A nurse in a prenatal clinic is reviewing the record of a patient at 28 weeks gestation. The woman's history reveals one pregnancy terminated by elective abortion at 12 weeks; the birth of twins at 34 weeks and a spontaneous abortion at 15 weeks. According to the GTPAL system, which of the following describes her present situation?
4-0-1-2-2
4-2-0-2-2
20-02-2
30-2-0-2
The Correct Answer is A
Step 1: Understand GTPAL
G = Gravida (total number of pregnancies, including current)
T = Term births (≥37 weeks)
P = Preterm births (20–36 6/7 weeks)
A = Abortions (spontaneous or elective <20 weeks)
L = Living children
Step 2: Count based on patient history
Gravida (G): Total pregnancies = 1 elective abortion + twins + spontaneous abortion = 3 completed pregnancies + current pregnancy = 4 → G = 4
Term births (T): Birth ≥37 weeks = None → T = 0
Preterm births (P): Birth 20–36 6/7 weeks = twins at 34 weeks → P = 1
Abortions (A): Spontaneous or elective <20 weeks = elective abortion at 12 weeks + spontaneous at 15 weeks → A = 2
Living children (L): Twins survived → L = 2
Step 3: Combine numbers
G = 4, T = 0, P = 1, A = 2, L = 2 → 4-0-1-2-2
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Develops object permanence is incorrect because object permanence is typically achieved by 8–12 months of age, during the sensorimotor stage of infancy, not during the preschool years.
B. Participates in imaginary play is correct because preschoolers (ages 3–5 years) engage in imaginative or pretend play, which is a hallmark of this developmental stage. Imaginary play supports cognitive, social, and emotional development and is consistent with Piaget’s preoperational stage.
C. Builds a collection of cards is incorrect because collecting items is more typical of school-age children (around 6–12 years), who are developing organizational skills and a sense of classification.
D. Learns to tell time is incorrect because this skill generally develops later in the school-age period, as it requires a more advanced understanding of abstract concepts and numerical sequencing.
Correct Answer is C
Explanation
A. Barking cough and inspiratory stridor, especially at night is incorrect because this is characteristic of croup, a respiratory condition, not tetralogy of Fallot. Tetralogy of Fallot primarily affects cardiac blood flow, not the upper airway.
B. Bradycardia and hypotension following minor activity or mild stress is incorrect because children with tetralogy of Fallot typically develop tachycardia in response to hypoxia or stress, rather than bradycardia. Hypotension is not a hallmark sign unless there is shock or severe complications.
C. Cyanosis that worsens during crying or feeding, often relieved by squatting is correct because children with tetralogy of Fallot have right-to-left shunting due to the combination of ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. This shunting reduces pulmonary blood flow, leading to cyanosis, which often becomes more pronounced during periods of increased oxygen demand, such as crying or feeding. Squatting increases systemic vascular resistance, temporarily reducing the shunt and improving oxygenation, which is known as a “Tet spell” relief maneuver.
D. Peripheral edema and hepatomegaly during exertion or prolonged play is incorrect because these signs are more typical of heart failure rather than tetralogy of Fallot in a child without chronic severe heart failure. Tetralogy of Fallot presents primarily with cyanosis and hypoxic spells.
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