Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 16 Assessment of Fetal Well-Being

1. A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Confirm fetal heart activity.
2. Evaluate the cervix.
3. Determine fetal presentation.
4. Assess amniotic fluid volume.
5. Determine fetal number.

Page Ref: 325

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. When assisting with a transabdominal ultrasound sampling, which of the following would the nurse do?
2. Obtain preliminary urinary samples.
3. Have the woman empty her bladder before the test begins.
4. Assist the woman into a supine position on the examining table.
5. Instruct the woman to eat a fat-free meal 2 hours before the scheduled test time.

Page Ref: 328

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Identify indications and interpret findings for ultrasound examinations performed in the first trimester.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching has been effective?
2. "If the ultrasound is normal, it means my baby has no abnormalities."
3. "The nuchal translucency measurement will diagnose Down syndrome."
4. "I might be able to see who the baby looks like with the ultrasound."
5. "Measuring the length of my cervix will determine whether I will deliver early."

Page Ref: 326

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. A woman at 28 weeks' gestation is asked to keep a fetal activity record and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for more than 30 minutes. Which of the following would be the nurse's most appropriate initial comment?
2. "You need to come to the clinic right away for further evaluation."
3. "Have you been smoking?"
4. "When did you eat last?"
5. "Your baby might be asleep."

Page Ref: 335

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 5 Identify pertinent information to be discussed with the woman regarding her own assessment of fetal activity and methods of recording fetal activity.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. Which of the following tests provides information about the fetal number?
2. Amniocentesis
3. Standard second-trimester sonogram
4. Beta h C G
5. Maternal serum alpha-fetoprotein

Page Ref: 326

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Knowledge and Science: Systematically reflect on practice as a basis for the generation of new knowledge and innovation. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The client at 24 weeks' gestation is experiencing painless vaginal bleeding after intercourse. The physician has ordered a transvaginal ultrasound examination. Which statements by the client indicate an understanding of why this exam has been requested?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "This ultrasound will show the baby's gender."
2. "This ultrasound might cause the miscarriage of my baby."
3. "This ultrasound carries a risk of creating a uterine infection."
4. "This ultrasound can determine the location of my placenta."
5. "This ultrasound might detect whether the placenta is detaching prematurely."

Page Ref: 326—327

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is returning phone calls from clients. Which client does the nurse anticipate would not require a serum beta h C G?
2. A client with a risk of ectopic pregnancy
3. A client with spotting during pregnancy
4. A client with previous pelvic inflammatory disease
5. A client with a previous history of twins

Page Ref: 327

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the lifespan continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify indications and interpret findings for ultrasound examinations performed in the first trimester.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. Which of the following tests has become a widely accepted method of evaluating fetal status?
2. Contraction stress test (C S T)
3. M S A F P test
4. Nonstress test (N S T)
5. Nuchal translucency test

Page Ref: 336

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Identify the indications for ordering a nonstress test for compromised or at-risk fetuses or maternal at-risk pregnancies.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The prenatal clinic nurse is explaining test results to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test results?
2. "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby."
3. "The reactive nonstress test means that my baby is not growing because of a lack of oxygen."
4. "Because my contraction stress test was positive, we know that my baby will tolerate labor well."
5. "My biophysical profile score of 6 points to everything being normal and healthy for my baby."

Page Ref: 342

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Identify the indications for ordering a nonstress test for compromised or at-risk fetuses or maternal at-risk pregnancies.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. At 32 weeks' gestation, a woman is scheduled for a second nonstress test (following one she had at 28 weeks' gestation). Which statement by the client would indicate an adequate understanding of this procedure?
2. "I can't get up and walk around during the test."
3. "I'll have an I V started before the test."
4. "I can still smoke before the test."
5. "I need to have a full bladder for this test."

Page Ref: 336

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Identify the indications for ordering a nonstress test for compromised or at-risk fetuses or maternal at-risk pregnancies.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. During a nonstress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test, and last 20 seconds each. The nurse realizes these results will be interpreted as which of the following?
2. A negative test
3. A reactive test
4. A nonreactive test
5. An equivocal test

Page Ref: 337—338

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 6 Identify the indications for ordering a nonstress test for compromised or at-risk fetuses or maternal at-risk pregnancies.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is responding to phone calls. Whose call should the nurse return first?
2. A client at 37 weeks' gestation reports no fetal movement for 24 hours.
3. A client at 29 weeks' gestation reports increased fetal movement.
4. A client at 32 weeks' gestation reports decreased fetal movement X 2 days.
5. A client at 35 weeks' gestation reports decreased fetal movement X 4 hours.

Page Ref: 340

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Identify the indications for ordering a nonstress test for compromised or at-risk fetuses or maternal at-risk pregnancies.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is working in an outpatient clinic. Which client's indications most warrant fetal monitoring in the third trimester?
2. Gravida 4, para 3, 39 weeks, with a history of one spontaneous abortion at 8 weeks
3. Gravida 1, para 0, 40 weeks, with a history of endometriosis and a prior appendectomy
4. Gravida 3, para 2, with a history of gestational diabetes controlled by diet
5. Gravida 2, para 1, 36 weeks, with a history of preterm labor or cervical insufficiency

Page Ref: 335

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 6 Identify the indications for ordering a nonstress test for compromised or at-risk fetuses or maternal at-risk pregnancies.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. A client at 37 weeks' gestation has a mildly elevated blood pressure. Her antenatal testing demonstrates three contractions in 10 minutes, no decelerations, and accelerations four times in 1 hour. What would this test be considered?
2. Positive nonstress test
3. Negative contraction stress test
4. Positive contraction stress test
5. Negative nonstress test

Page Ref: 339

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Compare the indications and procedures used when conducting a nonstress test, a contraction stress test, the biophysical profile, and the collection of an amniotic fluid index.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. Of all the clients who have been scheduled to have a biophysical profile, the nurse should check with the physician to clarify the order for which client?
2. A gravida with intrauterine growth restriction
3. A gravida with mild hypotension of pregnancy
4. A gravida who is postterm
5. A gravida who complains of decreased fetal movement for 2 days

Page Ref: 340

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Compare the indications and procedures used when conducting a nonstress test, a contraction stress test, the biophysical profile, and the collection of an amniotic fluid index.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The client with an abnormal quadruple screen is scheduled for an ultrasound. Which statement indicates that the client understands the need for this additional antepartal fetal surveillance?
2. "After the ultrasound, my partner and I will decide how to decorate the nursery."
3. "During the ultrasound we will see which of us the baby looks like most."
4. "The ultrasound will show whether there are abnormalities with the baby's spine."
5. "The blood test wasn't run correctly, and now we need to have the sonogram."

Page Ref: 325

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patient or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 8 Explain the purposes of the sequential screen, quad screen, and cell-free D N A testing and the implications of abnormal values.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. A 27-year-old married woman is 16 weeks pregnant and has an abnormally low maternal serum alpha-fetoprotein test. Which statement indicates that the couple understands the implications of this test result?
2. "We have decided to have an abortion if this baby has Down syndrome."
3. "If we hadn't had this test, we wouldn't have to worry about this baby."
4. "I'll eat plenty of dark green leafy vegetables until I have the ultrasound."
5. "The ultrasound should be normal because I'm under the age of 35."

Page Ref: 344

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 8 Explain the purposes of the sequential screen, quad screen, and cell-free D N A testing and the implications of abnormal values.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is preparing a client for amniocentesis. Which statement would indicate that the client clearly understands the risks of amniocentesis?
2. "I might go into labor early."
3. "It could produce a congenital defect in my baby."
4. "Actually, there are no real risks to this procedure."
5. "The test could stunt my baby's growth."

Page Ref: 345—346

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 12. Facilitate informed patient consent for care. | A A C N Essentials Competencies: Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is reviewing amniocentesis results. Which of the following would indicate that client care was appropriate?
2. The client who is R h-positive received R h immune globulin after the amniocentesis.
3. The client was monitored for 30 minutes after completion of the test.
4. The client began vaginal spotting before leaving for home after the test.
5. The client identified that she takes insulin before each meal and at bedtime.

Page Ref: 346

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. Each of the following pregnant women is scheduled for a 14-week antepartal visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (A F P) screening to which client?
2. 28-year-old with history of rheumatic heart disease
3. 18-year-old with exposure to H I V
4. 20-year-old with a history of preterm labor
5. 35-year-old with a child with spina bifida

Page Ref: 344

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 8 Explain the purposes of the sequential screen, quad screen, and cell-free D N A testing and the implications of abnormal values.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The pregnant client and her partner are both 40 years old. The nurse is explaining the options of chorionic villus sampling (C V S) and amniocentesis for genetic testing. The nurse should correct the client if she makes which statement?
2. "Amniocentesis results are available sooner than C V S results are."
3. "C V S carries a higher risk of limb abnormalities."
4. "Amniocentesis cannot detect a neural tube defect."
5. "C V S is performed through my belly or my cervix."

Page Ref: 348

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The client and her partner are carriers of sickle cell disease. They are considering prenatal diagnosis with either amniocentesis or chorionic villus sampling (C V S). Which statements indicate that further teaching is needed on these two diagnostic procedures?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Chorionic villus sampling carries a lower risk of miscarriage."
2. "Amniocentesis can be done earlier in my pregnancy than C V S."
3. "Neither test will conclusively diagnose sickle cell disease in our baby."
4. "The diagnosis comes sooner if we have C V S, not amniocentesis."
5. "Amniocentesis is more accurate in diagnosis than the C V S."

Page Ref: 348

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse anticipates that the physician will most likely order a cervicovaginal fetal fibronectin test for which client?
2. The client at 34 weeks' gestation with gestational diabetes
3. The client at 32 weeks' gestation with regular uterine contractions
4. The client at 37 weeks' multi-fetal gestation
5. The client at 20 weeks' gestation with ruptured amniotic membranes

Page Ref: 349

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 10 Discuss fetal fibronectin and transvaginal ultrasound measurement of cervical length as predictors of preterm labor.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The client at 14 weeks' gestation has undergone a transvaginal ultrasound to assess cervical length. The ultrasound revealed cervical funneling. How should the nurse explain these findings to the client?
2. "Your cervix has become cone-shaped and more open at the end near the baby."
3. "Your cervix is lengthened, and you will deliver your baby prematurely."
4. "Your cervix is short, and has become wider at the end that extends into the vagina."
5. "Your cervix was beginning to open but now is starting to close up again."

Page Ref: 327

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Discuss fetal fibronectin and transvaginal ultrasound measurement of cervical length as predictors of preterm labor.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse knows that a lecithin/sphingomyelin (L/S) ratio finding of 2:1 in amniotic fluid means which of the following?
2. Fetal lungs are still immature.
3. The fetus has a congenital anomaly.
4. Fetal lungs are mature.
5. The fetus is small for gestational age.

Page Ref: 349

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 11 Discuss how the lecithin/sphingomyelin ratio of the amniotic fluid and phosphatidylglycerol (P G) can be used to assess fetal lung maturity.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. A 28-year-old woman has been an insulin-dependent diabetic for 10 years. At 36 weeks' gestation, she has an amniocentesis. A lecithin/sphingomyelin (L/S) ratio test is performed on the sample of her amniotic fluid. Because she is a diabetic, what would an obtained 2:1 ratio indicate for the fetus?
2. The fetus may or may not have immature lungs.
3. The amniotic fluid is contaminated.
4. The fetus has a neural tube defect.
5. There is blood in the amniotic fluid.

Page Ref: 349

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | N L N Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 11 Discuss how the lecithin/sphingomyelin ratio of the amniotic fluid and phosphatidylglycerol (P G) can be used to assess fetal lung maturity.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse provides the following diagram to a patient who is 10 weeks pregnant and scheduled for a sonogram. Why is this test being used?

1. Estimate fetal weight
2. Determine gestational age
3. Evaluate placenta integrity
4. Calculate pelvis dimensions

Page Ref: 329

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 2 Identify indications and interpret findings for ultrasound examinations performed in the first trimester.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. A pregnant patient's healthcare provider is using the Hadlock method to determine gestational age and growth of the fetus. Which measurements will be used to make this fetal determination?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Femur length
2. Biparietal diameter
3. Head circumference
4. Abdominal circumference
5. Crown to rump measurement

Page Ref: 331

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment; Nursing Process.

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse is preparing to conduct a nonstress test with a pregnant patient. In which order should the nurse complete the steps of the procedure?
2. Obtain baseline measurement for 20 minutes
3. Place the patient in the semi-Fowler's position
4. Place the pressure transducer over the uterine fundus
5. Give the patient a handheld marker to indicate when fetal movement is felt
6. Place the ultrasound transducer from the external fetal monitor over the F H R

Page Ref: 336

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 7 Compare the indications and procedures used when conducting a nonstress test, a contraction stress test, the biophysical profile, and the collection of an amniotic fluid index.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. A pregnant patient is completing an ultrasound to grade the integrity of the placenta. Which diagram should the nurse provide to the patient if the findings are grade 0?

Page Ref: 343

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 7 Compare the indications and procedures used when conducting a nonstress test, a contraction stress test, the biophysical profile, and the collection of an amniotic fluid index.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.

1. The nurse provides the following diagram to a patient in the 3rd trimester of pregnancy. For which diagnostic test is the nurse preparing this patient?

1. Ultrasound
2. Amniocentesis
3. Biophysical profile
4. Contraction stress test

Page Ref: 346

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Compare the indications and procedures used when conducting a nonstress test, a contraction stress test, the biophysical profile, and the collection of an amniotic fluid index.

M N L L O: Demonstrate ability to perform assessment and interpret data for a fetal during antenatal period.