Pregnancy Assessment Questions

Pregnancy Assessment Questions Related

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A pregnant patient has received the results of her triple-screen testing and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the patient's plan of care?

  • A. No further testing is indicated at this time because results are normal.
  • B. Refer to the physician for additional testing.
  • C. Validate the results with the lab facility.
  • D. Repeat the test in 2 weeks and have the patient return for her regularly scheduled prenatal visit.
Correct Answer: B

Rationale: The correct answer is B: Refer to the physician for additional testing. When a triple-screen test is positive in a pregnant patient, it indicates an increased risk of certain conditions such as neural tube defects or chromosomal abnormalities. Therefore, the appropriate course of action is to refer the patient to a physician for further diagnostic testing, such as amniocentesis or ultrasound, to confirm or rule out these conditions.

Choice A is incorrect because a positive result on a triple-screen test does not indicate that results are normal; it suggests the need for further investigation. Choice C is incorrect because validating the results with the lab facility does not address the need for additional diagnostic testing. Choice D is incorrect because waiting 2 weeks to repeat the test and returning for a regular prenatal visit may delay necessary interventions or treatment for the patient.

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The nurse in the obstetrician’s office is caring for four 25-week-gestation prenatal clients who are carrying singleton pregnancies. With which of the following clients should the nurse carefully review the signs and symptoms of preterm labor?

  • A. African American, 15 years old, with newly diagnosed gestational diabetes.
  • B. Asian American, 23 years old, with five-year-old twins who were born at term.
  • C. Jewish, 25 years old, working as a certified public accountant.
  • D. Mormon, 33 years old, who recently moved into a new apartment.
Correct Answer: A

Rationale: Young age and gestational diabetes are risk factors for preterm labor, making it important to educate this client.

A relaxation technique that can be used during the childbirth experience to decrease maternal pain perception is

  • A. using increased environmental stimulation as a method of distraction.
  • B. restricting family and friends from visiting during the labor period to keep the patient focused on breathing techniques.
  • C. medicating the patient frequently to reduce pain perception.
  • D. assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction pattern.
Correct Answer: D

Rationale: Step-by-step rationale for why answer D is correct:
1. Breathing techniques help in managing pain perception during labor.
2. By assisting the patient in breathing methods, she gains control over her pain perception.
3. Controlled breathing can help distract from the intensity of contractions.
4. By focusing on breathing patterns, the patient can stay calm and manage pain effectively.
Summary:
A, B, and C are incorrect because they do not address pain management directly through breathing techniques. Option A relies on distraction, B focuses on isolation rather than coping mechanisms, and C suggests heavy reliance on medication rather than self-control.

The nurse is admitting a client, who reports, 'My water broke yesterday, and I haven't felt my baby move any today.' She is 38 weeks with a history of gestational diabetes. Which assessment data is of most concern to the nurse on admission?

  • A. Maternal vital signs: T 100.2, HR 104, RR 20, BP 136/82
  • B. Pain score 6/10
  • C. Minimal variability and variable decelerations
  • D. 5 cm/80% effaced/0 station
Correct Answer: C

Rationale: The correct answer is C because minimal variability and variable decelerations on fetal heart monitoring indicate fetal distress, which is a critical concern. Minimal variability suggests the baby's nervous system is compromised, and decelerations can indicate umbilical cord compression or placental insufficiency, possibly leading to fetal hypoxia. This situation requires immediate intervention to prevent potential harm to the baby.

Choice A is incorrect as the vital signs are slightly elevated but not as concerning as fetal distress. Choice B is incorrect as pain score is subjective and not as critical as fetal well-being. Choice D is incorrect as cervical dilation/effacement/station is important for labor progress but not as concerning as fetal distress in this scenario.

Which complaint made by a patient at 35 weeks of gestation requires additional assessment?

  • A. Abdominal pain
  • B. Ankle edema in the afternoon
  • C. Backache with prolonged standing
  • D. Shortness of breath when climbing stairs
Correct Answer: A

Rationale: The correct answer is A: Abdominal pain. This complaint at 35 weeks of gestation requires additional assessment as it could indicate a serious issue such as preterm labor, placental abruption, or other complications. Abdominal pain in late pregnancy should never be ignored. Ankle edema in the afternoon, backache with prolonged standing, and shortness of breath when climbing stairs are common discomforts in pregnancy and may not necessarily indicate a serious problem at this stage.

The nurse is caring for a client in labor with her third baby. She is 39 weeks gestation, 6 cm dilated, 80% effaced, and 0 station, with minimal variability and recurrent variable decelerations. What action is the highest priority for the nurse?

  • A. Administer oxygen
  • B. Change maternal position
  • C. Perform fetal scalp stimulation
  • D. Perform vaginal examination
Correct Answer: B

Rationale: The correct answer is B: Change maternal position. This is the highest priority because the client is experiencing recurrent variable decelerations, which can indicate umbilical cord compression. Changing the maternal position can help relieve the pressure on the cord, potentially improving fetal oxygenation. Administering oxygen (choice A) can be important but addressing the cause of the variable decelerations is crucial. Performing fetal scalp stimulation (choice C) is not appropriate at this time as the focus should be on improving fetal oxygenation. Performing a vaginal examination (choice D) is not necessary at this moment and may even exacerbate the situation.

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