NURSING 366 Practice Exam Questions with Answers
A 40yearold woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
A Biophysical profile B Amniocentesis
C Maternal serum alphafetoprotein (MSAFP) D Transvagin...
A 40yearold woman with a high body mass index (BMI) is 10 weeks pregnant. Which
diagnostic tool is appropriate to suggest to her at this time?
A Biophysical profile
B Amniocentesis
C Maternal serum alphafetoprotein (MSAFP)
D Transvaginal ultrasound D
A biophysical profile is a method of biophysical assessment of fetal wellbeing in the
third trimester. An amniocentesis is performed after the fourteenth week of pregnancy.
A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18
are ideal). 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.
A nurse providing care for the antepartum woman should understand that the contraction
stress test (CST):
A sometimes uses vibroacoustic stimulation.
B is an invasive test; however, contractions are stimulated.
C is considered negative if no late decelerations are observed with the
contractions. D is more effective than nonstress test (NST) if the membranes have
already been ruptured. C
Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is
by IV oxytocin but not if by nipple stimulation. No late decelerations indicate a positive
CST. CST is contraindicated if the membranes have ruptured.
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?
A Doppler blood flow analysis
B Contraction stress test (CST)
C Amniocentesis
D Daily fetal movement counts A
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 highrisk
pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus,
multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and
causing fetal distress, a CST is not performed on a woman whose fetus is preterm.
,Indications for an amniocentesis include diagnosis of genetic disorders or congenital
anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic
disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in
pregnancies complicated by
,conditions that may affect fetal oxygenation. Although this may be a useful tool at some
point later in this woman's pregnancy, it is not used to diagnose IUGR.
Nurses should be aware of the strengths and limitations of various
biochemical assessments during pregnancy, including that:
A chorionic villus sampling (CVS) is becoming more popular because it provides early
diagnosis.
B screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended
only for women at risk for neural tube defects.
C percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for
Down syndrome.
D MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
-D
CVS does provide a rapid result, but it is declining in popularity because of advances in
noninvasive screening techniques. MSAFP screening is recommended for all pregnant
women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome. This is
correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is
indicated after an abnormal MSAFP.
The nurse is reviewing lab values to determine Rh incompatibility between mother
and fetus. The nurse should assess which specific lab result?
A Indirect Coombs test
B Hemoglobin level
C hCG level
D Maternal serum alpha-fetoprotein (MSAFP) - A
The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal
titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin
in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia.
Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of
pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening
tool for NTDs in pregnancy
The nurse is caring for a woman with mitral stenosis who is in the active stage. Which
action should the nurse take to promote cardiac function?
A Maintain the woman in a side-lying position with the head and shoulders elevated
to facilitate hemodynamics
B Prepare the woman for delivery by cesarean section since this is the
recommended delivery method to sustain hemodynamics
C Encourage the woman to avoid the use of narcotics or epidural regional analgesia
since this alters cardiac function
, D Promote the use of the Valsalva maneuver during pushing in the second stage
to improve diastolic ventricular filling - A
The side-lying position with the head and shoulders elevated helps to facilitate
hemodynamics during labor. A vaginal delivery is the preferred method of delivery for a
woman with cardiac disease as it sustains hemodynamics better than a cesarean section.
The use of supportive care, medication, and narcotics or epidural regional analgesia is
not contraindicated with a woman with heart disease. The use of the Valsalva maneuver
during pushing in the second stage should be avoided because it reduces diastolic
ventricular filling and obstructs left ventricular outflow.
Maternal and neonatal risks associated with gestational diabetes mellitus are:
A maternal premature rupture of membranes and neonatal sepsis.
B maternal hyperemesis and neonatal low birth weight.
C maternal preeclampsia and fetal macrosomia.
D maternal placenta previa and fetal prematurity - C
Premature rupture of membranes and neonatal sepsis are not risks associated with
gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an
association with low birth weight of the infant. Women with gestational diabetes have
twice the risk of developing hypertensive disorders such as preeclampsia, and the baby
usually has macrosomia. Placental previa and subsequent prematurity of the neonate are
not risks associated with gestational diabetes.
In planning for the care of a 30-year-old woman with pregestational diabetes, the
nurse recognizes that the most important factor affecting pregnancy outcome is the:
A mother's age.
B number of years since diabetes was
diagnosed. C amount of insulin required
prenatally.
D degree of glycemic control during pregnancy. - D
Although advanced maternal age may pose some health risks, for the woman with
pregestational diabetes the most important factor remains the degree of glycemic control
during pregnancy. The number of years since diagnosis is not as relevant to outcomes
as the degree of glycemic control. The key to reducing risk in the pregestational diabetic
woman is not the amount of insulin required but rather the level of glycemic control.
Women with excellent glucose control and no blood vessel disease should have
good pregnancy outcomes.
Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:
A with good control of maternal glucose levels, sudden and unexplained stillbirth is
no longer a major concern.
B the most important cause of perinatal loss in diabetic pregnancy is
congenital malformations.
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