Assessment of High Risk Pregnancy NCLEX Questions

Assessment of High Risk Pregnancy NCLEX Questions Related

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Which complication could occur as a result of percutaneous umbilical blood sampling (PUBS)?

  • A. Postdates pregnancy
  • B. Fetal bradycardia
  • C. Placenta previa
  • D. Uterine rupture
Correct Answer: B

Rationale: The correct answer is B: Fetal bradycardia. During PUBS, a needle is inserted into the umbilical cord to obtain fetal blood for testing. This procedure carries a risk of causing fetal bradycardia, which is a decrease in the fetal heart rate. This can be a serious complication as it may indicate fetal distress. It is important to monitor the fetal heart rate during and after the procedure to detect and address any signs of bradycardia promptly.

Other choices are incorrect because:
A: Postdates pregnancy - PUBS is not known to cause postdates pregnancy.
C: Placenta previa - PUBS is not associated with the development of placenta previa.
D: Uterine rupture - PUBS does not typically lead to uterine rupture.

In summary, fetal bradycardia is the potential complication of PUBS due to the invasive nature of the procedure and the risk of affecting fetal well-being.

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The nurse receives a phone call from a pregnant patient who states she has not felt the baby move. Identify the first question for the nurse to ask the patient.

  • A. Have you experienced any recent vaginal bleeding?
  • B. Have you experienced any recent vaginal discharge?
  • C. How many weeks pregnant are you?
  • D. When was the last time you felt the baby move?
Correct Answer: D

Rationale: The correct first question for the nurse to ask the patient is D: When was the last time you felt the baby move? This question is crucial because it helps assess the fetal well-being and can indicate any potential issues with the baby's health or development. It allows the nurse to determine if there has been a recent decrease in fetal movements, which could be a sign of distress. Asking about vaginal bleeding or discharge (choices A and B) may not provide immediate insight into the baby's well-being. Question C is relevant but not as urgent as knowing when the baby was last felt moving.

The nurse is caring for a client being monitored for oligohydramnios. The NST is nonreactive. Which findings correlate with these results?

  • A. Less than 2 accelerations in 20 to 40 minutes
  • B. Accelerations of at least 15 bpm lasting at least 15 seconds (more than 32 weeks gestation)
  • C. Accelerations of at least 10 bpm lasting at least 10 seconds (less than 32 weeks gestation)
  • D. Four accelerations in 20 to 40 minutes
Correct Answer: A

Rationale: Step 1: Oligohydramnios indicates decreased amniotic fluid, which can lead to fetal hypoxia.
Step 2: Nonreactive NST suggests lack of appropriate fetal heart rate accelerations in response to fetal movement.
Step 3: Less than 2 accelerations in 20-40 minutes is consistent with nonreactive NST due to decreased fetal movement.
Step 4: Choice A is correct as it reflects the expected findings in a nonreactive NST scenario.
Summary:
- Choice B: The criteria for accelerations are too high for a nonreactive NST.
- Choice C: The criteria for accelerations are too low for a nonreactive NST.
- Choice D: Four accelerations in the given time frame do not correlate with a nonreactive NST.

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.

A woman is seeking counseling regarding tubal ligation. Which of the following should the nurse include in her discussion?

  • A. The woman will no longer menstruate.
  • B. The surgery should be done when the woman is ovulating.
  • C. The surgery is easily reversible.
  • D. The woman will be under anesthesia during the procedure.
Correct Answer: D

Rationale: Tubal ligation is a permanent form of contraception and requires anesthesia. It does not affect menstruation, and reversal is not guaranteed.

A woman has been diagnosed with chlamydia. The nurse would expect the client to complain of which of the following signs/symptoms?

  • A. No signs or symptoms.
  • B. Painful lesions on the labia.
  • C. Foul-smelling discharge.
  • D. Severe lower abdominal pain.
Correct Answer: A

Rationale: Chlamydia is often asymptomatic, but if symptoms occur, they may include discharge or pain.

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