A 24-year-old woman arrives at the clinic to confirm her pregnancy.
She has a body mass index (BMI) of 17, admits to occasional cocaine use and alcohol consumption, and has a blood pressure of 108/70 mm Hg. Her family history includes diabetes mellitus and cancer, including a sister who recently gave birth to an infant with a neural tube defect (NTD). Which factors place her in a high-risk category?

Drug/alcohol use, age, and family history.

Blood pressure, age, and BMI.

Family history, BMI, and drug/alcohol abuse.

Age, BMI, and family history.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Drug/alcohol use: While substance abuse during pregnancy can lead to adverse outcomes such as preterm labor, fetal growth restriction, and birth defects, it is not considered a primary factor in determining high-risk status for this patient. The specific substances involved (cocaine and alcohol) are indeed associated with risks, but they are not as significant as other factors in this case.

Age: The patient's age of 24 is not considered a high-risk factor for pregnancy. Advanced maternal age (typically defined as 35 years or older) is associated with increased risks for chromosomal abnormalities and other complications, but this patient falls below that age threshold.

Family history: Family history of diabetes mellitus, cancer, and neural tube defects can be relevant to pregnancy risk, but in this case, other factors outweigh their significance.

Choice B rationale:

Blood pressure: The patient's blood pressure of 108/70 mm Hg is within the normal range and does not contribute to highrisk categorization. High blood pressure (hypertension) during pregnancy can lead to preeclampsia and other complications, but this patient does not present with hypertension.

Age: As explained in Choice A, the patient's age is not a high-risk factor.

BMI: A BMI of 17 is considered underweight, which can increase the risk of certain pregnancy complications such as preterm birth and low birth weight. However, in this case, other factors are more significant in determining high-risk status.

Choice C rationale:

Family history: The patient's family history of a neural tube defect (NTD) in a close relative is a significant risk factor for NTDs in her own pregnancy. NTDs are serious birth defects that affect the brain and spinal cord, and they can have lifelong implications for the child. This factor alone warrants a high-risk categorization.

BMI: The patient's underweight BMI of 17 further contributes to her high-risk status, as it can increase the likelihood of certain complications as mentioned earlier.

Drug/alcohol abuse: The patient's admission of cocaine and alcohol use, even if occasional, is a concerning factor for pregnancy. Cocaine, in particular, is a potent vasoconstrictor that can negatively impact fetal growth and development. Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders (FASDs), which can cause a range of physical, cognitive, and behavioral problems.

Choice D rationale:

Age: As explained previously, the patient's age is not a high-risk factor.

BMI: The patient's BMI is a contributing factor, but not the most significant one in this case.

Family history: The patient's family history is relevant, but the presence of a neural tube defect in a close relative is the most significant aspect of her family history in terms of pregnancy risk.

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Correct Answer is D

Explanation

Choice A rationale:

Fetal lung maturity is not assessed through chorionic villus sampling (CVS). It's primarily evaluated through amniocentesis, a different prenatal diagnostic procedure that involves sampling amniotic fluid.

CVS focuses on placental tissue, not lung development.

It's essential for clients to understand the specific purposes of each prenatal test to make informed decisions and have accurate expectations.

Choice B rationale:

While a non-stress test (NST) might be recommended after CVS in some cases, it's not a routine part of the procedure.

The decision to conduct an NST is based on individual risk factors and assessment by healthcare providers.

It's essential for clients to understand the potential need for additional testing but not assume it's always required.

Choice C rationale:

CVS is considered an invasive procedure, as it involves entering the uterus to collect placental tissue.

Non-invasive prenatal testing (NIPT) methods, which analyze fetal DNA in maternal blood, are available for screening purposes.

It's crucial for clients to differentiate between invasive and non-invasive prenatal testing options to make informed choices based on their preferences and risk factors.

Choice D rationale:

This statement accurately reflects the primary purpose of CVS.

It's a diagnostic procedure that can detect various genetic abnormalities, such as Down syndrome, cystic fibrosis, and TaySachs disease, during the first trimester of pregnancy.

Understanding the ability to detect genetic abnormalities early in pregnancy allows clients to make informed decisions about their pregnancy management and prepare for potential outcomes.

A. Semen analysis B. Transvaginal ultrasound C. Hysterosalpingography D. Hysteroscopy

Correct Answer is A

Explanation

Choice A rationale:

Semen analysis is the initial test often performed in the evaluation of infertility. It's a non-invasive, cost-effective, and informative assessment of male fertility. Here's a detailed explanation of its significance:

Assessment of Sperm Quality:

Measures sperm count, motility (movement), and morphology (shape).

Abnormalities in any of these parameters can significantly impact the chances of conception.

Identification of Male Factor Infertility:

Contributes to approximately 40% of infertility cases.

Early identification of male factor infertility guides treatment options and avoids unnecessary testing for the female partner.

Non-Invasive and Cost-Effective:

Simple procedure involving the collection of a semen sample.

Relatively inexpensive compared to other fertility tests.

Informative Results:

Provides valuable insights into sperm health and potential causes of infertility.

Guides further diagnostic evaluation and treatment strategies.

Rationale for other choices:

Choice B: Transvaginal ultrasound

Primarily evaluates female reproductive organs.

Assesses uterine structure, ovarian function, and potential abnormalities like fibroids or cysts.

Not typically the first test in infertility evaluation unless there's a specific female-factor concern.

Choice C: Hysterosalpingography (HSG)

Assesses the patency of the fallopian tubes.

Involves X-ray imaging after injecting contrast dye into the uterus.

Often performed after semen analysis if male factor infertility is not identified.

Choice D: Hysteroscopy

A more invasive procedure involving direct visualization of the inside of the uterus.

Used to diagnose and treat uterine abnormalities such as polyps or fibroids.

Not typically a first-line test in infertility evaluation.

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Naxlex Comprehensive Predictor Exams

A pregnant woman is getting ready for a chorionic villus sampling procedure at 10 weeks. The nurse has been educating her about the procedure. Which of the following statements, if made by the client, would indicate that the teaching has been effective?

Correct Answer is D

Explanation

A couple has been diagnosed with infertility after trying to conceive for a year. Which test would likely be performed first?

Correct Answer is A

Explanation

The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.

When assessing the knowledge of new parents of a child born with Maple Syrup Urine Disease (MSUD), an autosomal recessive inherited disorder, which statement is true?

The nurse is assessing a newborn after delivery and observes the following: epicanthal folds, heart murmur, low-set ears, and poor muscle tone. What does the nurse suspect?

During the initial prenatal visit, the nurse completes a history for a 25-year-old G1PO client. During the interview, the client states her mother has been diagnosed with Huntington’s Disease. Which of the following is a correct statement by the nurse about this autosomal dominant disorder?

A pregnant client is at the prenatal clinic for a fetal nuchal translucency test. What does the nurse understand about this test?

A pregnant patient has a biophysical profile score of 8. What does this result mean?

A client, who is 39 weeks pregnant, has been admitted to the hospital for induction. The doctor has prescribed misoprostol (Cytotec). Which statement by the client indicates a need for further education?

When preparing a client for an emergency cesarean birth with no time to administer spinal anesthesia, what is the greatest risk of administering general anesthesia to the client?