A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? Select all that apply.
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Solution
Answer: B, C, and D
The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
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Solution
Doppler blood flow analysis
Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancy due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor.
Option B: Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm.
Option C: Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of the pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR.
Option D: Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although it may be a useful tool at some point later in this woman’s pregnancy, it is not used to diagnose IUGR.
What is an appropriate indicator for performing a contraction stress test?
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Solution
Maternal diabetes mellitus and postmaturity
Option A: Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator.
Option C: Although adolescent pregnancy and poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test.
Option D: Intrauterine growth restriction is an indicator; history of a previous stillbirth, not preterm labor, is another indicator.
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?
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Solution
“This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”
The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.
Option A: An ultrasound requires a full bladder.
Option B: An amniocentesis is a test after which a pregnant woman should be driven home.
Option C: A maternal serum alpha-fetoprotein test is used in conjunction with unconjugated estriol levels and human chorionic gonadotropin helps to detect Down syndrome.
In the past, factors to determine whether a woman was likely to have a high-risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category?
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Solution
Geographic
The fourth category is correctly referred to as the sociodemographic risk category.
A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
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Solution
Is considered to have a negative result if no late decelerations are observed with the contractions.
No late decelerations indicate a positive CST result.
Option A: Vibroacoustic stimulation is sometimes used with NST.
Option B: CST is invasive if stimulation is performed by IV oxytocin but not if by nipple stimulation.
Option D: CST is contraindicated if the membranes have ruptured.
A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
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Solution
Transvaginal ultrasound
An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.
Option A: A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester.
Option B: An amniocentesis is performed after the fourteenth week of pregnancy.
Option C: A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).
Which of the following is the most common kind of placental adherence seen in pregnant women?
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Solution
Accreta
Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium.
Option B: In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient’s risk for painless vaginal bleeding during the pregnancy and/or delivery process.
Option C: Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete.
Option D: Placenta increta leads to deep penetration of the myometrium.
Which behaviors would be exhibited during the letting-go phase of maternal role adaptation. Select all that apply.
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Solution
Answer: A, C, and D
The emergence of family unit, sexual intimacy relationship continuing and defining one’s individual roles represent interdependent behaviors associated with the letting-go phase.
Option B: Dependent behaviors are exhibited in the taking-in phase.
Option E: Being talkative and excited about becoming a mother represents the taking-hold phase and is an example of dependent-independent behaviors.
While making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:
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Solution
Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn.
One week after birth the woman should exhibit behaviors characteristic of the dependent-independent or taking-hold stage. She still has needs for nurturing and acceptance by others.
Options A and B: Wanting to discuss the events of her labor and delivery are characteristics of the taking-in stage, as are a limited readiness to learn and reduced attention span; this stage lasts from the first 24 hours until 2 days after delivery.
Option D: Having reestablished her role as a spouse reflects the letting-go stage, which indicates that psychosocial recovery is complete.