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A fetus is in the LOA position in utero. Which of the following findings would the nurse observe when doing Leopold's maneuvers?
- A. Hard, round object in the fundal region.
- B. Flat object above the symphysis pubis.
- C. Soft, round object on the left side of the uterus.
- D. Small objects on the right side of the uterus.
Correct Answer: C
Rationale: In the LOA (left occiput anterior) position, the baby's back is on the left side of the uterus, which would feel like a soft, round object during Leopold's maneuvers.
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A G1 P0000 gravida, whose labor was uneventful, delivered 1 minute ago. The baby’s Apgar score at this time is 3. Which of the following actions is appropriate for the nurse to make?
- A. Administer ophthalmic prophylaxis.
- B. Place the baby on the abdomen of the mother.
- C. Obtain assistance for neonatal resuscitation.
- D. Repeat the score to confirm its accuracy.
Correct Answer: C
Rationale: An Apgar score of 3 indicates the baby is in distress and requires immediate neonatal resuscitation.
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 triage nurse is interviewing a client, 19 years old, unmarried, who states, 'I felt a hard thing on the lip of my vagina this morning. It doesn’t hurt.' Which of the following questions is most important for the nurse to ask at this time?
- A. Have any of your partners ever hurt you?'
- B. Do you ever have unprotected intercourse?'
- C. Have you ever had a baby?'
- D. Do you think you may be pregnant?'
Correct Answer: B
Rationale: Unprotected intercourse increases the risk of sexually transmitted infections (STIs), which could explain the hard lump.
The nurse is providing education to a patient at 16 weeks' gestation who is undecided about consenting to the quad screen. How can the nurse explain the purpose of the quad screen to the patient?
- A. It indicates the risk of the fetus for heart defects.
- B. It indicates the risk of the fetus for neural tube defects.
- C. It indicates the risk of the fetus for neural tube defects and chromosome abnormalities.
- D. It indicates the risk of the fetus for chromosome abnormalities.
Correct Answer: C
Rationale: The correct answer is C because the quad screen is a prenatal screening test that assesses the risk of the fetus for neural tube defects and chromosome abnormalities. At 16 weeks' gestation, this test helps identify potential issues early on, allowing for further diagnostic testing and appropriate interventions if needed. Choice A is incorrect because the quad screen does not specifically target heart defects. Choice B is incorrect as the quad screen does not solely focus on neural tube defects. Choice D is incorrect because the quad screen assesses both neural tube defects and chromosome abnormalities, not just chromosome abnormalities alone. Therefore, choice C is the most comprehensive and accurate explanation of the purpose of the quad screen for the patient at 16 weeks' gestation.
What point in the pregnancy is the most accurate time to determine gestational age through ultrasound?
- A. First trimester
- B. Second trimester
- C. Third trimester
- D. No difference in accuracy among the trimesters
Correct Answer: A
Rationale: The correct answer is A: First trimester. During the first trimester, gestational age can be accurately determined through ultrasound by measuring the crown-rump length of the fetus. This measurement is most accurate during this time as the fetus is small and growth is consistent. In the second and third trimesters, other factors such as fetal growth variations and positioning can affect the accuracy of gestational age determination. Therefore, the first trimester is the most accurate time for determining gestational age through ultrasound. Other choices are incorrect because the precision of ultrasound measurements decreases as pregnancy progresses, making the first trimester the optimal window for accurate gestational age assessment.