
c. Fetal abnormalities
d. Amniotic fluid volume
e. Ectopic pregnancy
ANS: 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 multifetal gestation, 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.
MATCHING
Biophysical risks include factors that originate with either the mother or the fetus and
affect the functioning of either one or both. The nurse who provides prenatal care should
have an understanding of these risk factors. Match the specific pregnancy problem with
the related risk factor.
a. Polyhydramnios
b. Intrauterine growth restriction (maternal cause)
c. Oligohydramnios
d. Chromosomal abnormalities
e. Intrauterine growth restriction (fetoplacental cause)
NOT: Each pregnancy problem can be attributed to a number of related risk factors.
Polyhydramnios may also be the result of poorly controlled diabetes mellitus. Other maternal
causes of IUGR include hypertensive disorders, diabetes, chronic renal disease, vascular disease,
thrombophilia, poor weight gain, and cyanotic heart disease. Fetoplacental causes of IUGR may be
related to chromosomal abnormalities, congenital malformations, intrauterine infection, or genetic
syndromes. Other contributors to oligohydramnios are renal agenesis, prolonged pregnancy,
uteroplacental insufficiency, and paternal hypertensive disorders. Although advanced maternal age
is a well-known cause of chromosomal abnormalities, other causes include parental chromosome
rearrangements and pregnancy with autosomal trisomy.