The nurse in a prenatal clinic is reviewing the files of four patients scheduled for visits.
Which patient does the nurse identify as having the highest-risk pregnancy?
The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension.
The patient with preexisting hypertension who is currently pregnant with twins.
The patient who is 16 years of age just diagnosed with gestational diabetes.
The patient who is 28 years old and delivered a premature neonate 3 years prior.
The Correct Answer is A
Choice A rationale
A 37-year-old patient with obesity and pregnancy-induced hypertension presents multiple risk factors. Advanced maternal age, obesity, and hypertension collectively increase the
likelihood of complications such as preeclampsia, gestational diabetes, and cesarean delivery, necessitating close monitoring and management.
Choice B rationale
A patient with preexisting hypertension and twins is indeed high-risk due to the combined strain on the cardiovascular system and potential for preterm labor or other complications
associated with multiple gestations. However, the presence of pregnancy-induced hypertension and obesity in the first patient poses a slightly higher cumulative risk.
Choice C rationale
A 16-year-old patient with newly diagnosed gestational diabetes is at increased risk, particularly because of age and the potential for poorly managed diabetes leading to
complications. However, this scenario presents fewer immediate cumulative risks compared to older age and existing hypertension.
Choice D rationale
A 28-year-old patient who had a premature birth three years prior must be monitored for signs of recurrent preterm labor. Yet, this history alone does not present as high a cumulative
risk as older maternal age, obesity, and pregnancy-induced hypertension. .
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Correct Answer is D
Explanation
Choice A rationale
A low transverse uterine scar is considered the safest type of uterine incision for a VBAC because it is less likely to rupture compared to other types of scars. Therefore, a low transverse uterine scar would not disqualify the patient for VBAC.
Choice B rationale
Patient asking multiple questions does not disqualify her for VBAC. Patient education and ensuring the patient’s understanding and agreement with the procedure is an essential part of the process.
Choice C rationale
Induction of labor in the first pregnancy does not automatically disqualify a patient from attempting VBAC. The success of VBAC depends on multiple factors including the reason for the initial cesarean section.
Choice D rationale
A cesarean due to pelvic abnormalities would disqualify the patient for VBAC because the underlying pelvic condition that necessitated the initial cesarean section is likely still present and would increase the risk of complications during vaginal birth.
Correct Answer is B
Explanation
Choice A rationale
Prior amniotic fluid leakage is not a required criterion for amniotomy. The main concern is cervical readiness and fetal head position, not previous leakage.
Choice B rationale
The fetal head engaged in the maternal pelvis ensures proper pressure and position for safe amniotomy. Engagement reduces the risk of umbilical cord prolapse and injury.
Choice C rationale
Certification of the nurse for amniotomy is not a standard criterion. The procedure is performed by qualified professionals, but certification isn't a prerequisite for the procedure to be scheduled.
Choice D rationale
Ultrasound to check the umbilical cord's position isn't a standard pre-amniotomy criterion. While it can be useful, the primary concern is the fetal head engagement and cervical readiness.