A nurse is teaching a newly licensed nurse about the uses of ultrasonography in the first trimester of pregnancy. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
"Ultrasound is used to observe for placental maturity in the first trimester."
"Ultrasound is used to detect intrauterine growth restriction in the first trimester."
"Ultrasound is used to determine gestational age in the first trimester."
"Ultrasound is used to perform a biophysical profile in the first trimester."
The Correct Answer is C
Ultrasonography is a diagnostic imaging technique that uses high-frequency sound waves to create images of the internal structures of the body. It is a safe and noninvasive method that can provide valuable information about the pregnancy, such as the number, size, location, and health of the fetus(es), the placenta, the amniotic fluid, and the uterus.
Ultrasonography can be performed at any time during pregnancy, but it is especially useful in the first trimester (the first 12 weeks of pregnancy) for several reasons, such as:
- To confirm the pregnancy and rule out ectopic pregnancy (a pregnancy that occurs outside the uterus) or molar pregnancy (a pregnancy that develops into an abnormal mass of tissue)
- To determine gestational age (the length of time since the first day of the last menstrual period) and estimate due date (the expected date of delivery)
- To screen for chromosomal abnormalities (such as Down syndrome) or structural defects (such as spina bifida) in the fetus
- To identify multiple gestations (such as twins or triplets) or complications (such as miscarriage or
bleeding)
One of the main uses of ultrasonography in the first trimester is to determine gestational age. This is important because it can affect many aspects of prenatal care and delivery, such as:
- The timing and accuracy of other tests and procedures
- The monitoring and evaluation of fetal growth and development
- The identification and management of potential problems or complications
- The planning and preparation for labor and delivery
Gestational age can be determined by measuring the crown-rump length (CRL) of the fetus, which is the distance from the top of the head to the bottom of the spine. The CRL can be measured by using a transvaginal ultrasound (an ultrasound probe that is inserted into the vagina) or a transabdominal ultrasound (an ultrasound probe that is moved over the abdomen). The CRL can be compared to a standard growth chart to estimate gestational age. The CRL measurement is most accurate between 7 and 13 weeks of pregnancy .
Therefore, the newly licensed nurse who says that ultrasound is used to determine gestational age in the first trimester indicates an understanding of the teaching.
The other statements show a lack of knowledge or misunderstanding of the uses of ultrasonography in the first trimester:
- a) "Ultrasound is used to observe for placental maturity in the first trimester." This is not correct because placental maturity is not assessed in the first trimester. Placental maturity refers to the changes that occur in the placenta as it ages and prepares for delivery. Placental maturity can be evaluated by using a grading system that ranges from 0 to 3, based on the appearance of calcifications (deposits of calcium) in the placenta. Placental maturity can be assessed by using a transabdominal ultrasound in the third trimester (after 28 weeks of pregnancy).
- b) "Ultrasound is used to detect intrauterine growth restriction in the first trimester." This is not correct because intrauterine growth restriction (IUGR) is not detected in the first trimester. IUGR is a condition in which the fetus does not grow as expected and has a low birth weight for its gestational age. IUGR can be caused by various factors, such as placental insufficiency, maternal malnutrition, infection, or chronic disease. IUGR can affect fetal development and increase the risk of complications, such as hypoxia, hypoglycemia, or stillbirth. IUGR can be diagnosed by measuring fetal growth parameters, such as abdominal circumference, head circumference, femur length, and estimated fetal weight. These measurements can be obtained by using a transabdominal ultrasound in the second or third trimester (after 20 weeks of pregnancy).
- d) "Ultrasound is used to perform a biophysical profile in the first trimester." This is not correct because a biophysical profile (BPP) is not performed in the first trimester. A BPP is a test that evaluates fetal well-being by assessing five parameters: fetal movement, fetal tone, fetal breathing, amniotic fluid volume, and fetal heart rate. A BPP can help detect fetal distress or hypoxia and guide management decisions. A BPP can be performed by using a combination of transabdominal ultrasound and nonstress test (NST) in the third trimester (after 32 weeks of pregnancy).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Group B Streptococcus β-hemolytic (GBS) is a type of bacteria that can cause serious infections in newborns, such as sepsis, pneumonia, and meningitis. GBS can be transmitted from the mother to the baby during labor and delivery if the mother is colonized with GBS in her vagina or rectum¹.
To prevent GBS infection in newborns, pregnant women who test positive for GBS or have risk factors for GBS should receive intravenous (IV) antibiotics during labor. The antibiotics can reduce the amount of GBS bacteria in the mother's body and lower the chance of passing them to the baby¹².
The recommended antibiotic for GBS prophylaxis is penicillin, which is safe and effective for most women. However, some women may be allergic to penicillin and need an alternative antibiotic. Ampicillin is one of the alternative antibiotics that can be used for GBS prophylaxis in women who have a mild allergy to penicillin (such as rash or itching). Ampicillin is also a type of penicillin, but it has a slightly different structure and may not cause an allergic reaction in some people²³.
Therefore, the nurse should plan to administer ampicillin to the client who tested positive for GBS and has a mild allergy to penicillin. The nurse should also monitor the client for any signs of anaphylaxis (a severe allergic reaction) and have epinephrine ready in case of emergency²³.
The other options are not medications that the nurse should administer to the client:
- a) Cefotetan is another alternative antibiotic that can be used for GBS prophylaxis in women who have a severe allergy to penicillin (such as anaphylaxis or angioedema). However, it is not indicated for women who have a mild allergy to penicillin, as it may still cause cross-reactivity and an allergic reaction²³.
- b) Fluconazole is an antifungal medication that is used to treat fungal infections, such as candidiasis (thrush) or cryptococcal meningitis. It is not effective against bacterial infections, such as GBS, and it is not indicated for GBS prophylaxis⁴.
- d) Doxycycline is an antibiotic that is used to treat bacterial infections, such as chlamydia, gonorrhea, or Lyme disease. It is not effective against GBS and it is not indicated for GBS prophylaxis. Moreover, doxycycline is contraindicated in pregnancy, as it can cause harm to the fetus, such as tooth discoloration or bone growth problems.
Correct Answer is D
Explanation
A postpartum client who has type 1 diabetes mellitus and is breastfeeding her newborn should maintain
scheduled mealtimes for herself to prevent hypoglycemia and ensure adequate milk production¹. Breastfeeding may lower glucose levels in the parent and the risk of type 1 and type 2 diabetes in the child¹. Breastfeeding may also help the parent lose weight, prevent diabetes-related complications, and reduce the chances of some cancers¹.
The other options are incorrect because:
a) Taking more insulin with each meal than you did prior to pregnancy may cause hypoglycemia, especially if you are breastfeeding. You should adjust your insulin doses according to your blood glucose levels and carbohydrate intake, and consult your doctor or diabetes educator for guidance²³.
b) Checking your blood glucose levels every 8 hours is not frequent enough to monitor your diabetes during breastfeeding. You should check your blood glucose levels before and after each breastfeeding session, as well as before meals and snacks, at bedtime, and during the night if needed²³.
c) Limiting your carbohydrate intake to 30 grams per day is too restrictive and may impair your milk production and quality, as well as cause hypoglycemia or ketoacidosis. You should consume adequate carbohydrates from healthy sources, such as whole grains, fruits, vegetables, legumes, and dairy products, to meet your energy and nutritional needs²³.
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