The patient at 37 weeks' gestation calls the clinic nurse to ...

[james9437]

The patient at 37 weeks' gestation calls the clinic nurse to report that neither she nor her partner has felt fetal movement for the past 48 hours. The nurse anticipates that the physician will order which test to assess fetal viability?
 
  1. Ultrasound
  2. Serum progesterone levels
  3. Computed tomography (CT) scan
  4. Contraction stress test

Question 2

The prenatal clinic nurse has received four phone calls. Which patient should the nurse call back first?
 
  1. Primip at 28 weeks with history of asthma reporting difficulty breathing and shortness of breath
  2. Multip at 6 weeks with a seizure disorder inquiring which foods are good folic acid sources for her
  3. Primip at 35 weeks with a positive HBsAG wondering what treatment her baby will receive after birth
  4. Multip at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding

[hugthug12]

Answer to Question 1

1
Rationale 1: Ultrasound is used to detect the presence or absence of fetal heart motion when fetal demise is suspected.
Rationale 2: Serum estriol levels drop during fetal demise, but progesterone levels are not measured.
Rationale 3: A computed tomography (CT) scan is not indicated.
Rationale 4: Contraction stress tests are used to determine whether a fetus will tolerate the stresses of labor.

Answer to Question 2

1
Rationale 1: Asthma exacerbations are most common between 24 and 36 weeks. Asthma attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This patient is the top priority.
Rationale 2: Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. However, this patient is not the highest priority.
Rationale 3: A patient with a positive HBsAG is contagious for hepatitis B. The risk of transmission to the fetus at birth is reduced by bathing the neonate as soon as possible after birth and giving the infant immunoprophylaxis and the first HBsAG vaccine dose. However, this patient is not the highest priority.
Rationale 4: Pregnant women with untreated hyperthyroidism have an increased risk of fetal loss. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. However, this patient is not the highest priority.