# A nurse is assessing the fundal height of a pregnant client at 28 weeks gestation during a routine prenatal visit and notes a measurement of 32 cm. Which condition should the nurse suspect based on this finding? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542827 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing the fundal height of a pregnant client at 28 weeks gestation during a routine prenatal visit and notes a measurement of 32 cm. Which condition should the nurse suspect based on this finding? ## 보기 1. Fundal height of 24 cm 2. Fundal height of 32 cm 3. Fundal height of 28 cm **✔ 정답** 4. Fundal height of 20 cm **정답: 3** ## 해설 At 28 weeks gestation, fundal height should correlate with gestational age, approximately 28 cm (±2-3 cm). This indicates normal fetal growth. Other options represent deviations requiring further assessment. ## 심화 해설 Understanding Fundal Height Assessment During pregnancy, the measurement of fundal height—the distance in centimeters from the pubic symphysis to the top of the uterine fundus—serves as a simple, cost-effective screening tool for fetal growth and amniotic fluid volume. After approximately 20 weeks of gestation, the fundal height in centimeters should correlate closely with the gestational age in weeks, with an acceptable variance of ±2 to 3 cm. This relationship is known as McDonald's rule. Analyzing the Clinical Scenario The client is at 28 weeks gestation. According to McDonald's rule, the expected fundal height would be approximately 28 cm. The nurse's measurement of 32 cm represents a discrepancy of +4 cm. This finding is clinically significant because it exceeds the typical upper limit of normal variance. A fundal height that is greater than expected for the gestational age prompts the nurse to suspect conditions associated with an enlarged uterus for the given date. Interpreting the Discrepancy A fundal height measurement of 32 cm at 28 weeks gestation is a finding that requires further investigation. The primary clinical implication is that the uterine size is larger than expected. This can be associated with several conditions, including multiple gestation (twins), polyhydramnios (excessive amniotic fluid), uterine fibroids, or a fetus that is large for gestational age (LGA). The provided research on LGA prediction underscores the clinical relevance of identifying such discrepancies. A study developing a nomogram for predicting large-for-gestational-age (LGA) newborns identified gestational age and gestational weight gain as significant predictors . An elevated fundal height measurement can be an early clinical indicator that a fetus is growing excessively, which is a key component of the LGA risk profile. Why the Other Options Are Incorrect The question asks what the nurse should suspect based on the finding of 32 cm at 28 weeks. The correct interpretation is that this measurement is abnormal and points toward a potential complication. - **Option 1 (Fundal height of 24 cm):** A measurement of 24 cm at 28 weeks would be classified as small for gestational age (SGA) or could indicate oligohydramnios or intrauterine growth restriction (IUGR). This is the opposite clinical concern from the one presented. - **Option 2 (Fundal height of 32 cm):** This is the actual measurement obtained, not the condition the nurse should suspect. The nurse must interpret the number to identify a potential underlying problem. - **Option 4 (Fundal height of 20 cm):** This measurement would be grossly abnormal for 28 weeks, suggesting a severe growth restriction, fetal demise, or a dating error. It does not align with the finding of an enlarged uterus. The finding of a fundal height that is 4 cm greater than the gestational week is a classic clinical red flag. The nurse’s immediate suspicion should be directed toward conditions that cause a larger-than-expected uterine size, with the next step being a more detailed assessment, such as an ultrasound, to evaluate fetal growth, amniotic fluid volume, and fetal number. The link between maternal nutritional status and birth outcomes, such as the association of inadequate folate intake with preterm birth, highlights the broader context of prenatal care, but the fundal height discrepancy in this scenario is most directly a mechanical indicator of uterine size relative to dates . ## 임상 시나리오 Clinical Scenario A nurse measures a fundal height of 32 cm on a client at 28 weeks gestation. The expected measurement is 28 cm (±2–3 cm). This 4 cm discrepancy is above the normal variance, indicating a larger-than-expected uterus. Immediate Nursing Actions - Re-measure fundal height to confirm accuracy, ensuring the client has an empty bladder and is in a supine position. - Review the prenatal record for previous fundal height trends and risk factors (e.g., diabetes, multiple gestation history). - Assess for clinical signs of polyhydramnios (e.g., shiny, taut skin; difficulty palpating fetal parts) or multiple fetuses (e.g., auscultation of more than one fetal heart rate). - Notify the healthcare provider of the discrepancy and prepare the client for a diagnostic ultrasound to evaluate fetal number, amniotic fluid volume, and fetal growth. Differential Considerations - **Multiple Gestation:** More than one fetus is a common cause of a fundal height exceeding dates. - **Polyhydramnios:** Excessive amniotic fluid, often linked to fetal anomalies or maternal diabetes. - **Large for Gestational Age (LGA) Fetus:** Often associated with maternal diabetes; fundal height may be elevated due to macrosomia. - **Uterine Fibroids:** Benign tumors can enlarge the uterus and distort fundal height measurements. - **Incorrect Dating:** Gestational age may be underestimated if last menstrual period recall is inaccurate. Patient Education - Explain that fundal height is a screening tool; a larger measurement does not always indicate a problem but requires further investigation. - Describe the purpose of a follow-up ultrasound to check the baby's growth, amniotic fluid, and the possibility of twins. - Reinforce the importance of attending all scheduled prenatal visits for ongoing monitoring. ## 핵심 개념 - **Fundal Height** — The distance from the pubic symphysis to the top of the uterine fundus, measured in centimeters to screen for fetal growth and amniotic fluid volume. - **McDonald's Rule** — A clinical guideline stating that after 20 weeks of gestation, fundal height in centimeters should approximate the gestational age in weeks, with a variance of ±2 to 3 cm. - **Polyhydramnios** — A condition characterized by excessive amniotic fluid volume, which can cause a fundal height measurement greater than expected for gestational age. - **Large for Gestational Age (LGA)** — A term describing a fetus whose estimated weight is above the 90th percentile for its gestational age, often associated with maternal diabetes. ## 같은 주제 문제 - [A nurse is assessing the fundal height of a pregnant client at 28 weeks gestation during a…](https://mymerci.kr/pages/nclex_q.php?qn_id=542826) - [A nurse is assessing a pregnant client at 24 weeks gestation during a routine prenatal vis…](https://mymerci.kr/pages/nclex_q.php?qn_id=542828) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._