A nurse prepares to assess the fundal height on a client who is in the second trimester of pregnancy. When measuring the fundal height, the nurse will most likely expect the measurement to?

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

Explanation

During the second and early third trimesters, fundal height is a reliable, non-invasive indicator of fetal growth and gestational age.
This principle is known as McDonald's Rule, which states that from approximately 18 to 32 weeks of gestation, the fundal height in centimeters is roughly equal to the gestational age in weeks, plus or minus 2 cm.
This predictable correlation allows the nurse to quickly screen for potential issues with fetal growth, amniotic fluid volume, or incorrect gestational dating.
The measurement is taken from the top of the symphysis pubis to the top of the uterine fundus.

Option A: A fundal height significantly less than the gestational age is not an expected finding and suggests a potential complication.
Option C: A fundal height significantly greater than the gestational age is also not an expected finding and indicates a potential issue.
Option D: This is factually incorrect. A strong and clinically significant correlation exists between fundal height and gestational age.

Clinical Relevance

Nursing practice connection: Use the key finding related to Fundal height assessment and its correlation with gestational age to guide bedside assessment, documentation, and the next nursing action.
Regularly measuring fundal height is a non-invasive, cost-effective method for nurses to monitor fetal well-being and identify pregnancies that may require further investigation, such as an ultrasound.
A consistent discrepancy between fundal height and gestational age (more than 2-3 cm) is a key indicator for escalating care to investigate potential complications.
What if? If a client at 28 weeks has a fundal height of 22 cm, the nurse should suspect potential IUGR or oligohydramnios and report this finding to the healthcare provider for further evaluation, which would likely include an ultrasound.

How to Approach the Question

Identify the core of the question, which is about the relationship between fundal height and gestational age.
Recall the context: the second trimester. This is the period when the correlation is most reliable and predictable.
Remember the clinical guideline known as McDonald's Rule, which establishes a direct correlation (approximately 1 week of gestation = 1 cm of fundal height).
Evaluate the options based on this rule. 'Correlate with gestational age' is the expected normal finding.
Recognize that measurements 'less than' or 'greater than' the gestational age are considered deviations from the norm and indicate potential problems, while 'no correlation' is factually incorrect.

Concept Tested & Keywords

Concept Tested: Fundal height assessment and its correlation with gestational age.
Stem keywords: fundal height, second trimester, pregnancy, gestational age
Lead-in keywords: most likely expect

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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) p. 199-201

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.