Assessment of High Risk Pregnancy_EAQ

Which of the following variables are scored on a biophysical profile? Select all that apply.

Fetal Tone Fetal Movement Amniotic Fluid Index Fetal Breathing Movements Fetal tone, fetal movement, amniotic fluid index, and fetal breathing movements are all scored on a biophysical profile. Fetal position is not one of the variables that are scored. A nonstress test, not a contraction stress test, is also part of the biophysical profile.

A client is to undergo amniocentesis at 38 weeks' gestation to determine fetal lung maturity. What lecithin/sphingomyelin ratio (L/S ratio) is adequate for the nurse to conclude that the fetus's lungs are mature enough to sustain extrauterine life?

2:1 The lecithin concentration increases abruptly at 35 weeks, reaching a level that is twice the amount of sphingomyelin, which decreases concurrently. At 30 to 32 weeks' gestation, the amounts of lecithin and sphingomyelin are equal, indicating lung immaturity. A ratio of 1:4 does not reflect fetal lung maturity; nor does a ratio of 3:4.

The nurse is caring for a client in her third trimester who is scheduled for an amniocentesis. What should the nurse do to prepare the client for this test?

Instruct her to void immediately before the test. The client is instructed to void immediately before the test to help prevent injury to the bladder as the needle is introduced into the amniotic sac. The supine position with a hip roll under the right hip is the preferred position for this procedure. Telling the client to assume the high Fowler position before the test will cause the bladder to fill, making it vulnerable to injury as the needle is inserted into the amniotic sac. Encouraging the client to drink three glasses of water before the test is advised if the amniocentesis is being performed early during pregnancy. There is no reason to withhold food or fluid, because the test does not involve the gastrointestinal tract.

The primary healthcare provider prescribes a contraction stress test (CST) for a client whose nonstress test (NST) was nonreactive. Which maternal complications should prompt the nurse to question the prescription? Select all that apply.

Preterm Labor Drug Addiction Incompetent Cervix Premature Rupture of Membranes

While reviewing laboratory results of clients seen at the maternity clinic, the nurse notes that one client's maternal serum alpha-fetoprotein level is lower than expected. What does the nurse recognizes that this may be associated with?

Down syndrome Chromosomal trisomies such as Down syndrome may be marked by a lower-than-typical level of alpha-fetoprotein. Fetal demise, neural tube defects, and esophageal obstruction typically result in increased levels of alpha-fetoprotein.STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections.

A nonstress test is scheduled for a client with preeclampsia. During the nonstress test the nurse concludes that if accelerations of the fetal heart rate occur with fetal movement, this probably indicates what?

Fetal well-being Accelerations of the fetal heart rate with fetal movement indicate fetal well-being. Early decelerations are associated with fetal head compression. Late decelerations are associated with uteroplacental insufficiency. Variable decelerations are associated with cord compression.

Which instruction is most important for the nurse to include when teaching a client about a contraction stress test (CST)?

Empty the bladder before the test. The CST will take 1 to 2 hours, during which time the client is confined to bed. Movement on and off a bedpan should be avoided. There are no food restrictions before or after this test. Alprazolam may interfere with results of the CST because it will sedate the fetus. If the test is explained in language that the client can comprehend, an anxiolytic should not be necessary. The client may go home 1 hour after the test is completed.

During their initial visit to the prenatal clinic, a couple asks the nurse whether the woman should have an amniocentesis for genetic studies. Which factor indicates that an amniocentesis should be performed?

Family history of genetic abnormalities Amniocentesis is usually reserved for those women considered at higher risk of carrying a fetus with a chromosomal or genetic abnormality. The main reason for performing amniocentesis is the diagnosis of genetic problems. Even though a recent history of drug abuse may increase the risk of the development of the fetus, it is not a genetic issue. A history of more than three prior spontaneous abortions is not a reason to perform this invasive procedure. The risk will outweigh the benefit and will increase the risk of another spontaneous abortion. Amniocentesis is no longer performed routinely if the client is an older primigravida. A sonogram is performed first. Determining the sex with an amniocentesis puts the mother at high risk for complications. Other less invasive procedures can be done to determine sex of fetus.

What is the priority nursing care immediately after an amniocentesis?

Monitoring for signs of uterine contractions It is possible that stimulation of the uterus resulting from the amniocentesis will initiate uterine contractions. Perineal care is not necessary, because an amniocentesis is not done by way of the vagina. Encouraging fluids every hour is irrelevant, because the amount of amniotic fluid is not influenced by fluid ingestion. Changing the abdominal dressing is not necessary, because the needlestick site seals immediately.

The nurse teaches a client who is about to undergo an amniocentesis that ultrasonography will be performed just before the procedure to determine what?

Position of the fetus and the placenta The position of the fetus and placenta is located by means of ultrasonography to assist in preventing trauma from the needle during the amniocentesis. Although ultrasonography can be used to determine gestational age, this is not its purpose before an amniocentesis. Determining the amount of fluid in the amniotic sac is not the purpose of ultrasonography just before an amniocentesis. The position of the placenta and fetus, not just the cord and the placenta, is needed for safe introduction of the needle.

A 37-year-old client with hypertension, type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate the need for a nonstress test? Select all that apply.

The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension Pregnant women with diabetes are prone to placental insufficiency, which can threaten fetal well-being. In addition, history of stillbirth is also an indication for NST. In addition, maternal conditions that can affect placental perfusion such as hypertension are an indication for an NST. Advanced maternal age alone is not an indicator for an NST; although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.

A 40-year-old multigravida's pregnancy is confirmed at 8 weeks' gestation. She says, "I can't wait another 2 months for an amniocentesis to find out whether my baby has a chromosomal anomaly like my first child." The nurse responds that she can have chorionic villus sampling (CVS) between the tenth and twelfth weeks; what is true about this test if it is performed before this time?

The test can cause fetal anomalies. The American Congress of Obstetricians and Gynecologists recommends that CVS not be performed before 9 weeks' gestation and should be performed between 10 to 12 weeks. If performed before 9 weeks' gestation, it has the potential of interfering with organogenesis. The test, if successfully performed, is 100% accurate, and it provides enough information for a diagnosis. A laparoscopic procedure is not necessary, because CVS is performed either by means of transcervical catheter aspiration or transabdominal needle aspiration.

A contraction stress test (CST) is performed on a client at 40 weeks' gestation. The findings are interpreted as negative. What does the nurse conclude from this interpretation?

There will be weekly retesting because, at this time, the fetus has adequate oxygen reserves. A negative test result implies that placental support is adequate; it is associated with a low fetal death rate within 1 week. A negative test result does not indicate hyperstimulation. This is a negative test result; if there were persistent late decelerations with contractions, the test would be positive and intervention would be required. Fetal heart rate accelerations with movement are reassuring; an expeditious birth is not indicated.

The nurse is interpreting the results of a nonstress test (NST) on a client at 41 weeks' gestation. Which result after 20 minutes is suggestive of fetal reactivity?

Two accelerations of 15 beats/min lasting 15 seconds According to the American Congress of Obstetricians and Gynecologists, fetal reactivity is a fetal tracing 15 beats' acceleration above baseline lasting 15 seconds or more, normal baseline rate, and long-term variability amplitude of 10 or more beats/min. An absence of long-term variability is an ominous sign that must be addressed. An above-average baseline heart rate is acceptable up to 160 beats/min. An increasing baseline heart rate is a sign of maternal infection. Contractions are not expected with a nonstress test; early, late, or variable fetal heart rate decelerations are associated with uterine contractions.

The nurse is caring for a client whose contraction stress test result (CST) is positive. The nurse remains with the client and continues to assess the fetal and maternal monitor strips. Which complication does the nurse anticipate?

Uteroplacental insufficiency A positive CST result is indicative of a compromised fetus; late decelerations during contractions are associated with uteroplacental insufficiency. Preeclampsia does not cause a positive CST result. A CST is contraindicated for a client with a suspected placenta previa, because the contractions may cause bleeding. A CST is contraindicated for a client with a suspected preterm birth or a gestation less than 33 weeks' duration, because the contractions may induce true labor.