A woman is at 32 weeks' gestation. Her fundal height measurement at this clinic appointment is 26 centimeters. After reviewing her ultrasound results, the health care provider asks the nurse to schedule the client for a series of ultrasounds to be done every 2 weeks. The nurse should ensure that the client understands that the main purpose for this is to:
Select one:

Rule out a suspected hydatidiform mole.

Assess for congenital anomalies.

Determine fetal presentation.

Monitor fetal growth.

Answer and Explanation

The Correct Answer is D

Choice A Reason: Rule out a suspected hydatidiform mole. This is an incorrect answer that describes an unlikely condition for this client. A hydatidiform mole is a type of gestational trophoblastic disease where abnormal placental tissue develops instead of a normal fetus. A hydatidiform mole can cause vaginal bleeding, hyperemesis gravidarum (severe nausea and vomiting), preeclampsia, and hyperthyroidism. A hydatidiform mole usually causes a fundal height measurement that is larger than expected for gestational age, not smaller.

Choice B Reason: Assess for congenital anomalies. This is an incorrect answer that implies that the client has not had a previous ultrasound to screen for fetal anomalies. Congenital anomalies are structural or functional defects that are present at birth, such as cleft lip, spina bifida, or Down syndrome. Ultrasound can detect some congenital anomalies by visualizing the fetal anatomy and morphology. However, ultrasound screening for fetal anomalies is usually done between 18 and 22 weeks of gestation, not at 32 weeks.

Choice C Reason: Determine fetal presentation. This is an incorrect answer that suggests that the client has an uncertain fetal presentation. Fetal presentation is the part of the fetus that is closest to the cervix, such as vertex (head), breech (butocks or feet), or transverse (shoulder). Fetal presentation can aﬀect the mode and outcome of delivery. Ultrasound can determine fetal presentation by locating the fetal head and spine. However, fetal presentation can also be assessed by abdominal palpation or vaginal examination, which are simpler and less invasive methods.

Choice D Reason: Monitor fetal growth. This is because fundal height measurement is a method of estimating fetal size and gestational age by measuring the distance from the pubic symphysis to the top of the uterus (fundus) in centimeters. A fundal height measurement that is significantly smaller or larger than expected for gestational age may indicate intrauterine growth restriction (IUGR) or macrosomia, respectively. IUGR means that the fetal growth is slower than expected for gestational age, which can increase the risk of fetal distress, hypoxia, acidosis, and stillbirth. Macrosomia means that the fetal weight is higher than expected for gestational age, which can increase the risk of birth injuries, shoulder dystocia, cesarean delivery, and hypoglycemia. Ultrasound is a more accurate way of assessing fetal size and growth by measuring various parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Ultrasound can also detect other factors that may aﬀect fetal growth such as placental function, amniotic ﬂuid volume, umbilical cord blood ﬂow, and fetal anomalies.

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Correct Answer is A

Explanation

Choice A Reason: "If I go too long overdue, the amniotic ﬂuid volume can become too low for my baby to be safe." This is a correct answer that indicates that the client understands one of the Reasons for induction of labor at 42 weeks' pregnancy.

Choice B Reason: "My baby took longer to grow, and now she's ready to be born." This is an incorrect answer that shows a misconception about fetal growth and development. Fetal growth does not depend on gestational age alone, but also on genetic, maternal, placental, and environmental factors. A post-term fetus does not necessarily grow faster or larger than a term fetus. In fact, some post-term fetuses may experience intrauterine growth restriction (IUGR), which means slower than expected growth for gestational age.

Choice C Reason: "I don't really need this induction, my baby will come whenever he wants to." This is an incorrect answer that reveals a lack of awareness or acceptance of the need for induction of labor at 42 weeks' pregnancy. Induction of labor is recommended for post-term pregnancies to prevent potential complications such as fetal distress, stillbirth, or maternal hemorrhage.

Choice D Reason: "Since I am so tired of being pregnant, I am being induced." This is an incorrect answer that implies that induction of labor is based on maternal preference or convenience rather than medical indication. Induction of labor should not be done without a valid Reason or informed consent, as it carries some risks such as failed induction, prolonged labor, infection, uterine rupture, or cesarean delivery.

A. Continuing to monitor and document fetal heart rate. B. Changing the mother's position to left lateral and giving oxygen by nasal cannula. C. With a sterile glove, maintaining pressure to lift the presenting part and emergently notifying the provider for a STAT C-section. D. Bolusing the patient with 1000cc lactated ringers

Correct Answer is C

Explanation

Choice A Reason: Continuing to monitor and document fetal heart rate. This is an inadequate response that does not address the urgency of the situation or intervene to prevent fetal distress or demise.

Choice B Reason: Changing the mother's position to left lateral and giving oxygen by nasal cannula. This is a partial response that may improve maternal-fetal blood ﬂow and oxygenation, but it does not resolve the cord compression or facilitate delivery.

Choice C Reason: With a sterile glove, maintaining pressure to lift the presenting part and emergently notifying the provider for a STAT C-section. This is an appropriate response that aims to reduce the cord compression by elevating the fetal head away from the cord and prepare for an immediate cesarean delivery.

Choice D Reason: Bolusing the patient with 1000cc lactated ringers. This is an irrelevant response that does not address the cause of the problem or improve fetal outcome.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The client at 42 weeks' pregnancy is admited for induction of her labor. Which statement indicates that she understands the Reasons for the induction? Select one:

Correct Answer is A

Explanation

The nurse, working in labor and delivery, performs a sterile vaginal exam on a laboring woman. During the exam, she feels a loop of pulsating cord in the vagina. The nurse would anticipate: Select one:

Correct Answer is C

Explanation

A couple who has had difficulty conceiving confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions that face them. Which of the following nursing strategies would be most appropriate and therapeutic? Select one:

Which of the following would be essential to implement to prevent late postpartum hemorrhage? Select one:

The Mother-Baby nurse is caring for a two hour old newborn who is 36 4/7 weeks gestation. The nurse assesses that the newborn is experiencing tremors (jiteriness). What nursing action has the highest priority? Select one:

Parents have been told their child has fetal alcohol syndrome (FAS). Which statement by a parent indicates that additional teaching is required? Select one:

In caring for the premature infant, the nurse must continually assess hydration status. Parameters to assess would include all of the following except: Select one:

When reviewing the causes of late postpartum hemorrhage, which of the following would the nurse identify as the most common cause? Select one:

When the nurse is assessing a postpartum client approximately 6 hours after delivery, which finding would warrant further investigation? Select one:

A term newborn weighs 4 pounds 5 ounces. The nurse assesses that this newborn is small for gestational age (SGA). The nurse knows that teaching has been eﬀective when the parents state: Select one: