Assessment of High Risk Pregnancy NCLEX Questions

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A biophysical profile is performed on a pregnant patient. The following assessments are noted: nonreactive stress test (NST), three episodes of fetal breathing movements (FBMs), limited gross movements, opening and closing of hang indicating the presence of fetal tone, and adequate amniotic fluid index (AFI) meeting criteria. Which answer would be the correct interpretation of this test result?

  • A. A score of 10 would indicate that the results are equivocal.
  • B. A score of 8 would indicate normal results.
  • C. A score of 6 would indicate that birth should be considered as a possible treatment option.
  • D. A score of 9 would indicate reassurance.
Correct Answer: B

Rationale: The correct answer is B: A score of 8 would indicate normal results. In a biophysical profile, each component is scored as either 0 or 2, totaling a maximum of 10. In this case, the patient has: 0 for NST, 2 for FBMs, 1 for gross movements, 2 for fetal tone, and 2 for AFI, totaling 7. However, if there are at least 2 episodes of FBMs, this component is given a score of 2. Therefore, the correct total score is 8. This score indicates normal results, as it meets the criteria for a reassuring biophysical profile.

Incorrect Choices:
A: A score of 10 would indicate that the results are equivocal - This is incorrect as a score of 10 would indicate normal results, not equivocal.
C: A score of 6 would indicate that birth should be considered as a possible treatment option - This is incorrect, as a score

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In a prenatal education class, the nurse is reviewing the importance of using relaxation techniques during labor. Which patient statement will the nurse need to correct?

  • A. We will practice relaxation techniques only in a quiet setting so I can focus.'
  • B. Relaxation is important during labor because it will help me conserve my energy.'
  • C. If I relax in between contractions, my baby will get more oxygen during labor.'
  • D. My partner and I will practice relaxation throughout the remainder of my pregnancy.'
Correct Answer: A

Rationale: The correct answer is A because relaxation techniques should be practiced not just in quiet settings but also during labor, regardless of the environment. This is important to help manage pain and promote a smoother labor process. Choice B is correct as relaxation can indeed help conserve energy. Choice C is incorrect as oxygenation to the baby is not directly related to the mother's relaxation between contractions. Choice D is also incorrect as relaxation techniques should be practiced specifically during labor as well, not just throughout the pregnancy.

An NST is performed on a client who is G6T3P1A1L4 38 weeks gestation. After the patient has been on the external monitor for 30 minutes, the nurse sees three fetal heart rate accelerations of 15 bpm lasting 5 seconds in association with fetal movement. The nurse documents this finding as which of the following?

  • A. Unsatisfactory
  • B. A reactive NST
  • C. A nonreactive nonstress test
  • D. Equivocal suspicious
Correct Answer: B

Rationale: The correct answer is B: A reactive NST. This is because the NST shows three fetal heart rate accelerations of 15 bpm lasting 5 seconds each, in association with fetal movement. A reactive NST indicates a normal response, which is characterized by the presence of fetal heart rate accelerations associated with fetal movement. This is a reassuring finding, suggesting fetal well-being.

Choice A (Unsatisfactory) is incorrect because the description of the findings indicates a satisfactory response. Choice C (A nonreactive nonstress test) is incorrect because the test showed accelerations in response to fetal movements, which is not consistent with a nonreactive test. Choice D (Equivocal suspicious) is incorrect as there is no indication of uncertainty or suspicion in the findings described.

Which analysis of maternal serum is the best predictor of chromosomal abnormalities in the fetus?

  • A. Biophysical profile
  • B. Multiple-marker screening
  • C. Lecithin-to-sphingomyelin ratio
  • D. Blood type and crossmatch of maternal and fetal serum
Correct Answer: B

Rationale: The correct answer is B: Multiple-marker screening. This analysis measures levels of certain proteins and hormones in maternal serum to assess the risk of chromosomal abnormalities in the fetus. It is considered the best predictor because abnormal levels of these markers can indicate conditions like Down syndrome. Biophysical profile (A) assesses fetal well-being but does not directly predict chromosomal abnormalities. Lecithin-to-sphingomyelin ratio (C) is used to assess fetal lung maturity, not chromosomal abnormalities. Blood type and crossmatch (D) are important for identifying Rh incompatibility but do not predict chromosomal abnormalities.

The nurse is determining the G/TPAL of a patient at her first prenatal visit. The patient informs the nurse she delivered a set of twins at 32 weeks of gestation who are now 5 years old, delivered her first child 8 years ago 1 week early, and miscarried at 2 months' gestation 3 years ago. What is this patient's Gravida [G] and Parity [P] using the G/TPAL nomenclature?

  • A. G3 P1113
  • B. G3 P2113
  • C. G4 P1113
  • D. G4 P2113
Correct Answer: D

Rationale: The correct answer is D: G4 P2113. To determine the Gravida (G) and Parity (P) of the patient:
- Gravida (G): The patient has been pregnant a total of 4 times (twins at 32 weeks, first child 1 week early, miscarriage at 2 months, and current pregnancy). Therefore, G is 4.
- Parity (P): P is divided into four categories: term births (T), preterm births (P), abortions (A), and living children (L). The patient delivered twins at 32 weeks (P2), her first child 1 week early (T1), and had a miscarriage at 2 months (A1). Therefore, the Parity is P2A1L3, represented as 2113. Other choices are incorrect because they do not accurately reflect the patient's obstetric history.

What patient symptom at 10 weeks of gestation requires further investigation by the nurse?

  • A. breast tenderness
  • B. infrequent nausea
  • C. change in appetite
  • D. weight loss
Correct Answer: D

Rationale: The correct answer is D: weight loss. At 10 weeks of gestation, weight loss is concerning as it may indicate potential issues like hyperemesis gravidarum or inadequate nutrition, posing risks to both the mother and fetus. Breast tenderness (A), infrequent nausea (B), and changes in appetite (C) are common symptoms during early pregnancy and may not necessarily indicate serious problems. Weight loss (D) should be investigated promptly to ensure the well-being of both the mother and the developing baby.

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