Chapter 10: Assessment of High Risk Pregnancy NCLEX

A (An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if fetal/maternal anomalies are detected. NST is performed to assess fetal well-being in the third trimester.)

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? A. Ultrasound examination B. Maternal serum alpha-fetoprotein (MSAFP) screening C. Amniocentesis D. Nonstress test (NST)

A (Fetal heart activity begins around 6 weeks, so 4 weeks is too early to detect fetal heart activity, and this is a normal finding. Absence of fetal heart activity at an advanced gestational age may indicate congenital anomalies, impaired growth, or cardiac disorders.)

A 4-week pregnant patient is undergoing an ultrasound. The report shows an absence of fetal heart activity. What does the nurse infer about the fetus from the report? A. Normal finding B. Congenital abnormality C. Impaired growth D. Cardiac disorder

D (Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the fourteenth week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal).)

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time? A. Biophysical profile (BPP) B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) screening D. Transvaginal ultrasound

D (Rationale: A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). 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 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound

D (Transvaginal ultrasound is 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 fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age.)

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? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound

B (Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have been performed earlier in the pregnancy. It is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.)

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? A. Ultrasound for fetal anomalies B. Biophysical profile (BPP) C. Maternal serum alpha-fetoprotein (MSAFP) screening D. Percutaneous umbilical blood sampling (PUBS)

A (An accurate and appropriate response is, "Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." Although "Your placenta isn't working properly, and your baby is in danger" may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response "Don't worry about it. Everything is fine" is not appropriate and discredits the client's concerns.)

A client asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" The best response by the nurse is: A. "Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." B. "Your placenta isn't working properly, and your baby is in danger." C. "This means that we will need to perform an amniocentesis to detect if you have any placental damage." D. "Don't worry about it. Everything is fine."

B, C, E (Vibroacoustic stimulation is often used to stimulate fetal activity if the initial NST result is nonreactive and thus hopefully shortens the time required to complete the test (Greenberg, Druzin, and Gabbe, 2012). A nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. Care providers sometimes suggest that the woman drink orange juice or be given glucose to increase her blood sugar level and thereby stimulate fetal movements. Although this practice is common, there is no evidence that it increases fetal activity (Greenberg, Druzin, and Gabbe, 2012). A needle biopsy is not part of a NST. The FHR is recorded with a Doppler transducer, and a tocodynamometer is applied to detect uterine contractions or fetal movements. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR.)

A nonstress test (NST) is ordered on a pregnant woman at 37 weeks of gestation. What are the most appropriate teaching points to include when explaining the procedure to the woman? Select all that apply. A. After 20 minutes, a nonreactive reading indicates the test is complete. B. Vibroacoustic stimulation may be used during the test. C. Drinking orange juice before the test is appropriate. D. A needle biopsy may be needed to stimulate contractions. E. Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

B, C, E (Rationale: A nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. During this time vibroacoustic stimulation (see later discussion) may be used to stimulate fetal activity. Vibroacoustic stimulation is often used to stimulate fetal activity if the initial NST result is nonreactive and thus hopefully shortens the time required to complete the test. Care providers sometimes suggest that the woman drink orange juice or be given glucose to increase her blood sugar level and thereby stimulate fetal movements. Although this practice is common, there is no evidence that it increases fetal activity. A needle biopsy is not part of a NST. The FHR is recorded with a Doppler transducer, and a tocodynamometer is applied to detect uterine contractions or fetal movements. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR.)

A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient? (Select all that apply) A. After 20 minutes, a nonreactive reading indicates the test is complete. B. Vibroacoustic stimulation may be used during the test. C. Drinking orange juice before the test is appropriate. D. A needle biopsy may be needed to stimulate contractions. E. Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

C (Rationale: Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. No late decelerations indicate a positive CST. CST is contraindicated if the membranes have ruptured.)

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): A. sometimes uses vibroacoustic stimulation. B. is an invasive test; however, contractions are stimulated. C. is considered negative if no late decelerations are observed with the contractions. D. is more effective than nonstress test (NST) if the membranes have already been ruptured.

A, B (Triple marker screening, which is performed in the first trimester of pregnancy, includes the measurement of two maternal biomarkers: PAPP-A and free β-hCG. High levels of free β-hCG and low levels of PAPP-A in the first trimester indicate that the fetus has Down syndrome, or trisomy 21.Inhibin-A is a placental hormone. Low levels of inhibin-A also indicate the possibility of Down syndrome, but inhibin-A levels are not measured in the triple marker screen; these levels are measured in quad screening. A low level of MSAFP and unconjugated estriol also indicate Down syndrome, but these can be measured only in the second and third trimesters.)

A patient in the first trimester of pregnancy undergoes a triple marker screening test. On reviewing the report, the nurse infers that the fetus may have Down syndrome. What clinical findings are noted by the nurse in the test reports? Select all that apply. A. High levels of beta-human chorionic gonadotropin (β-hCG) B. Low levels of pregnancy-associated placental protein (PAPP-A) C. Low levels of inhibin-A in the fetal blood D. Low levels of maternal serum alpha-fetoprotein (MSAFP) E. Low levels of unconjugated estriol in the fetal blood

A (Three-dimensional (3D) or four-dimensional (4D) ultrasonography is advisable for women who want to see the fetus. MRI cannot be used in this case because it requires the fetus to be still for a long period of time for a clear image. CT uses ionizing radiation for imaging, which can be harmful to the fetus. Therefore CT is contraindicated for fetal imaging. NT is a specific ultrasonography screening procedure used to test for genetic abnormalities in the fetus.)

A patient in the sixth month of pregnancy expresses her wish to see the fetus. What investigation does the nurse suggest for the patient to help her see the fetus? A. Ultrasonography B. Magnetic resonance imaging (MRI) C. Computed tomography (CT) D. Nuchal translucency (NT)

D (MRI is a noninvasive technique that causes little pain. Therefore the patient undergoing MRI should be advised to not worry about pain. The patient undergoing MRI should be positioned in a supine position. The lithotomy position is not suitable for this procedure. The patient need not take fluids before the scan to ensure a full bladder because this procedure enables a full pelvic view without a full bladder. The patient should be instructed not to move during the scanning process because it may blur the images obtained.)

A pregnant patient is about to undergo magnetic resonance imaging (MRI). What information does the nurse give the patient before the procedure? The patient will: A. Be positioned in a lithotomy position. B. Need to take fluids to have a full bladder. C. Be able to move freely during the procedure. D. Not have pain during the process

A (A normal fetal kick count is an indication of fetal activity. The patient has undergone nonstress testing, which may have high false-positive rates. Therefore the patient may be scheduled for a contraction stress test. Biophysical profile testing allows detailed assessment of the physical and physiologic characteristics of the fetus. Because the kick count is normal, biophysical profile testing is not needed. Maternal serum analysis is done to determine fetal abnormalities. It is not advised in this case, because the fetal kick count indicates adequate fetal activity. Doppler blood flow analysis is a noninvasive test for analyzing fetal circulation. It cannot be used to assess the fetal heart rate.)

A pregnant patient with a normal fetal kick count has come for a regular nonstress testing session. The nurse notices that there are no heart accelerations after 40 minutes of testing. What diagnostic testing will the nurse include in the plan of care? A. Contraction stress test B. Biophysical profile test C. Maternal serum analysis D. Doppler blood flow test

A (The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.)

A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is: A. "The test results are within normal limits." B. "Immediate delivery by cesarean birth is being considered." C. "Further testing will be performed to determine the meaning of this score." D. "An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery."

D (Her family history of NTD, low BMI, and substance abuse all are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal.)

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? A. Blood pressure, age, BMI B. Drug/alcohol use, age, family history C. Family history, blood pressure, BMI D. Family history, BMI, drug/alcohol abuse

B (The nurse can best help the woman and her husband regain a sense of control in their lives by providing support and encouragement (including active involvement in preparations and classes). The nurse can try to present opportunities for the couple to make as many choices as possible in prenatal care.)

A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion, showing declining interest. The nurse can best help the couple by: A. Telling her that the physician will isolate the problem with more tests. B. Encouraging her and urging her to continue with childbirth classes. C. Becoming assertive and laying out the decisions the couple needs to make. D. Downplaying her risks by citing success rate studies.

A (Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.)

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be: A. Negative. B. Positive. C. Satisfactory. D. Unsatisfactory.

D (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 is the test that requires a full bladder. An amniocentesis is the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome.)

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

D (Rationale: An ultrasound is the test that requires a full bladder. An amniocentesis would be the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome. 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.)

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test? A. "I will need to have a full bladder for the test to be done accurately." B. "I should have my husband drive me home after the test because I may be nauseous." C. "This test will help to determine if the baby has Down syndrome or a neural tube defect." D. None of the above

B (Exposure to nicotine from maternal smoking has been reported to increase the fetal S/D ratio. An elevated S/D ratio indicates a poorly perfused placenta. To improve the blood supply to the placenta, the patient should quit smoking as soon as possible. The AFV cannot be assessed through Doppler umbilical blood flow study. Moreover, smoking does not affect amniotic fluid volume. Smoking increases the S/D ratio; it does not decrease it.)

After reviewing the Doppler umbilical flow reports of a pregnant patient, the nurse advises the patient to quit smoking immediately. Which finding in the report could be the reason for this instruction? A. High amniotic fluid volume (AFV) B. High systolic-to-diastolic (S/D) ratio C. Low amniotic fluid volume (AFV) D. Low systolic-to-diastolic (S/D) ratio

D (If the BPP score is 8 to 10, then the test should be repeated weekly or twice weekly. If the BPP score is 0 to 2, then chronic asphyxia may be suspected. In this case the testing time should be extended to 120 minutes. If the BPP score is 4 after 36 weeks' gestation, then clinical conditions exist that may lead to an eminent delivery. If the BPP score is 4 before 32 weeks' gestation, the test should be repeated. If the BPP score is 6 at 36 to 37 weeks' gestation with positive fetal pulmonary testing, then delivery can be performed. If the BPP score is 6 before 36 weeks' gestation with negative pulmonary testing, then BPP can be repeated in 4 to 6 hours, and if oligohydramnios is present, then delivery can be done. The BPP provides an insight into fetal maturity and well-being and as such should be used as a diagnostic tool to plan and evaluate management of care. Findings are related to several factors involving both maternal and fetal characteristics.)

After reviewing the biophysical profile (BPP) reports of a pregnant patient close to term, the nurse advises the patient to repeat the test on a weekly basis. What BPP score did the nurse find in the report? A. 1 B. 4 C. 6 D. 9

A (An AFI less than 5 cm indicates oligohydramnios. Oligohydramnios is associated with intrauterine growth restriction and congenital anomalies. An AFI of 10 cm or greater indicates that the fetus is normal. AFI values between 5 and 10 cm are considered low normal, indicating a comparatively low risk for congenital anomalies. An AFI greater than 25 cm indicates polyhydramnios. This is associated with neural tube defects and obstruction of the fetal gastrointestinal tract.)

After reviewing the reports of a pregnant patient, the nurse infers that there might be a high risk for intrauterine growth restriction (IUGR). What could be the reason for this? The amniotic fluid index (AFI) is: A. Less than 5 cm. B. Equal to or more than 10 cm. C. Between 5 and 10 cm. D. More than 25 cm

C (Specialized or targeted ultrasound scans are performed only if a patient is suspected of carrying an anatomically or physiologically abnormal fetus. Limited ultrasound examination is used to estimate the amniotic fluid volume. Standard ultrasound scan is used to see the detailed anatomy of the fetus. Ultrasound scan is not used to find genetic abnormalities in the fetus.)

After reviewing the standard ultrasound scan reports of a pregnant patient, the nurse advises the patient to undergo a specialized ultrasound scan. What is the nurse's rationale for this suggestion? A. To estimate the amniotic fluid volume B. To identify the detailed fetal anatomy C. To assess for physiologic abnormalities D. To assess for fetal genetic abnormalities

B, D, E (The triple marker screen measures the levels of three maternal serum markers: unconjugated estriol, hCG, and MSAFP. Low values of unconjugated estriol, hCG, and MSAFP indicate that the fetus has trisomy 18. The quad screen has an additional serum marker: inhibin-A. A low inhibin-A level indicates the possibility of Down syndrome. NT is not a serum marker protein. Moreover, elevated NT indicates that the fetus has a chromosomal abnormality but does not specifically indicate that the fetus has trisomy 18.)

After reviewing the triple marker screen reports of a patient who is in the second trimester of pregnancy, the nurse concludes that the fetus has trisomy 18. What factors in the report led to the nurse's conclusion? Select all that apply. A. Low level of inhibin-A in the maternal serum B. Low level of unconjugated estriol in serum C. Elevated nuchal translucency (NT) in the fetus D. Low level of maternal human chorionic gonadotrophin (hCG) E. Low level of maternal serum alpha-fetoprotein (MSAFP)

C (Amniocentesis would be performed to assess fetal lung maturity in the event of a preterm birth. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Typically, fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario. NST measures the fetal response to fetal movement in a noncontracting mother.)

At 35 weeks of pregnancy a woman experiences preterm labor. Tocolytics are administered and she is placed on bed rest, but she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time? A. Percutaneous umbilical blood sampling (PUBS) B. Ultrasound for fetal size C. Amniocentesis for fetal lung maturity D. Nonstress test (NST)

A (Biochemical findings such as an L/S ratio of 2:1, an S/A ratio of 60 mg/g, and the presence of PG in amniotic fluid indicate that the fetal lungs are well developed. The gestational age can be predicted only with the help of creatinine and lipid levels in the amniotic fluid. Creatinine levels greater than 2 mg/dL in amniotic fluid indicate that the gestational age is more than 36 weeks. The presence of alpha-fetoprotein (AFP) in the amniotic fluid indicates a neural tube defect in the fetus. The nurse needs to assess AFP levels in the amniotic fluid to determine whether the fetus has an open neural tube defect. A high AFP level in amniotic fluid after 15 weeks' gestation indicates that the fetus has an open neural tube defect.)

Biochemical examination of the amniotic fluid of a pregnant patient yields the following results: lecithin-to-sphingomyelin (L/S) ratio, 2:1; surfactant-to-albumin (S/A) ratio, 60 mg/g; and phosphatidylglycerol (PG) present. What conclusions will the nurse draw from this report? A. The fetal lungs are well developed. B. The gestational age is 36 weeks. C. The fetus has a neural tube defect. D. The fetus has an open neural tube defect.

E (NOT: Each pregnancy problem can be attributed to a number of related risk factors. Polyhydramnios may also be the result of poorly controlled diabetes mellitus. Other maternal causes of IUGR include hypertensive disorders, diabetes, chronic renal disease, vascular disease, thrombophilia, poor weight gain, and cyanotic heart disease. Fetoplacental causes of IUGR may be related to chromosomal abnormalities, congenital malformations, intrauterine infection, or genetic syndromes. Other contributors to oligohydramnios are renal agenesis, prolonged pregnancy, uteroplacental insufficiency, and paternal hypertensive disorders. Although advanced maternal age is a well-known cause of chromosomal abnormalities, other causes include parental chromosome rearrangements and pregnancy with autosomal trisomy.)

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. Abnormal placenta development A. Polyhydramnios B. Intrauterine growth restriction (maternal cause) C. Oligohydramnios D. Chromosomal abnormalities E. Intrauterine growth restriction (fetoplacental cause)

D (NOT: Each pregnancy problem can be attributed to a number of related risk factors. Polyhydramnios may also be the result of poorly controlled diabetes mellitus. Other maternal causes of IUGR include hypertensive disorders, diabetes, chronic renal disease, vascular disease, thrombophilia, poor weight gain, and cyanotic heart disease. Fetoplacental causes of IUGR may be related to chromosomal abnormalities, congenital malformations, intrauterine infection, or genetic syndromes. Other contributors to oligohydramnios are renal agenesis, prolonged pregnancy, uteroplacental insufficiency, and paternal hypertensive disorders. Although advanced maternal age is a well-known cause of chromosomal abnormalities, other causes include parental chromosome rearrangements and pregnancy with autosomal trisomy.)

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. Advanced maternal age A. Polyhydramnios B. Intrauterine growth restriction (maternal cause) C. Oligohydramnios D. Chromosomal abnormalities E. Intrauterine growth restriction (fetoplacental cause)

A (NOT: Each pregnancy problem can be attributed to a number of related risk factors. Polyhydramnios may also be the result of poorly controlled diabetes mellitus. Other maternal causes of IUGR include hypertensive disorders, diabetes, chronic renal disease, vascular disease, thrombophilia, poor weight gain, and cyanotic heart disease. Fetoplacental causes of IUGR may be related to chromosomal abnormalities, congenital malformations, intrauterine infection, or genetic syndromes. Other contributors to oligohydramnios are renal agenesis, prolonged pregnancy, uteroplacental insufficiency, and paternal hypertensive disorders. Although advanced maternal age is a well-known cause of chromosomal abnormalities, other causes include parental chromosome rearrangements and pregnancy with autosomal trisomy.)

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. Fetal congenital anomalies A. Polyhydramnios B. Intrauterine growth restriction (maternal cause) C. Oligohydramnios D. Chromosomal abnormalities E. Intrauterine growth restriction (fetoplacental cause)

C (NOT: Each pregnancy problem can be attributed to a number of related risk factors. Polyhydramnios may also be the result of poorly controlled diabetes mellitus. Other maternal causes of IUGR include hypertensive disorders, diabetes, chronic renal disease, vascular disease, thrombophilia, poor weight gain, and cyanotic heart disease. Fetoplacental causes of IUGR may be related to chromosomal abnormalities, congenital malformations, intrauterine infection, or genetic syndromes. Other contributors to oligohydramnios are renal agenesis, prolonged pregnancy, uteroplacental insufficiency, and paternal hypertensive disorders. Although advanced maternal age is a well-known cause of chromosomal abnormalities, other causes include parental chromosome rearrangements and pregnancy with autosomal trisomy.)

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. Premature rupture of membranes A. Polyhydramnios B. Intrauterine growth restriction (maternal cause) C. Oligohydramnios D. Chromosomal abnormalities E. Intrauterine growth restriction (fetoplacental cause)

B (NOT: Each pregnancy problem can be attributed to a number of related risk factors. Polyhydramnios may also be the result of poorly controlled diabetes mellitus. Other maternal causes of IUGR include hypertensive disorders, diabetes, chronic renal disease, vascular disease, thrombophilia, poor weight gain, and cyanotic heart disease. Fetoplacental causes of IUGR may be related to chromosomal abnormalities, congenital malformations, intrauterine infection, or genetic syndromes. Other contributors to oligohydramnios are renal agenesis, prolonged pregnancy, uteroplacental insufficiency, and paternal hypertensive disorders. Although advanced maternal age is a well-known cause of chromosomal abnormalities, other causes include parental chromosome rearrangements and pregnancy with autosomal trisomy.)

Biophysical risks include factors that originate with either the mother or the fetus and affect the functioning of either one or both. The nurse who provides prenatal care should have an understanding of these risk factors. Match the specific pregnancy problem with the related risk factor. Smoking, alcohol, and illicit drug use A. Polyhydramnios B. Intrauterine growth restriction (maternal cause) C. Oligohydramnios D. Chromosomal abnormalities E. Intrauterine growth restriction (fetoplacental cause)

A (CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive.)

Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment: A. Has no known contraindications. B. Has fewer false-positive results. C. Is more sensitive in detecting fetal compromise. D. Is slightly more expensive.

D (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.)

During a prenatal checkup, the 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? To check: A. For fetal anomalies B. Gestational age C. Fetal position D. For fetal well-being

D (The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty bladder. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman feels pressure as the probe is moved.)

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their clients that: A. Both require the woman to have a full bladder. B. The abdominal examination is more useful in the first trimester. C. Initially the transvaginal examination can be painful. D. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

B (During the first trimester, ultrasound examination is performed to obtain information regarding the number, size, and location of gestatials sacs; the presence or absence of fetal cardiac and body movements; the presences or absence of uterine abnormalities (e.g., bicornuate uterus or fibroids) or adnexal masses (e.g., ovarian cysts or an ectopic pregnancy); and pregnancy dating.)

In the first trimester, ultrasonography can be used to gain information on: A. Amniotic fluid volume. B. Location of Gestational sacs C. Placental location and maturity. D. Cervical length.

C (This category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are risks that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.)

In the past, factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the following is not one of these categories? A. Biophysical B. Psychosocial C. Geographic D. Environmental

A, B, C, E (Poor nutrition, maternal collagen disease, gestational hypertension, and smoking all are risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.)

Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors (Select all that apply). A. Poor nutrition B. Maternal collagen disease C. Gestational hypertension D. Premature rupture of membranes E. Smoking

B (If MSAFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated MSAFP screening, ultrasound examination, and possibly amniocentesis. Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. BPP is a method of assessing fetal well-being in the third trimester. Before amniocentesis is considered, the client first would have an ultrasound for direct visualization of the fetus.)

Maternal serum alpha-fetoprotein (MSAFP) screening indicates an elevated level. MSAFP screening is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus? A. Percutaneous umbilical blood sampling (PUBS) B. Ultrasound for fetal anomalies C. Biophysical profile (BPP) for fetal well-being D. Amniocentesis for genetic anomalies

D (MSAFP is a screening tool, not a diagnostic tool. CVS provides a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP screening, not PUBS, is part of the triple-marker tests for Down syndrome.)

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: A. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. B. Maternal serum alpha-fetoprotein (MSAFP) screening is recommended only for women at risk for neural tube defects. C. Percutaneous umbilical blood sampling (PUBS) is one of the triple-marker tests for Down syndrome. D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

D (MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome.)

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: A. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. B. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. C. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

D (Rationale: CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome. This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.)

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: A. chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. B. screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. C. percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

A (An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.)

Nurses should be aware that the biophysical profile (BPP): A. Is an accurate indicator of impending fetal well-being. B. Is a compilation of health risk factors of the mother during the later stages of pregnancy. C. Consists of a Doppler blood flow analysis and an amniotic fluid index. D. Involves an invasive form of ultrasound examination.

A (Rationale: 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 before amniocentesis as this would increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required before amniocentesis, because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.)

Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to: A. administer RhoD immunoglobulin. B. administer anticoagulant. C. send the patient for a computed tomography (CT) scan before the procedure. D. assure the mother that short-term radiation exposure is not harmful to the fetus.

B (Polyhydramnios (amniotic fluid >2000 mL) is 10 times more likely to occur in diabetic compared with nondiabetic pregnancies. Polyhydramnios puts the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.)

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus, the nurse is aware that she is at a greater risk for: A. Oligohydramnios. B. Polyhydramnios. C. Postterm pregnancy. D. Chromosomal abnormalities.

C (The normal value of AFI is 10 cm or greater, with the upper limit of normal around 25 cm. An AFI less than 5 cm indicates oligohydramnios. This condition is associated with renal agenesis in the fetus. A high AFI indicates neural tube defects and fetal hydrops. The AFI is not directly related to fetal movement. Fetal activity can be assessed using ultrasonography.)

The amniotic fluid index (AFI) of a pregnant patient is 3 cm. What clinical information related to the fetus does the nurse infer from this? A. Neural tube defect B. Fetal hydrops C. Renal defects D. Low activity level

D (If the BPP score is less than 2, regardless of gestational age, delivery can be performed. If the BPP score is 0 to 2 and chronic asphyxia is suspected, then testing time should be extended to 120 minutes. If the BPP score is 8 to 10 and a low risk for chronic asphyxia is suspected, then the test should be repeated at twice-weekly intervals. If the fetal pulmonary test result is negative and the BPP score is 6, then the BPP profile should be repeated in 4 to 6 hours.)

The biophysical profile (BPP) testing report of a pregnant patient gives the following information: one episode of fetal breathing movement lasting for 30 seconds in a 30-minute observation; three limb movements of the fetus in 30 minutes; an amniotic fluid index greater than 5; a reactive nonstress test; and a BPP score of 1. The test is performed for 120 minutes. What does the nurse expect the primary health care provider to do? A. Extend the test time to 120 minutes. B. Repeat the test twice a week. C. Repeat the test in 4 to 6 hours. D. Consider delivery of the fetus.

C (The nonstress test is the most widely used technique for prenatal evaluation of the fetus. The results are either nonreactive or reactive. In a nonreactive test, there are less than two qualifying accelerations of the fetal heart rate in a 20-minute period. Absence of fetal heart rate accelerations during the nonstress test indicates that the fetus is sleeping. In a reactive test, there are at least two qualifying accelerations in a 20-minute time period. More than two fetal heart rate accelerations within a 20-minute time period also would be considered a reactive test.)

The nurse finds that the nonstress test of a pregnant patient is nonreactive. Which factor in the report might have led the nurse to this finding? A. No qualifying accelerations in a 20-minute period B. Two qualifying accelerations in a 20-minute period C. Less than two qualifying accelerations in a 20-minute period D. More than two qualifying accelerations in a 20-minute period

C (Maternal hypertension can cause serious adverse effects on the fetus. A blood pressure reading of 150/90 mm Hg indicates that the mother is hypertensive. To assess the effect of maternal hypertension on the fetus, the nurse should refer the patient for a Doppler blood flow analysis. It is a noninvasive ultrasonic technique used to study fetal blood flow. NT is a technique used to assess genetic abnormalities in the fetus. CVS is a prenatal test used to diagnose structural defects in the fetus. PUBS is used to assess the fetal circulation.)

The nurse is assessing a pregnant patient and finds that her blood pressure is 150/90 mm Hg. What procedure does the nurse recommend for this patient? A. Nuchal translucency (NT) test B. Chorionic villus sampling (CVS) C. Doppler blood flow analysis D. Percutaneous umbilical blood sampling (PUBS)

A (Rationale: The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy)

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result? A. Indirect Coombs test B. Hemoglobin level C. hCG level D. Maternal serum alpha-fetoprotein (MSAFP)

A (The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy.)

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. Which specific lab result should the nurse assess? A. Indirect Coombs test B. Hemoglobin level C. hCG level D. Maternal serum alpha-fetoprotein (MSAFP)

B (Meconium is normally stored in the infant's intestines until after birth, but sometimes (in cases of fetal distress and hypoxia) it is expelled into the amniotic fluid before birth. The amniotic fluid is then said to be meconium stained. Fewer than three contractions in 10 minutes or late decelerations occurring with 50% or more of contractions constitute positive CST results. Positive CST results are associated with meconium-stained amniotic fluid. Negative CST results indicate that the fetus is normal. Suspicious or unsatisfactory CST results are not associated with any other fetal conditions.)

The nurse is reviewing the contraction stress test (CST) reports of a pregnant patient. The nurse expects the fetus to have meconium-stained amniotic fluid. What would be the reason for that conclusion? A. Negative CST results B. Positive CST results C. Suspicious CST results D. Unsatisfactory CST results

C (No late decelerations is good news. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured.)

The nurse providing care for the antepartum woman should understand that contraction stress test (CST): A. Sometimes uses vibroacoustic stimulation. B. Is an invasive test; however, contractions are stimulated. C. Is considered negative if no late decelerations are observed with the contractions. D. Is more effective than nonstress test (NST) if the membranes have already been ruptured.

D (The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats/min (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. Contraction stress test (CST) uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term.)

The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is: A. Nonreactive B. Positive C. Negative D. Reactive

A (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 because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, CST is not performed on a woman whose fetus is preterm. Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease, 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.)

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 other tool would be useful in confirming the diagnosis? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

A (Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and placenta. It is a helpful tool in the management of high risk pregnancies because of 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, 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.)

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 tool is useful in confirming the diagnosis? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

A (Rationale: 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 because of 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, 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.)

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? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

B (The presence of bilirubin in the amniotic fluid indicates the possibility of hemolytic anemia in the fetus. The degree of hemolytic anemia can be determined by using Doppler blood flow analysis. The presence of the placental hormone inhibin-A in the quad screen indicates Down syndrome. The amniotic fluid index values are used to detect Potter syndrome. Fetal hydrops is caused by polyhydramnios, which can be assessed by ultrasound scanning.)

The primary health care provider advises a pregnant woman to undergo a Doppler blood flow analysis after reviewing the amniocentesis reports. What clinical condition in the fetus could be the reason for this referral? A. Down syndrome B. Hemolytic anemia C. Potter syndrome D. Fetal hydrops

A, B, C, E (Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying multifetal gestation, ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.)

Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations (Select all that apply). A. Multifetal gestation B. Obesity C. Fetal abnormalities D. Amniotic fluid volume E. Ectopic pregnancy

B (Rationale: Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Although adolescent pregnancy and poor prenatal care are risk factors of poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; but history of a previous stillbirth, not preterm labor, is the other indicator.)

What is an indicator for performing a contraction stress test? A. Increased fetal movement and small for gestational age B. Maternal diabetes mellitus and postmaturity C. Adolescent pregnancy and poor prenatal care D. History of preterm labor and intrauterine growth restriction

B (The L/S ratio indicates fetal lung maturity. AFP is assessed to check for the presence of neural defects. Presence of creatinine in the amniotic fluid indicates that the patient's gestational age is more than 36 weeks. The antibody titer is used to determine Rh incompatibility in the fetus.)

What parameter does the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth? A. Alfa-fetoprotein (AFP) levels B. Lecithin-to-sphingomyelin (L/S) ratio C. Creatinine levels in the blood D. Antibody titer in the blood

C (No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity ("kick counts") two or three times daily for 60 minutes each time. Obese women have a harder time assessing fetal movement.)

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: A. Alcohol or cigarette smoke can irritate the fetus into greater activity. B. "Kick counts" should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. C. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. D. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women.

A (Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch would not predict chromosomal defects in the fetus.)

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? A. Multiple-marker screening B. Lecithin/sphingomyelin (L/S) ratio C. Biophysical profile D. Type and crossmatch of maternal and fetal serum

B (When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a "window" through which the uterus and its contents can be viewed. The woman needs a full bladder to elevate the uterus; therefore being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure.)

Which nursing intervention is necessary before a second-trimester transabdominal ultrasound? A. Place the woman NPO for 12 hours. B. Instruct the woman to drink 1 to 2 quarts of water. C. Administer an enema. D. Perform an abdominal preparation.

A, B, C (Assessment of physiologic parameters such as AFV, FBMs, and limb and head movements of the fetus by ultrasonography gives a reliable picture of fetal well-being. Abnormalities in the amniotic fluid volume are frequently associated with fetal disorders. Fetal breathing and limb and head movements reflect the status of the central nervous system. Daily fetal movement count is the most common method used to assess fetal activity. Ultrasound is not used to assess the daily fetal movement count. The fluid volume in the nape of the fetal neck is measured to assess structural abnormalities in the fetus.)

Which physiologic parameters does the nurse check in the ultrasound report to assess fetal well-being? Select all that apply. A. Amniotic fluid volume (AFV) B. Fetal breathing movements (FBMs) C. Fetal limb and head movements D. Daily count of fetal movements E. Fluid volume in the nape of the fetal neck

C (The NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 and 14 weeks' gestation. Fluid volume greater than 3 mm is considered abnormal. NT is used mostly to identify possible fetal genetic abnormalities. AFV, fetal body movements, and fetal heart activity are measured to assess fetal well-being.)

Which test does the nurse recommend for the patient to help assess fetal genetic abnormalities? A. Amniotic fluid volume (AFV) B. Fetal body movements C. Nuchal translucency (NT) D. Fetal heart activity

B (Lack of response after 3 minutes of FAST indicates that the fetus has low activity levels. In this situation, to accurately assess fetal activity, the nurse should recommend a BPP of the fetus. Amniocentesis helps detect genetic abnormalities in the fetus. Fetal activity cannot be determined using this technique. In cordocentesis, the umbilical blood is tested for Rh incompatibility and hemolytic anemia in the fetus. Coombs' test is used to determine the presence of antibody incompatibilities in the fetus and the mother.)

While performing the fetal acoustic stimulation test (FAST) in a patient, the nurse observes that there is no fetal response even after 3 minutes of testing. Which test does the nurse suggest? A. Amniocentesis B. Biophysical profile (BPP) C. Cordocentesis D. Coombs' test

C, D (A floating fetus is seen in cases of elevated amniotic fluid volume, or polyhydramnios. Polyhydramnios is associated with neural tube defects and gastrointestinal obstruction. Renal agenesis and severe intrauterine growth restriction are associated with oligohydramnios, or low amniotic fluid volume. A low amount of fluid may not result in a floating fetus in the scanned image. The amniotic fluid level is unrelated to cardiac disease in the fetus.)

While reviewing the ultrasound reports of a patient, the nurse notices a floating fetus in the scanned image. What potential fetal risks should the nurse interpret from this finding? Select all that apply: A. Renal agenesis B. Growth restriction C. Neural tube defects D. Gastrointestinal obstruction E. Cardiac disease.

C (CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, the risk of limb reduction is no greater than in the general population.)

While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at: A. 4 weeks B. 8 weeks C. 10 weeks D. 14 weeks

C (Diluted fluid is mixed with ethanol and shaken. After 15 minutes, the bubbles tell the story. Amniocentesis is possible after the fourteenth week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasound. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.)

With regard to amniocentesis, nurses should be aware that: A. Because of new imaging techniques, amniocentesis is now possible in the first trimester. B. Despite the use of ultrasound, complications still occur in the mother or infant in 5% to 10% of cases. C. The shake test, or bubble stability test, is a quick means of determining fetal maturity. D. The presence of meconium in the amniotic fluid is always cause for concern.