Chapters 9 Assessing the Fetus OB

Which test will be included in a pregnant patient's appointment at 17 weeks of gestation? 1 Multiple-marker triple screen 2 Combined test 3 Nuchal translucency 4 Amniocentesis

1 A multiple-marker triple screen is a blood test that measures maternal serum markers; it is done in the second trimester. A combined test is a first trimester screening test. A nuchal translucency ultrasound is a prenatal screening test that measures the small space behind the fetal neck to check for chromosomal abnormalities, cardiac anomalies, and genetic disorders. An amniocentesis is a screening of the amniotic fluid to test to check for chromosomal abnormalities.

The nurse is performing a contraction stress test (CST) and notes no late decelerations. How should the nurse interpret this test result? 1 Negative CST 2 Positive CST 3 Suspicious CST 4 Equivocal CST

1 A negative CST describes a fetal heart rate response to contractions with no decelerations. A positive CST describes a fetal heart rate deceleration with a minimum of 50% of the contractions. A suspicious or equivocal response describes intermittent late decelerations or a sudden decrease in fetal heart rate that quickly returns to the baseline.

The nurse is providing discharge instructions for a patient following an amniocentesis. What information should be included? 1 "Report leaking amniotic fluid that continues 24 hours after the procedure." 2 "Report any lower abdominal discomfort immediately after the procedure." 3 "Expect vaginal bleeding for 48 hours after the procedure." 4 "Expect difficulty urinating for 24 hours after the procedure."

1 An amniocentesis can cause amniotic fluid leakage for 24 hours; the physician should be notified of any leaking that occurs after this time. Uterine cramping and abdominal discomfort is expected and may last several hours after an amniocentesis. Vaginal bleeding is not an expected finding after an amniocentesis. The patient should not have difficulty urinating after an amniocentesis.

The nurse is caring for a patient scheduled for an amniocentesis. Which statement made by the patient indicates an understanding of how an amniocentesis is performed? 1 "A needle will be inserted into my abdomen, and a small amount of amniotic fluid will be removed." 2 "A monitor will be placed on my abdomen to measure my baby's activity." 3 "A transducer will be placed into my vagina for visualization of the amniotic sac." 4 "A catheter will be inserted into my cervix, and a small sample of chorionic villi will be removed."

1 An amniocentesis is performed by inserting an ultrasound-guided needle into the amniotic sac and removing a small amount of fluid for testing. A toco monitor is placed on the abdomen to measure fetal heart sounds and activity. A transvaginal ultrasound is performed by placing a transducer in the vagina to visualize the neonate. A transcervical chorionic villi sampling is performed by inserting a catheter into the cervix and removing a small sample of chorionic villi.

Why is an amniocentesis performed? 1 To identify chromosomal abnormality 2 To measure chorionic villi 3 To determine sexual identity 4 To determine gestational age

1 An amniocentesis is performed to identify chromosomal abnormalities. A transcervical chorionic villi sampling measures chorionic villi. Sexual identity and gestational age are determined by ultrasound.

The nurse understands that an ultrasound that is scheduled in the second trimester may be primarily done for which purpose? 1 To confirm fetal viability 2 To identify multifetal gestations 3 To identify the marker for nuchal translucency 4 To determine the locations of the uterus, cervix, and placenta

1 An ultrasound in the second trimester is primarily done to confirm fetal viability. The identification of multifetal gestations, the marker for nuchal translucency, and the determination of the location of the uterus, cervix, and placenta are all done in the first trimester.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? 1 Doppler blood flow analysis 2 Contraction stress test (CST) 3 Amniocentesis 4 Daily fetal movement counts

1 Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, but not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

How is percutaneous umbilical blood sampling (PUBS) performed? 1 A long needle is inserted through the abdomen into the umbilical vein. 2 A transducer probe is inserted into the vagina. 3 A Doppler ultrasound transducer is placed on the abdomen. 4 A long needle is inserted through the abdomen into the amniotic sac.

1 PUBS is performed by inserting a long needle through the abdomen into the umbilical vein. Transvaginal ultrasound is performed by inserting a transducer probe into the vagina. A transabdominal ultrasound transducer is performed by placing a Doppler ultrasound on the abdomen. An amniocentesis is performed by inserting a long needle through the abdomen into the amniotic sac.

A nurse working in a prenatal clinic understands that which maternal risk factors require antepartum fetal assessment? 1 Obesity 2 Asthma 3 Cholestasis 4 Thrombophilia 5 Chronic hypertension

1 The maternal risk factors that require antepartum fetal assessment include obesity, cholestasis, thrombophilia, and chronic hypertension. Asthma does not require antepartum fetal assessment.

The nurse is helping a pregnant patient monitor the daily fetal movement. Which finding should be reported to the primary health care provider? 1 Fetal movement was not detected for 12 hours. 2 An episode of limb straightening was observed. 3 One episode of fetal breathing was seen in 30 minutes. 4 An amniotic fluid index value of more than 5 cm.

1 The presence of fetal movements is a reassuring sign of fetal health. If fetal movements are not felt by the mother for 12 hours, then it is reported as the fetal alarm signal. Limb straightening, breathing movement, and amniotic fluid index do not indicate the fetal alarm signal. One episode of limb straightening is also a normal finding. One episode of fetal breathing movement seen in 30 minutes is a normal finding. An amniotic fluid index greater than 5 cm is a normal finding.

The nurse is preparing a patient who is at 10 weeks of gestation for a transvaginal ultrasound. In what position should this woman be placed? 1 Lithotomy 2 Left lateral Sims 3 Semi-Fowler 4 Prone

1 The woman should be placed in a lithotomy position for a transvaginal ultrasound. A left lateral Sims position is used to administer enemas or rectal medication. A semi-Fowler position is used to improve respiratory complications. A prone position is used for decreasing the risk for pressure ulcers.

The nurse is performing a nonstress test (NST) on a patient who is at 37 weeks of gestation. The nurse notes the fetal heart rate is increased at 12 bpm above the baseline and stays elevated for 20 seconds with fetal movement. How should the nurse document this assessment? 1 Accelerations 2 Decelerations 3 Poor fetal reaction 4 Bradycar

1 When an NST shows fetal heart is increased at 12 bpm above the baseline and stays elevated for 20 seconds with fetal movement, it is documented as an acceleration. Deceleration is a decrease in fetal heart rate. An acceleration in heart rate does not indicate poor fetal reaction. Bradycardia is indicated by a fetal heart rate below the normal range for gestational age.

What is the recommended time period for cell-free fetal DNA (cfDNA) screening? 1 First trimester 2 Second trimester 3 Third trimester 4 Postpartum

1 cfDNA screening is done in the first trimester of pregnancy. It is not done in the second or third trimesters, or after delivery.

The amniotic fluid index (AFI) in a patient is 15 cm. What should the nurse interpret form this finding? 1 The patient has normal AFI. 2 The fetus has intrauterine growth restriction. 3 The fetus has congenital abnormalities. 4 The fetus has neural tube defects.

1 4 The fetus has neural tube defects. AFI values between 10 and 25 cm are considered normal. Therefore, a 15-cm amniotic fluid index is normal and does not indicate any fetal abnormality. An AFI of less than 5 cm indicates that the patient has oligohydramnios, which is characterized by intrauterine growth restriction and congenital abnormalities. If the patient has an AFI above 25 cm, it indicates that the patient has polyhydramnios, which would put the fetus at risk of neural tube defects.

Which screening test monitors fetal activity? 1 Nonstress test (NST) 2 Amniocentesis 3 Percutaneous umbilical blood sampling (PUBS) 4 Chorionic villus sampling (CVS)

1 An NST measures fetal activity and fetal heart rate. An amniocentesis evaluates the amniotic fluid. PUBS examines the blood of the fetus. CVS examines the chorionic villus of the fetus.

After a woman with blood type Rh negative undergoes amniocentesis, which is the most appropriate nursing intervention? 1 Administer RhoD immunoglobulin. 2 Administer anticoagulant. 3 Send the patient for a computed tomography (CT) scan before the procedure. 4 Assure the mother that short-term radiation exposure is not harmful to the fetus.

1 Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered because this can increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required because the procedure is ultrasound-guided. The mother is not exposed to radiation during amniocentesis.

The nurse is caring for several patients, all at 40 weeks of gestation. Which patient's nonstress test (NST) is most likely to show altered fetal movement? 1 The patient who took metoprolol before the NST 2 The patient who complains of being nauseated 3 The patient who had a previous placenta abruption 4 The patient who has gestational diabetes

1 Ingestion of a beta-blocker such as metoprolol can alter fetal movement. Complaints of nausea, a previous placental abruption, and gestational diabetes should not cause altered fetal movement.

After fetal ultrasonography, the nurse observes that a patient has elevated levels of alpha-fetoprotein in the amniotic fluid. For which conditions is the fetus at risk? Select all that apply. 1 Meningocele 2 Anencephaly 3 Encephalocele 4 Tetralogy of Fallot 5 Ventricular septal defect

1,2,3 Neural tube defects (NTDs) are diagnosed by elevated levels of alpha-fetoprotein in the amniotic fluid using fetal ultrasonography. Therefore, the fetus is at risk for meningocele, anencephaly, and encephalocele. Tetralogy of Fallot and ventricular septal defects are congenital heart defects that are diagnosed using echocardiography and cardiac catheterization.

The levels of which hormones and proteins are measured in a triple screen maternal serum test? Select all that apply. 1 Human chorionic gonadotropin (hCG) 2 Alpha-fetoprotein (AFP) 3 Unconjugated estriol (uE3) 4 Hemoglobin 5 Bilirubin

1,2,3 The hormones and proteins that are measured in a triple screen are hCG, AFP, and uE3. Hemoglobin and bilirubin are not measured in a triple screen.

Which hormones and proteins produced by an embryo are detected in maternal circulation? Select all that apply. 1 Human chorionic gonadotropin (hCG) 2 Alfa feta protein (AFP) 3 Unconjugated estriol (uE3) 4 Inhibin A 5 Serum glucose

1,2,3,4 The hormones and proteins produced by the embryo that are detected in maternal circulation are hCG, AFP, uE3, and inhibin A. Serum glucose is not detected in maternal circulation.

A nurse is caring for a patient who is scheduled for a biophysical profile. Which criteria are included in the scoring of a biophysical profile? Select all that apply. 1 Fetal tone 2 Nonstress test (NST) 3 Contraction stress test (CST) 4 Gross body movements 5 Amniotic fluid volume 6 Fetal breathing movements

1,2,4,5.6 The biophysical profile includes the fetal tone, NST, gross body movement, amniotic fluid volume, and fetal breathing movements. A CST is not included in the scoring for a biophysical profile.

Which are prenatal tests used for diagnosing fetal defects in pregnancy? Select all that apply. 1 Amniocentesis 2 Polyhydramnios 3 Amniotic fluid index (AFI) 4 Chorionic villus sampling (CVS) 5 Daily fetal movement count (DFMC) 6 Percutaneous umbilical blood sampling (PUBS)

1,4,6 Amniocentesis, PUBS, and CVS are prenatal tests used for diagnosing fetal defects in pregnancy. Polyhydramnios is increased amniotic fluid. AFI is a method in which the vertical depths (in centimeters) of the largest pocket of amniotic fluid in all four quadrants surrounding the maternal umbilicus are totaled. DFMC, the kick count, is frequently used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation.

How is a four-dimensional (4D) ultrasound different from a three-dimensional (3D) ultrasound? 1 It provides greater detail of features. 2 It provides live streaming video images. 3 It provides the width, height, and depth of structures. 4 It provides a flat picture of structures.

2 A 4D ultrasound provides live streaming video images. Greater detail of features is seen on both 3D and 4D ultrasound images. The width, height, and depth of structures can been seen on both 3D and 4D ultrasound images. A two-dimensional ultrasound provides a flat picture of structures.

What is a disadvantage of an amniocentesis? 1 It cannot be performed until 36 weeks of gestation. 2 Test results take at least 10 days to obtain. 3 It does not determine fetal lung maturity. 4 It cannot be used to identify genetic abnormalities.

2 A disadvantage of an amniocentesis is the length of time it takes to get test results. It takes at least 10 to 14 days to get test results. An amniocentesis is often performed between 15 and 20 weeks of gestation. An amniocentesis is performed to determine fetal lung maturity and genetic abnormalities.

The nurse is reviewing a 17-week gestational patient's multiple-marker screen and notes it is elevated. Which diagnostic test does the nurse anticipate the health care provider will request? 1 Ultrasound 2 Amniocentesis 3 Chorionic villus sampling (CVS) 4 Percutaneous umbilical blood sampling (PUBS)

2 An amniocentesis is used to identify chromosomal, metabolic, or genetic abnormalities. Amniocentesis for prenatal diagnosis is usually performed midtrimester, between 15 and 20 weeks of gestation. An ultrasound is not used as a diagnostic tool to evaluate an elevated multiple marker. CVS is normally performed between 10 and 13 weeks of gestation to diagnose fetal chromosomal, metabolic, or deoxyribonucleic acid (DNA) abnormalities. PUBS can be used to obtain fetal chromosomes after 18 weeks of gestation but is not as safe as an amniocentesis and is only performed for high-risk patients on a case-by-case basis.

The nurse is caring for a patient who has undergone a contraction stress test. The test results were found to be equivocal. What intervention should the nurse perform based on the test results? 1 Perform a nonstress test. 2 Repeat the contraction stress test next day. 3 Resume the weekly testing schedule. 4 Prepare to admit the patient.

2 If the results of contraction stress test are equivocal, it indicates that decelerations that occur in the presence of contractions are more frequent than every 2 minutes. Therefore, the primary health care provider would ask the nurse to repeat the test the next day. The contraction stress test is prescribed after a nonstress test if the test results are nonreactive. If the contraction stress test is negative, then the primary health care provider would ask the patient to resume the weekly testing schedule. If the contraction stress test is positive, then the primary health care provider would instruct the nurse to admit the patient to the hospital.

The nurse is caring for four patients, all at 38 weeks of gestation. Which patient's nonstress test (NST) is most likely to show altered fetal movement? 1 The patient who ate eggs and grits prior to the NST 2 The patient who is taking methadone daily 3 The patient who takes ferrous sulfate daily 4 The patient who is pregnant with twins

2 Ingestion of methadone can alter fetal movement. Intake of eggs and grits, ingestion of ferrous sulfate, and the presence of twins should not cause altered fetal movement.

The nurse is reviewing the laboratory results of a woman who is at 8 weeks of gestation. The nurse notes the human chorionic gonadotropin (hCG) levels more than doubled since the patient's 6-week checkup. What is the most appropriate nursing action? 1 Prepare the woman for a miscarriage. 2 Nothing; this is a normal finding. 3 Check for a fetal heart rate. 4 Schedule a transvaginal ultrasound.

2 The hCG levels in the mother's blood should increase up until 8 to 10 weeks of gestation. It is normal for the hCG level to double between 6 and 8 weeks of gestation. Because this is a normal finding, it is unnecessary to prepare the woman for a miscarriage, check for fetal heart rate, or schedule a transvaginal ultrasound.

What is the preferred gestational age to have chorionic villi sampling (CVS) performed? 1 6 weeks 2 11 weeks 3 20 weeks 4 30 weeks

2 The preferred time to have CVS performed is between 10 and 13 weeks of gestation; 11 weeks falls into this range. Six weeks of gestation is too early for CVS to be performed; 20 and 30 weeks of gestation are too late for CVS to be performed.

The nurse is caring for a patient recovering from a transcervical chorionic villi sampling (CVS) procedure. What can the patient expect? 1 Bright-red vaginal spotting for a week 2 Uterine cramping for 12 hours 3 Leaking of amniotic fluid 4 Low-grade fever

2 Uterine cramping is a normal finding in the 12 hours after a CVS procedure. Vaginal spotting is normal for the first 2 days, not the first week, after CVS. Leaking of amniotic fluid and a low-grade fever are abnormal findings after a CVS procedure.

Which prenatal screening test measures the small space behind the fetal neck? 1 Multiple-marker triple screen 2 Serum integrated screen 3 Nuchal translucency ultrasound 4 Amniocentesis

3 A nuchal translucency ultrasound is a prenatal screening test that measures the small space behind the fetal neck to check for chromosomal abnormalities, cardiac anomalies, and genetic disorders. A multiple-marker triple screen is a blood test to screen for trisomies 21 and 18. A serum integrated screen is a blood test to check for trisomies 21 and 28. An amniocentesis is a screening of the amniotic fluid to test for chromosomal abnormalities.

The nurse is caring for a pregnant patient who is scheduled for cordocentesis. What could be the consequences of the test on the fetus? 1 Destruction of red blood cells 2 Fetal hyperbilirubinemia 3 Fetomaternal hemorrhage 4 Deformity of extremities

3 Cordocentesis is an invasive procedure also known as percutaneous umbilical blood sampling. In this procedure, the fetal umbilical vessel is punctured. Therefore, there is a direct risk of fetomaternal hemorrhage. Fetal anemia is diagnosed using cordocentesis; it does not cause destruction of red blood cells. The test may not cause hyperbilirubinemia, because there is no destruction of the red blood cells. Deformity of extremities is caused by certain medications like thalidomide (Thalomid). It is not caused by cordocentesis.

The nurse is caring for a patient recovering from a transcervical chorionic villi sampling (CVS) procedure. Which information will the nurse include in the patient's discharge instructions? 1 Rest for 72 hours. 2 Avoid sexual intercourse for 2 weeks. 3 Avoid exercise for 24 hours. 4 Expect occasional episodes of passing clots from the vagina.

3 Discharge instructions after a CVS should include avoiding exercise for 24 hours. The patient should rest for 24 hours, not 72. Sexual intercourse should be avoided for 24 hours, not 2 weeks. Passage of clots from the vagina is an abnormal finding that should be reported

What does a nurse providing care for the antepartum woman need to understand about the contraction stress test (CST)? 1 It sometimes uses vibroacoustic stimulation. 2 It is an invasive test; however, contractions are stimulated. 3 It is considered negative if no late decelerations are observed with the contractions. 4 It is more effective than nonstress test (NST) if the membranes have already been ruptured.

3 No late decelerations indicate a negative CST. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. CST is contraindicated if the membranes have ruptured.

Which patient would best qualify for a specialized obstetric ultrasound? 1 A woman who is at 36 weeks of gestation with suspected breech fetal presentation 2 A woman who is at 8 weeks of gestation with suspected twins 3 A woman who is at 10 weeks of gestation and had a child with a cleft palate 4 A woman who is at 26 weeks of gestation and hasn't felt any fetal activity in 24 hours

3 A specialized obstetric ultrasound is performed to give more detailed imaging, such as to assess for cleft palate. A standard ultrasound is used to determine fetal presentation, multiple gestations, and the presence of fetal cardiac activity. Topics

The nurse is performing a nonstress test (NST) on a patient at 38 weeks of gestation. The nurse notes an increased fetal heart rate with fetal movement. What is the most appropriate nursing intervention? 1 Notifying the physician 2 Preparing the patient for a cesarean section 3 Nothing; this is a normal finding 4 Preparing to administer Pitocin (synthetic oxytocin)

3 An NST that shows increased fetal heart rate with fetal movement is a normal finding, and no interventions are needed. Because this is a normal finding, the nurse does not need to notify the physician, prepare the patient for a cesarean section, or administer Pitocin.

While performing a contraction stress test in a pregnant patient, the nurse finds that the patient has three uterine contractions in a 10-minute period with no significant variable decelerations. The nurse communicates the test findings to the primary health care provider. Which instruction would the nurse expect to receive from the primary health care provider? 1 "Repeat the test in the patient the next day." 2 "Administer intravenous fluids to the patient." 3 "Immediately admit the patient to the hospital." 4 "Resume a routine weekly testing schedule for the patient."

4 A contraction stress test helps determine fetal heart rate during uterine contraction. If the patient has three uterine contractions within 10 minutes, with no significant deceleration, it indicates normal or negative results and the fetus is doing well. Therefore, the primary health care provider would resume a routine weekly testing schedule for the patient. If three contractions are not produced within 10 minutes and no fetal heart rate is heard, then the test will be repeated the next day. Presence of uterine contractions is a normal finding, and it does not indicate risk of dehydration. Therefore, the primary health care provider will not instruct the nurse to administer intravenous fluids to the patient. If the patient has late decelerations with 50% or more of contractions, then the primary health care provider would instruct the nurse to admit the patient for further evaluation.

The nurse notes a patient had a reactive nonstress test (NST). How should the nurse interpret this test result? 1 There were two or more fetal heart rate decelerations within a 15-minute period. 2 There was a fetal heart rate deceleration that lasted for at least 1 minute. 3 There was a fetal heart rate acceleration that lasted for 4 minutes. 4 There were two or more fetal heart rate accelerations within a 20-minute period.

4 A reactive NST is defined as having two or more fetal heart rate accelerations within a 20-minute period. This is a normal finding. A deceleration, whether over 15 minutes or 1 minute, is when the fetal heart rate decreases; this is not a reactive NST. A 4-minute fetal heart rate acceleration is not a reactive NST; it is too long.

A 40-year-old woman with a high body mass index is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? 1 Biophysical profile 2 Amniocentesis 3 Maternal serum alpha-fetoprotein (MSAFP) 4 Transvaginal ultrasound

4 An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the 14th week of pregnancy. A MSAFP test is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal).

While caring for a patient receiving a nonstress test, the nurse does not observe accelerations in the fetal heart rate after 30 minutes of FHR monitoring. What intervention might the nurse perform in order to elicit FHR accelerations? 1 Place the patient in a lateral position. 2 Help the patient to elevate her legs. 3 Administer oxygen by face mask. 4 Provide vibroacoustic stimulation.

4 If fetal heart rate accelerations do not occur after 20 to 30 minutes of continuous FHR monitoring, the nurse can use vibroacoustic stimulation. The patient in labor is usually placed in a lateral or semi-Fowler's position to prevent umbilical cord prolapse. Often, the patient is assisted to turn to the left side. The nurse administers oxygen via a nonrebreather face mask in case of fetal hypoxemia.

Which statement made by a patient indicates an understanding of the transvaginal ultrasound? 1 "I will have to lie in a prone position." 2 "A transducer will be moved across my abdomen." 3 "I will need to take a laxative prior to the ultrasound." 4 "This procedure will be minimally invasive."

4 In a transvaginal ultrasound, a lubricating gel is placed on a transducer that is inserted into the vagina; this procedure is minimally invasive. The patient will be in a supine position. A transducer is moved across the abdomen in a transabdominal ultrasound. It is not necessary to take a laxative prior to a transvaginal ultrasound.

What is the primary test performed to determine fetal lung maturity? 1 TDx FLM assay 2 Amniocentesis 3 Doppler velocimetry 4 Lamellar body count (LBC)

4 Lamellar bodies are surfactant-containing particles secreted by type II pneumocytes. Therefore, LBC is used to determine fetal lung maturity. TDx FLM assay is no longer available in United Sates as a primary test for determining fetal lung maturity. Amniocentesis is used as a secondary test if simpler and less expensive processes indicate lung immaturity. Doppler velocimetry is used to assess fetal blood supply.

The primary health care provider recommends genetic screening to a pregnant patient to identify the risk of Down syndrome in the fetus. The patient requests a noninvasive test. Which test does the nurse expect that the provider will order for the patient? 1 Amniocentesis 2 Urine analysis 3 Maternal serum testing 4 Chronic villus sampling

4 Maternal serum testing is a blood test that is used to identify whether the fetus of a pregnant patient is at risk for Down syndrome. It is a noninvasive technique that requires only the maternal serum sample. Amniocentesis is an invasive technique that is used for testing fetal aneuploidy. Urine analysis is involved in the detection of pregnancy but is not used to detect chromosomal abnormalities. Chronic villus sampling is also an invasive technique that is used for determining fetal aneuploidy.

Which is a complication related to percutaneous umbilical blood sampling (PUBS)? 1 Fetal tachycardia 2 Decreased fetal lung maturity 3 Postterm labor 4 Thrombosis

4 PUBS increases the risk of thrombosis formation. Fetal bradycardia, not tachycardia, is a complication of PUBS. Decreased fetal lung maturity is not a complication of PUBS. Preterm, not postterm, labor is a complication of PUBS.

The nurse is precepting a new nurse on the antepartum unit. Together they are reviewing the reactive nonstress test (NST) of a patient who is at 34 weeks of gestation. Which statement made by the new nurse indicates an understanding of a reactive NST? 1 "I see there is fetal movement that has occurred at least 10 times in 1 hour." 2 "The tracing is reactive when there is fetal movement that causes accelerations." 3 "Variable decelerations that last less than 30 seconds indicate the tracing is reactive." 4 "I see that there are accelerations of 15 bpm above the baseline, lasting at least 15 seconds.

4 The criteria for a reactive NST for a patient who is at least 32 weeks of gestation includes normal oscillations and fluctuations of the fetal heart rate and increases in the fetal heart rate that reach a peak of 15 bpm above the baseline, with the entire acceleration lasting a minimum of 15 seconds but less than 2 minutes. Fetal movement at least 10 times an hour is the criterion for fetal movement counting. A fetal heart rate tracing in which fetal movement causes accelerations and variable decelerations that are less than 30 seconds are not criteria for a reactive NST.

The nurse is teaching a patient in the second trimester about fetal kick count. Which statement by the patient needs correction? 1 "I should count the fetal kicks once a day for 60 minutes." 2 "I may not feel any movements when the fetus is sleeping." 3 "I should count the fetal kicks either after meals or before bedtime." 4 "I should consult an obstetrician if the fetal movements are less than 10 in 1 hour."

4 The fetal movement count helps monitor the condition of the fetus. If the fetal movements are less than three in 1 hour, it indicates a risk of abnormality. Therefore, less than 10 fetal movements in an hour may not be abnormal and the patient may not need to consult the obstetrician. The patient should count fetal kicks at least once a day for a period of 60 minutes because it helps assess fetal activity. Fetal movements are usually not present during the fetal sleep cycle. The patient can count the fetal kicks either after meals or before bedtime when fetal movements are typically highest.

The nurse is preparing a patient for a fetal ultrasound. What instructions will the nurse give the patient? 1 "You should not eat or drink anything 8 hours before the procedure." 2 "Increase your sodium intake 24 hours prior to the ultrasound." 3 "Avoid taking your prenatal vitamin prior to the ultrasound." 4 "You should have a full bladder for this procedure."

4 A full maternal bladder improves visualization in a fetal ultrasound. The pregnant patient can eat or drink prior to the ultrasound. There is no reason to increase sodium intake prior to the ultrasound; increased sodium intake is generally inadvisable for most patients. Prenatal vitamins can be taken prior to the ultrasound.

During a prenatal checkup a patient who is 7 months pregnant reports that she is able to feel about two kicks in an hour. The nurse refers the patient for an ultrasound. What is the primary reason for this referral? 1 To check for fetal anomalies 2 To check gestational age 3 To check fetal position 4 To check for fetal well-being

4 Fetal kick count is a simple method to determine the presence of complications related to fetal oxygenation and activity level. The fetal kick count during the third trimester of pregnancy is approximately 30 kicks an hour; a count lower than that is an indication of poor health of the fetus. Fetal anomalies may not affect the oxygenation levels of the fetus. The nurse already knows the gestational age of the fetus; therefore, the nurse need not refer the woman for ultrasonography to find the gestational age. Fetal position does not affect the activity level of the fetus.

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? 1 "I will need to have a full bladder for the test to be done accurately." 2 "I should have my husband drive me home after the test because I may be nauseated." 3 "This test will help to determine if the baby has Down syndrome or a neural tube defect." 4 "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

4 The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements. An ultrasound requires a full bladder. An amniocentesis is a test after which a pregnant woman should be driven home. A maternal serum alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps determine Down syndrome.

The nurse is caring for a patient in the second month of pregnancy. Which condition can be diagnosed through ultrasonography? 1 Polyhydramnios 2 Ectopic pregnancy 3 Congenital anomalies 4 Intrauterine growth restriction

4 Ultrasonography is conducted during various stages of pregnancy to determine whether the patient has any risks or complications. During the first trimester, the embryo implants in the uterus. By conducting ultrasonography, the nurse can find whether the patient has a risk of ectopic pregnancy. Polyhydramnios is characterized by the presence of excessive amniotic fluid in the amniotic sac and can be detected during the second trimester, not in the first trimester. Congenital anomalies can be detected during either the second or third trimester but not in the first trimester. Intrauterine growth restriction is the condition in which the growth rate of the fetus is not normal. Intrauterine growth restriction is detected during the second or third trimester of pregnancy.

The nurse is preparing to draw a blood sample for a multiple-marker screening on a pregnant patient. The nurse understands that which factor predisposes the fetus to the highest risk of a neural tube defect (NTD), but may have a lower alpha-fetoprotein (AFP) level? 1 Race 2 Asthma 3 Systemic lupus 4 Type I diabetes

4 Women with type 1 diabetes have a greater risk for a fetus with an NTD but have a lower AFP level. Black women have a lower risk for a baby with an NTD but a higher AFP level than other ethnic groups. Asthma and systemic lupus are not associated with NTDs or abnormal AFP levels.

The nurse is performing a contraction stress test (CST) and notes a positive CST. Based on these findings, what is the most appropriate nursing action? 1 Do nothing, as this is a normal finding. 2 Notify the health care provider. 3 Instruct the patient to return for a repeat CST in 1 week. 4 Instruct the patient to anticipate a stillbirth.

A positive CST is an abnormal finding that can be linked to fetal complications, so the nurse should notify the health care provider. Doing nothing is not an appropriate response because this is not a normal finding. The nurse should not instruct the patient to return for a repeat CST, because this is abnormal. It is not appropriate to instruct the patient to anticipate a stillbirth.