Nokea
A pregnant woman undergoes a triple/quadruple screen at 16 to 18 weeks' gestation. What would the nurse suspect if the woman's alpha-fetoprotein (AFP) level is decreased?
- A. Sickle-cell anemia
- B. Cardiac defects
- C. Down syndrome
- D. Respiratory disorders
Correct Answer: C
Rationale: Low AFP suggests Down syndrome, often with altered hCG and estriol. Sickle-cell anemia uses other tests, cardiac defects may raise AFP, and respiratory issues don't typically affect AFP levels.
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A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating
- A. Hemodilution of pregnancy
- B. A multiple gestation pregnancy
- C. Greater-than-expected weight gain
- D. Iron-deficiency anemia
Correct Answer: A
Rationale: Hemodilution of pregnancy occurs as plasma volume increases more than red blood cell mass, lowering hemoglobin to 10.5-14 g/dL in the second trimester, which includes 11 g/dL. Multiple gestation may raise hemoglobin, weight gain doesn't affect it, and iron-deficiency anemia typically shows lower hemoglobin with symptoms like fatigue.
Which information on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy?
- A. Recurrent pelvic infections
- B. Ovarian cyst 2 years ago
- C. Use of oral contraceptives for 8 years
- D. Heavy, irregular periods
Correct Answer: A
Rationale: Recurrent pelvic infections (e.g., PID) scar fallopian tubes, increasing ectopic pregnancy risk by hindering egg transport. Ovarian cysts, oral contraceptives (which reduce risk), and irregular periods don't directly contribute.
A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating:
- A. Hemoconcentration by hypertension
- B. A multiple gestation pregnancy
- C. Greater-than-expected weight gain
- D. Iron-deficiency anemia
Correct Answer: D
Rationale: A hemoglobin of 11 g/dL is low for the second trimester (10.5-14 g/dL), suggesting iron-deficiency anemia, especially with symptoms like fatigue. Hemoconcentration raises hemoglobin, multiple gestation lowers it slightly, and weight gain is unrelated.
On the first prenatal visit, an examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as:
- A. Chadwick's sign
- B. Goodell's sign
- C. Hegar's sign
- D. Homan's sign
Correct Answer: A
Rationale: Chadwick's sign is bluish discoloration of the cervix and vagina from increased blood flow, seen early in pregnancy. Goodell's is cervical softening, Hegar's is uterine softening, and Homan's indicates thrombosis, not pregnancy.
After reviewing the information provided in the client's medical record, which of the following complications should the nurse identify that the client is at risk of developing?
- A. Preeclampsia; uric acid
- B. Gestational diabetes; glucose
- C. Eclampsia; magnesium
- D. Placenta previa; hemoglobin
Correct Answer: B
Rationale: Gestational diabetes risk is linked to glucose intolerance, detectable by serum glucose levels, causing complications like macrosomia. Preeclampsia involves hypertension, not uric acid alone; eclampsia isn't tied to magnesium levels; placenta previa relates to prior surgeries, not hemoglobin.