A nurse is teaching routine prenatal care to a group of clients who are pregnant.
Which of the following statements by a client indicates an understanding of the teaching?
I will be able to hear my baby's heartbeat when I am 6 weeks pregnant.
I will have monthly prenatal visits for the first 28 weeks of pregnancy.
I will have a complete blood count performed at each prenatal visit.
I will have a blood test to check for neural tube defects when I am 32 weeks pregnant.
The Correct Answer is B
Choice A rationale
Fetal cardiac activity is typically detectable via transvaginal ultrasound as early as 5.5 to 6 weeks gestational age, when the embryo is approximately 2-4 mm in crown-rump length. However, hearing the heartbeat with a Doppler stethoscope usually occurs later, around 10 to 12 weeks, as the fetal heart is still very small and sound transmission is limited.
Choice B rationale
The standard schedule for prenatal visits involves monthly appointments from the first prenatal visit until 28 weeks of gestation. This frequency allows for consistent monitoring of maternal and fetal well-being, early detection of potential complications, and timely interventions. After 28 weeks, visits typically become more frequent.
Choice C rationale
While a complete blood count (CBC) is a crucial laboratory test performed during pregnancy, it is not typically done at every prenatal visit. Initial CBCs are obtained at the first prenatal visit to establish baseline values, and then repeated later in pregnancy, often around 28 weeks, to screen for anemia and other hematologic changes.
Choice D rationale
Screening for neural tube defects, often through maternal serum alpha-fetoprotein (MSAFP) testing, is typically performed between 15 and 20 weeks of gestation. This timing is crucial for accurate interpretation of results and allows for further diagnostic evaluation if abnormalities are detected, well before 32 weeks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is []
Explanation
Rationale for correct condition:
Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, typically in the fallopian tube. The absence of an intrauterine pregnancy on transvaginal ultrasound at an hCG level of 2000 IU/L (above the discriminatory zone of 1500-2000 IU/L) strongly suggests ectopic pregnancy. The patient’s left lower quadrant pain and vaginal bleeding are classic signs. Progesterone >4 ng/dL indicates a potentially viable pregnancy, but no intrauterine gestation confirms ectopic risk. Early diagnosis is crucial to prevent tubal rupture and hemorrhagic shock.
Rationale for correct actions:
Intramuscular methotrexate is a folic acid antagonist used to medically manage unruptured ectopic pregnancies by inhibiting trophoblastic cell division. It is preferred when the patient is hemodynamically stable, avoiding surgery. CBC monitors for anemia from bleeding; liver function tests assess methotrexate toxicity risk, as the drug is hepatotoxic. Both are essential for safe medical management.
Rationale for correct parameters:
Hypotension indicates potential internal bleeding from tubal rupture requiring immediate intervention. Referred shoulder pain occurs from diaphragmatic irritation by blood in the peritoneal cavity, signaling intra-abdominal hemorrhage. Monitoring these signs allows early detection of complications.
Rationale for incorrect conditions:
Spontaneous abortion typically shows declining hCG and intrauterine findings of miscarriage, which are absent here. Molar pregnancy presents with markedly elevated hCG (>100,000 IU/L) and characteristic ultrasound “snowstorm” appearance, not seen. Cervical insufficiency causes painless cervical dilation in the second trimester, not early pregnancy pain with bleeding.
Rationale for incorrect actions:
Dilation and curettage is indicated in incomplete abortion, not ectopic pregnancy. Cervical cerclage treats cervical insufficiency, unrelated to this presentation. Oxytocic agents induce uterine contractions in miscarriage or labor, not ectopic management.
Rationale for incorrect parameters:
Size of uterus is irrelevant here because no intrauterine pregnancy is seen. Uterine cramping is nonspecific and more relevant in miscarriage. Leakage of amniotic fluid occurs in membrane rupture, not ectopic pregnancy.
Take-home points:
- Absence of intrauterine pregnancy at hCG >1500 IU/L suggests ectopic pregnancy.
- Methotrexate is first-line medical treatment for stable ectopic pregnancies.
- Hypotension and referred shoulder pain are critical signs of rupture and hemorrhage.
- Differentiation from miscarriage, molar pregnancy, and cervical insufficiency is vital for appropriate care.
Correct Answer is A
Explanation
Choice A rationale
In the scenario of ruptured membranes with a breech presentation, there is an elevated risk of umbilical cord prolapse due to the disproportionate fit of the presenting part in the maternal pelvis. Checking fetal heart tones immediately allows for rapid detection of cord compression, which manifests as abrupt decelerations, indicating fetal distress and necessitating urgent intervention.
Choice B rationale
While a cesarean birth is often indicated for breech presentations, especially with ruptured membranes, it is not the immediate first action. The priority is to assess fetal well-being, specifically ruling out umbilical cord prolapse, as this is an acute emergency that requires immediate intervention to prevent fetal hypoxia and mortality, prior to surgical preparation.
Choice C rationale
Assessing the color, amount, and odor of the amniotic fluid provides information about potential infection or meconium presence, which are important data points. However, the immediate life-threatening complication with ruptured membranes and breech presentation is umbilical cord prolapse, making fetal heart tone assessment a more urgent priority.
Choice D rationale
Performing a Nitrazine test confirms the rupture of membranes, but the client has already reported "my water just broke.”. While a confirmatory test, it is not the immediate priority. The critical concern is the potential for umbilical cord prolapse, which directly impacts fetal oxygenation and requires immediate assessment via fetal heart tones.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.