A nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and expects the finding to be which of the following?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

According to McDonald's rule, between 20 and 36 weeks of gestation, the fundal height in centimeters is approximately equal to the gestational age in weeks.
A normal variation of ±2 cm is expected, which accounts for individual differences.
For a client at 28 weeks of gestation, the expected fundal height is 28 ± 2 cm, resulting in a normal range of 26 cm to 30 cm.
The measurement of 30 cm falls at the upper limit of this expected normal range, making it the correct answer among the choices.

Option A: A fundal height of 22 cm is too low for a 28-week gestation.
Option C: A fundal height of 36 cm is too high for a 28-week gestation.
Option D: A fundal height of 40 cm is too high for 28 weeks. It is also an unlikely measurement even at 40 weeks.

Clinical Relevance

Nursing practice connection: Use the key finding related to Measurement of fundal height to assess fetal growth and gestational age to guide bedside assessment, documentation, and the next nursing action.
Fundal height measurement is a crucial, non-invasive nursing assessment to screen for fetal growth, estimate gestational age, and detect potential complications.
A fundal height greater than expected may indicate multiple gestation, polyhydramnios, or a large-for-gestational-age (LGA) fetus. A height less than expected may suggest intrauterine growth restriction (IUGR), oligohydramnios, or an error in the estimated due date.
What if? If the client at 28 weeks had a fundal height of 23 cm, this would be significantly below the expected range (26-30 cm). The nurse should document this finding and notify the healthcare provider, as it could indicate IUGR and warrants further investigation with an ultrasound.

How to Approach the Question

First, identify the key information in the question: the client is at 28 weeks of gestation and the nurse is measuring fundal height.
Recall the principle used to estimate fetal growth based on fundal height, which is McDonald's Rule.
Apply McDonald's Rule: after 20-24 weeks, the fundal height in centimeters should roughly equal the number of weeks of gestation, with an accepted variation of about ±2 cm.
Calculate the expected range for 28 weeks: 28 cm ± 2 cm = 26 cm to 30 cm.
Compare the options provided to this calculated range.
Select the option that falls within the 26-30 cm range.

Concept Tested & Keywords

Concept Tested: Measurement of fundal height to assess fetal growth and gestational age.
Stem keywords: pregnant client, 28 weeks of gestation, fundal height, centimeters
Lead-in keywords: expects the finding to be
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 15-23

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) pp. 199-201, 198-200

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.