Contemporary Maternal Newborn Nursing 9e (Ladewig et al.) Test bank

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Contemporary Maternal Newborn Nursing 9e (Ladewig et al.) Test bank

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Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)
Chapter 13 Assessment of Fetal Well-Being

1) The nurse is responding to phone calls. Which call should the nurse return first?
1. 37 weeks gestation, reports no fetal movement for 24 hours
2. 29 weeks gestation, reports increased fetal movement
3. 32 weeks gestation, reports decreased fetal movement for 2 days
4. 35 weeks gestation, reports decreased fetal movement for 4 hours
Answer: 1
Explanation: 1. A lack of fetal movement in a fetus in the third trimester can indicate fetal hypoxia or fetal death. This client is the highest priority.
2. Increased fetal movement is not indicative of a problem.
3. Although decreased fetal movement can indicate intrauterine growth restriction or fetal hypoxia, this patient is not the highest priority.
4. Although decreased fetal movement can indicate intrauterine growth restriction or fetal hypoxia, four hours is a very short amount of time to assess decreased fetal movement.
Page Ref: 234-235
Cognitive Level: Application
Client Need&Sub: Physiological Integrity
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care
Learning Outcome: LO 13.1-Identify pertinent information to be discussed with the woman regarding her own assessment of fetal activity and methods of recording fetal activity as a means of establishing fetal well-being.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

2) A woman at 28 weeks gestation is asked to keep a fetal activity diary 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 over 30 minutes. The most appropriate initial comment by the nurse would be:
1. You need to come to the clinic right away for further evaluation.
2. Have you been smoking?
3. When did you eat last?
4. Your baby might be asleep.
Answer: 4
Explanation: 1. The mother would need to come to the clinic only if there had been no fetal activity for several hours.
2. Smoking typically will stimulate the infant.
3. After meals, an infant typically is active and moving.
4. Lack of fetal activity for 30 minutes typically is insignificant and means only that the infant is sleeping. If the mother truly is concerned, in 30 minutes, she could eat a complex-carbohydrate snack. This would stimulate the infant, and the mother should have fetal activity. But at present, this is an indicator the infant is sleeping.
Page Ref: 234-235
Cognitive Level: Analyzing
Client Need&Sub: Physiological Integrity
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion
Learning Outcome: LO 13.1-Identify pertinent information to be discussed with the woman regarding her own assessment of fetal activity and methods of recording fetal activity as a means of establishing fetal well-being.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

3) The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching had been effective?
1. If the ultrasound is normal, it means my baby has no abnormalities.
2. The nuchal translucency measurement will diagnose Down syndrome.
3. I might be able to see who the baby looks like with the ultrasound.
4. Measuring the length of my cervix will determine if I will deliver early.
Answer: 3
Explanation: 1. Not all fetal anomalies are detectable by ultrasound.
2. Nuchal translucency measurements are screening, not diagnostic, for trisomies 13, 18, and 21.
3. Ultrasounds provide a very clear photo-like image of the fetus, often providing parents the opportunity to identify a familial characteristic such as nose shape.
4. Transvaginal ultrasound is used to measure the cervical length as a screening for risk of preterm labor. However, a normal-length cervix does not preclude preterm birth.
Page Ref: 236-238
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion
Learning Outcome: LO 13.2-Describe the methods, clinical applications, and results of ultrasound in the nursing care management of the pregnant woman.
MNL LO: Examine indications and procedures for antenatal testing performed during the second trimester.

4) A woman is at 32 weeks gestation. Her fundal height measurement at this clinic appointment is 26 centimeters. After reviewing her ultrasound results, the healthcare provider asks the nurse to schedule the patient for a series of sonograms to be done every two weeks. The nurse should make sure that the patient understands that the main purpose for this is to:
1. Assess for congenital anomalies.
2. Evaluate fetal growth.
3. Determine fetal presentation.
4. Rule out a suspected hydatidiform mole.
Answer: 2
Explanation: 1. Assessment of anomalies would require only one ultrasound.
2. A person who is at 32 weeks gestation should measure 32 cm of fundal height. When a discrepancy between fundal height and measurement exists, the purpose of serial ultrasounds is to monitor fetal growth.
3. Fetal presentation would require only one ultrasound.
4. Ruling out a hydatidiform mole would require only one ultrasound.
Page Ref: 239
Cognitive Level: Application
Client Need&Sub: Physiological Integrity
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion
Learning Outcome: LO 13.2-Describe the methods, clinical applications, and results of ultrasound in the nursing care management of the pregnant woman.
MNL LO: Examine indications and procedures for antenatal testing performed during the third trimester.

5) In assisting with an abdominal ultrasound procedure for determination of fetal age, the nurse:
1. Asks the woman to sign an operative consent form prior to the procedure.
2. Has the woman empty her bladder before the test begins.
3. Assists the woman into a supine position on the examining table.
4. Instructs the woman to eat a fat-free meal two hours before the scheduled test time.
Answer: 3
Explanation: 1. Abdominal ultrasounds are not invasive procedures and do not require a consent form.
2. The recommendation is that the patient should have a full bladder to help elevate the uterus out of the pelvic cavity for better visualization.
3. Patients are placed in a supine position on the table.
4. Dietary intake is not relevant to the ultrasound.
Page Ref: 239
Cognitive Level: Application
Client Need&Sub: Physiological Integrity | Reduction of Risk Potential
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care
Learning Outcome: LO 13.2-Describe the methods, clinical applications, and results of ultrasound in the nursing care management of the pregnant woman.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

6) The prenatal clinic nurse is responding to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test result?
1. The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby.
2. The reactive nonstress test means that my baby is not growing because of a lack of oxygen.
3. Because my contraction stress test was positive, we know that my baby will tolerate labor well.
4. My biophysical profile score of 6 points indicates everything being normal and healthy for my baby.
Answer: 1
Explanation: 1. The Doppler velocimetry test looks at blood flow through the umbilical artery. A normal result indicates there is no vasospasm decreasing blood flow to the placenta; therefore, the baby is getting an adequate blood supply.
2. The nonstress test utilizes external fetal monitoring to assess the fetal heart rate in relationship to fetal movement. When accelerations in the fetal heart rate are associated with fetal movement (a reactive result), the fetus is well oxygenated, and the placenta is functioning well.
3. A contraction stress test creates mild contractions. The presence of decelerations is termed a positive result and indicates a lack of adequate placental functioning.
4. The biophysical profile score should be 8 (with adequate amniotic fluid) or 10. A score of 6 is abnormal and indicates that further assessment is needed.
Page Ref: 240
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion
Learning Outcome: LO 13.4-Describe the use, procedure, information obtained, and nursing considerations to evaluate fetal well-being when using Doppler blood flow studies/umbilical velocimetry, nonstress test, contraction stress test, and biophysical profile test.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

7) At 32 weeks gestation, a woman is scheduled for a second nonstress test (following the one she had at 28 weeks gestation). Which response by the client would indicate an adequate understanding of this procedure?
1. I cant get up and walk around during the test.
2. Ill have an IV started before the test.
3. I must avoid drinks containing caffeine for 24 hours before the test.
4. I need to have a full bladder for this test.
Answer: 1
Explanation: 1. The purpose of the nonstress test is to determine the results of movement on fetal heart rate. The client will have to lie still on her side during the procedure.
2. There is no IV needed to administer medications.
3. Caffeine might cause the infant to be more active and cause the test to go more quickly.
4. Clients usually are asked to have their bladders full only for ultrasounds.
Page Ref: 240
Cognitive Level: Application
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion
Learning Outcome: LO 13.4-Describe the use, procedure, information obtained, and nursing considerations to evaluate fetal well-being when using Doppler blood flow studies/umbilical velocimetry, nonstress test, contraction stress test, and biophysical profile test.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

8) 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:
1. A negative test.
2. A reactive test.
3. A non-reactive test.
4. An equivocal test
Answer: 3
Explanation: 1. Nonstress tests are scored as either reactive or non-reactive.
2. A reactive stress test has the expected results of an increase in heart rate of 15 beats per minute for 15 seconds or more.
3. In a non-reactive stress test, the reactivity criteria are not met. Since this client experienced a deceleration during the test, this is considered non-reactive.
4. Nonstress tests are scored as either reactive or non-reactive.
Page Ref: 240-241
Cognitive Level: Application
Client Need&Sub: Physiological Integrity | Reduction of Risk Potential
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care
Learning Outcome: LO 13.4-Describe the use, procedure, information obtained, and nursing considerations to evaluate fetal well-being when using Doppler blood flow studies/umbilical velocimetry, nonstress test, contraction stress test, and biophysical profile test.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.
9) A pregnant woman is having a nipple-stimulated contraction stress test. Which result indicates hyperstimulation?
1. The fetal heart rate decelerates when three contractions occur within a 10-minute period.
2. The fetal heart rate accelerates when contractions last up to 60 seconds.
3. There are more than five fetal movements in a 10-minute period.
4. There are more than three uterine contractions in a 6-minute period.
Answer: 4
Explanation: 1. Decelerations are considered a positive contraction stress test.
2. The acceleration of the heart rate is considered a negative contraction stress test.
3. The fetal movement is considered a negative contraction stress test.
4. Hyperstimulation is characterized by contractions closer than or equal to every 6 minutes or lasting longer than 90 seconds.
Page Ref: 243
Cognitive Level: Analyzing
Client Need&Sub: Physiological Integrity | Reduction of Risk Potential
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care
Learning Outcome: LO 13.4-Describe the use, procedure, information obtained, and nursing considerations to evaluate fetal well-being when using Doppler blood flow studies/umbilical velocimetry, nonstress test, contraction stress test, and biophysical profile test.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

10) Of all the clients who have been scheduled to have a biophysical profile, for which patient should the nurse clarify the physicians order?
1. A gravida with intrauterine growth restriction
2. A gravida with mild hypertension of pregnancy
3. A gravida who is post-term
4. A gravida who complains of decreased fetal movement for 2 days
Answer: 2
Explanation: 1. The infant who has intrauterine growth problems might be compromised due to placental insufficiency.
2. The biophysical profile is used when there is a risk of placental and/or fetal compromise. The gravida with mild hypertension will need to be monitored more closely throughout the pregnancy but is not a candidate at present for a biophysical profile.
3. The infant who is post-term might be compromised due to placental insufficiency.
4. The gravida who is experiencing decreased fetal movement for 2 days needs assessment of the placenta and the fetus.
Page Ref: 242-243
Cognitive Level: Analyzing
Client Need&Sub: Physiological Integrity | Reduction of Risk Potential
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care
Learning Outcome: LO 13.4-Describe the use, procedure, information obtained, and nursing considerations to evaluate fetal well-being when using Doppler blood flow studies/umbilical velocimetry, nonstress test, contraction stress test, and biophysical profile test.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

11) The nurse is reviewing nursing documentation related to the care of a client who had an amniocentesis. Which nursing notes reflect appropriate client care?
1. An Rh-positive client received RhoGAM after the amniocentesis.
2. The client was monitored for 30 minutes after completion of the test.
3. Prior to discharge, the client demonstrated vaginal spotting.
4. The client reported that she takes insulin before each meal and at bedtime.
Answer: 2
Explanation: 1. Only Rh-negative patients receive RhoGAM after amniocentesis. The Rh-positive client should not ever receive RhoGAM.
2. Twenty to thirty minutes of fetal monitoring is performed to assess for fetal well-being and to rule out injury of the fetus or placenta during the exam.
3. Vaginal spotting after the amniocentesis is not an expected finding. A client experiencing vaginal bleeding of any amount after amniocentesis requires additional assessment and should not be sent home.
4. Whether or not a client takes insulin has nothing to do with amniocentesis. This answer does not relate to the question asked.
Page Ref: 245-247
Cognitive Level: Evaluating
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Informatics | AACN Essential Competencies: Essential IV: Information management and application of patient care technology | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Quality of practice
Learning Outcome: LO 13.5-Explain the use of amniocentesis as a diagnostic tool.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

12) Each of the following pregnant women is scheduled for a 14-week antepartum visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (AFP) screening to which client?
1. 28-year-old with history of rheumatic heart disease
2. 18-year-old with exposure to HIV
3. 20-year-old with a history of preterm labor
4. 35-year-old with a child with spina bifida
Answer: 4
Explanation: 1. The client with rheumatic heart disease would need to be monitored for pregnancy and the stressors it places on the patient.
2. The client with HIV exposure needs HIV testing and protection education.
3. The client with a history of preterm labor needs education on prevention and signs and symptoms of preterm labor.
4. Alpha-fetoprotein (AFP) is elevated in multi-gestational pregnancies and in pregnancies with neural tube defects such as spina bifida and Down syndrome. The 35-year-old is considered to be of advanced maternal age and is at risk for having a child with Down syndrome, and with the past history of a child with spina bifida, would be highly encouraged to have the AFP screening.
Page Ref: 245
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion
Learning Outcome: LO 13.5-Explain the use of amniocentesis as a diagnostic tool.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

13) The nurse is creating a client education brochure describing amniocentesis. Which statement is most important for the nurse to include in the brochure?
1. Prior to the amniocentesis, you will be asked to sign a consent form.
2. After the amniocentesis, your vital signs will be monitored.
3. During the amniocentesis, you might experience leaking of fluid.
4. Following the amniocentesis, you can return to normal activities.
Answer: 2
Explanation: 1. This is a true statement, but direct client care, including monitoring for complications, is a higher priority.
2. Vital signs are monitored and fetal monitoring is performed after amniocentesis to verify that both mother and fetus are physiologically stable after the test is completed.
3. Leaking of fluid is a complication of amniocentesis indicating rupture of membranes.
4. Activity should be restricted for 24 hours after the amniocentesis to help prevent complications.
Page Ref: 245-247
Cognitive Level: Application
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion
Learning Outcome: LO 13.6-Describe the nurses role and responsibilities in assisting during amniocentesis.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

14) A woman who is 12 weeks gestation asks the nurse if she can undergo chorionic villus sampling (CVS) testing in order to determine whether her baby has a neural tube defect. Which response is best?
1. Yes, at 12 weeks gestation, CVS can be used to diagnose a neural tube defect.
2. No, because CVS testing is not performed until after 20 weeks gestation.
3. Yes, at 12 weeks gestation, CVS is combined with amniocentesis to diagnose neural tube defects.
4. No, because CVS testing alone at any stage cannot detect neural tube defects.
Answer: 4
Explanation: 1. CVS is typically performed between 10 and 13 weeks gestation; however, CVS does not detect neural tube defects.
2. While CVS is typically performed between 10 and 13 weeks gestation, this test cannot detect neural tube defects.
3. CVS is typically performed between 10 and 13 weeks gestation; however, amniocentesis is not performed until 15 weeks gestation.
4. While CVS is typically performed between 10 and 13 weeks gestation, this test cannot detect neural tube defects.
Page Ref: 247
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion
Learning Outcome: LO 13.7-Compare the advantages and disadvantages of chorionic villus sampling (CVS) to amniocentesis.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

15) A woman who is 15 weeks gestation received normal chorionic villus sampling (CVS) results and abnormal quadruple screen test results. For detection of congenital anomalies, which test should the nurse expect the woman to be offered next?
1. Amniocentesis
2. Ultrasound
3. Contraction Stress Test (CST)
4. Nonstress test (NST)
Answer: 1
Explanation: 1. Women who have a normal CVS and an abnormal quadruple screen test would be offered amniocentesis to screen for congenital anomalies.
2. While ultrasound has many uses, is not useful in the diagnosis of congenital anomalies.
3. The contraction stress test is used to assess fetal status.
4. The nonstress test is used to assess fetal status.
Page Ref: 247
Cognitive Level: Understanding
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care
Learning Outcome: LO 13.7-Compare the advantages and disadvantages of chorionic villus sampling (CVS) to amniocentesis.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.
16) Prior to performing amniocentesis, which nursing action is appropriate?
1. Administering Rh immune globulin to a woman who is Rh-negative
2. Prepping the abdominal skin with povidone-iodine (Betadine)
3. Assisting the woman with assuming a right lateral position
4. Providing non-sterile gloves for use by the physician performing the procedure
Answer: 2
Explanation: 1. Rh immune globulin is administered prophylactically following an amniocentesis to prevent Rh sensitization in an Rh-negative woman.
2. Prior to amniocentesis, current guidelines recommend prepping the abdominal skin with povidone-iodine (Betadine).
3. The woman should be positioned supine for amniocentesis.
4. When performing amniocentesis, sterile gloves are worn by the physician.
Page Ref: 245-246
Cognitive Level: Understanding
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care
Learning Outcome: LO 13.8-Identify nursing interventions that are aimed at ensuring the safety of the mother and fetus during antepartum testing.
MNL LO: Determine factors to consider when providing care during the antepartum period.

17) The nurse is assisting a nurse-midwife with performing a contraction stress test (CST) on a client who is 30 weeks gestation. The monitor reveals a hypersystole pattern. What order should the nurse expect to receive from the physician?
1. Change the clients position to Trendelenburg.
2. Assist the client with application of an electric breast pump.
3. Obtain a 15-minute recording of uterine activity.
4. Administer a tocolytic medication.
Answer: 4
Explanation: 1. The client is demonstrating hypersystole pattern of uterine contraction and would most likely receive a tocolytic medication.
2. Breast stimulation may be used to produce uterine contractions during CST.
3. While monitoring is appropriate, a hypersystole pattern of uterine contractions requires pharmacologic treatment with a tocolytic agent.
4. During CST, development of a hypersystole pattern requires prompt administration of a tocolytic agent.
Page Ref: 243-244
Cognitive Level: Application
Client Need&Sub: Physiological Integrity
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO 13.8-Identify nursing interventions that are aimed at ensuring the safety of the mother and fetus during antepartum testing.
MNL LO: Determine factors to consider when providing care during the antepartum period.

18) The nurse is explaining the importance of fetal activity assessment to the client. What should the nurse do to best reinforce the significance of fetal kick counting to the client?
1. Perform daily phone calls to the client at work or home.
2. Review the clients written record of fetal movement at each visit.
3. Ask the client to remember to count the fetal movements.
4. Explain the rationale for counting fetal movement to the client.
Answer: 2
Explanation: 1. Daily phone calls would take emphasis away from the importance of the clients counting of fetal movement.
2. Clients should be instructed to begin counting fetal movement between 24 and 28 weeks. A fetus that has been active and has a sudden decrease in movements could be conserving energy due to hypoxia. Movements are counted in a specified time period, such as for one hour after each meal, or beginning with arising in the morning.
3. Writing down the count is more accurate than the clients simply remembering. When the nurse examines the written record the patient has kept, it reinforces the importance of the record and improves the likelihood of continued record keeping.
4. Knowing the reasons for the counting will increase understanding of the process but will not reinforce its significance of the task.
Page Ref: 234-235
Cognitive Level: Application
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care
Learning Outcome: LO 13.1-Identify pertinent information to be discussed with the woman regarding her own assessment of fetal activity and methods of recording fetal activity as a means of establishing fetal well-being.
MNL LO: Implement client teaching that promotes health maintenance during pregnancy.

19) A woman at 15 weeks gestation is to have an amniocentesis completed for genetic diagnosis. What important information does the woman need to know before this procedure?
1. The test is only 75 percent accurate in diagnosing genetic abnormalities.
2. A regional anesthetic will be administered by 18-gauge needle.
3. The bladder must be full to proceed with the test.
4. Complications occur in 10 percent of cases.
Answer: 3
Explanation: 1. Amniocentesis is 99 percent accurate in diagnosing genetic abnormalities.
2. A local anesthetic is administered by a 22-gauge needle.
3. The bladder must be full enough to lift the uterus out of the pelvis.
4. Complications occur in less than 1 percent of cases.
Page Ref: 245-247
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care
Learning Outcome: LO 13.5-Explain the use of amniocentesis as a diagnostic tool.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.
20) Nursing care for the woman that just completed amniocentesis testing includes (select all that apply):
1. Continually monitor and obtain an CST after the procedure.
2. Monitor maternal heart rate for 4-hours after the procedure.
3. Assess for uterine contractions and irritability.
4. Assess the fetal blood type.
5. Assess I & O.
Answer: 2, 3
Explanation: 1. Maintain continuous monitoring and obtain an NST after the procedure.
2. Maintain continuous fetal monitoring and obtain an NST after the procedure.
3. Assess for uterine contractions and irritability, this helps detect any complications such as inadvertent fetal puncture.
4. Assess mother for Rh-negative blood type. Rh immune globulin is administered prophylactically following an amniocentesis to prevent Rh sensitization in a Rh-negative woman.
5. There is no need to assess I & O, although the woman is given instructions to increase her intake of fluids for 24-hours.
Page Ref: 245-246
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care
Learning Outcome: LO 13.5-Explain the use of amniocentesis as a diagnostic tool.
MNL LO: Explain the nurses role and responsibilities in the administration of antenatal testing.

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