Review Practice Exercise 3

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A pregnant client reports her last menstrual period (LMP) began on May 10, 2020. Using Näegele’s Rule, what is her estimated date of delivery (EDD)?

A. February 17, 2021 B. February 3, 2021 C. August 17, 2021 D. March 10, 2021

Answer and Explanation

Choice A:

LMP = May 10, 2020. Using Nägele’s Rule:
→ Add 1 year = May 10, 2021
→ Subtract 3 months = February 10, 2021
→ Add 7 days = February 17, 2021
This gives an estimated date of delivery of February 17, 2021.

Choice B:

February 3, 2021 is incorrect. This would only be accurate if the LMP had been April 27, 2020. It results from either miscalculating the LMP or adding the wrong number of days. It shortens gestation to about 38 weeks instead of 40.

Choice C:

August 17, 2021 is 15 months from the LMP, extending the pregnancy far beyond the normal 280-day gestation. This choice reflects a critical misunderstanding of the formula and is not physiologically plausible.

Choice D:

March 10, 2021 is incorrect. It adds 10 months rather than adjusting by Nägele’s Rule. This calculation mistakenly adds only months without following the 1 year − 3 months + 7 days pattern. It leads to a gestation of about 44 weeks.

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Question 2:

A nurse is assessing a patient at 28 weeks gestation. Which physical assessment finding supports the estimation of gestational age?

A. Fundal height of 20 cm B. Fetal heart tones absent C. Quickening not yet reported D. Fundal height of 28 cm

Answer and Explanation

Choice A:

A fundal height of 20 cm is consistent with approximately 20 weeks gestation, not 28 weeks. This finding suggests either incorrect dating or possible intrauterine growth restriction and does not support a 28-week pregnancy.

Choice B:

Fetal heart tones should be clearly audible by 10 to 12 weeks gestation. At 28 weeks, absence of fetal heart tones is an abnormal and concerning finding and may indicate fetal demise, not normal gestational progression.

Choice C:

Quickening, or the mother's perception of fetal movement, usually occurs between 16 and 20 weeks gestation. By 28 weeks, fetal movement should be regularly felt. Not yet reporting quickening at this stage is abnormal and does not support a 28-week gestation.

Choice D:

A fundal height of 28 cm at 28 weeks gestation directly supports normal growth and matches the expected correlation between fundal height and gestational age. This is within the normal ±2 cm range, indicating appropriate fetal development.

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Question 3:

Which of the following methods is considered the most accurate for estimating gestational age in the first trimester?

A. Fundal height measurement B. Last menstrual period (LMP) C. Crown-rump length (CRL) on ultrasound D. Auscultation of fetal heart tones with a fetoscope

Answer and Explanation

Choice A:

Fundal height measurement is not accurate in the first trimester. Uterine growth is not easily palpable or consistent before 20 weeks. This method becomes more useful only after 20 weeks gestation when the fundal height correlates with gestational age.

Choice B:

LMP is commonly used but less accurate than CRL because it relies on patient memory and assumes a regular 28-day cycle with ovulation on day 14. Cycle variability, implantation timing, and irregular periods can lead to dating errors.

Choice C:

CRL via ultrasound in the first trimester is the gold standard for dating pregnancy. It has the least margin of error compared to other methods, especially before 14 weeks gestation. It provides a highly reproducible and objective measurement.

Choice D:

Fetal heart tones with a fetoscope are typically not heard until around 18 to 20 weeks gestation. Auscultation does not provide precise gestational dating and is not a first-trimester tool.

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Question 4:

Which of the following factors can affect the accuracy of fundal height measurements? Select all that apply.

A. Maternal obesity B. Fetal position C. Amniotic fluid volume D. Maternal blood pressure E. Fetal heart rate

Answer and Explanation

Choice A:

Maternal obesity can affect accuracy by increasing abdominal wall thickness, which can make palpation of the fundus difficult and lead to underestimation or overestimation of fundal height.

Choice B:

Fetal position impacts fundal height. For example, a transverse lie or breech presentation may alter uterine shape and cause the fundal height to be lower or higher than expected.

Choice C:

Amniotic fluid volume affects uterine distention. Polyhydramnios can elevate fundal height, while oligohydramnios can decrease it, leading to inaccurate correlation with gestational age.

Choice D:

Maternal blood pressure does not alter uterine size or fundal height. Hypertension may impact placental perfusion and fetal growth over time, but it does not acutely change fundal height measurement.

Choice E:

Fetal heart rate does not influence fundal height. While it is a vital sign of fetal well-being, it has no structural or volumetric effect on uterine growth or size.

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Question 5:

Which of the following are methods used to estimate fetal age? Select all that apply.

A. Last menstrual period (LMP) B. Ultrasound C. Maternal weight gain D. Fetal heart rate E. Quickening

Answer and Explanation

Choice A:

LMP is a traditional method used to estimate gestational age. It assumes a 28-day cycle with ovulation on day 14. The expected date of delivery is calculated using Nägele’s Rule: LMP + 1 year − 3 months + 7 days.

Choice B:

Ultrasound is the most accurate method, especially in the first trimester. Crown-rump length (CRL) gives precise gestational age (±3–5 days). In the second and third trimesters, biparietal diameter, femur length, and head/abdominal circumference are used.

Choice C:

Maternal weight gain is influenced by many variables such as pre-pregnancy BMI, diet, metabolism, and edema. It does not provide a reliable or consistent method for estimating fetal age.

Choice D:

Fetal heart rate ranges from 110 to 160 bpm and can vary with gestational age, activity, and oxygenation. However, it does not correlate linearly with gestational age and cannot be used to accurately date a pregnancy.

Choice E:

Quickening refers to the first maternal perception of fetal movement, usually between 16 and 20 weeks gestation. While subjective and variable, it supports estimation when combined with other clinical data.

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