Chapter 26, Assessment of High-Risk Pregnancy

While reviewing the laboratory reports of 38-year-old pregnant client, the nurse finds that the lecithin/sphingomyelin (L/S) ratio is 2:1, amniotic fluid index is 12 cm, and inhibin A level is elevated. Which condition may the fetus be at risk for based on these findings?

Down syndrome

The nurse is caring for a client in the second month of pregnancy. Which condition can be diagnosed through ultrasonography?

Ectopic pregnancy

A client is undergoing percutaneous umbilical blood sampling (PUBS). What is the best intervention for the nurse to perform after conducting the test?

Monitor the fetal heart rate (FHR).

Which clinical significance does a maternal blood Coombs test with a titer of 1:8 and increasing indicate?

Significant Rh incompatibility

The nurse is caring for a pregnant client at 19 weeks of gestation. On reviewing the ultrasound reports, the nurse notes that the fetus has a ventricular septal defect (VSD). The nurse knows which type of ultrasound helps detect VSD?

Specialized or targeted examination

Which describes the nurse's understanding of the fetal risk for intrauterine growth restriction (IUGR)?

Stillbirth

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?

"This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

The primary health care provider suspects a pregnant client to be at risk for an ectopic pregnancy and instructs the nurse to prepare the client for ultrasonography. Which step should the nurse do to prepare the client for the test?

Assist the client into a lithotomy position during the test.

Which would be the best timeframe to establish gestational age based on ultrasonography?

Between 14 and 22 weeks of gestation

In assessing a pregnant client, the nurse is aware of the four high-risk factors when performing a health history. What are the four categories? Select all that apply.

Biophysical Psychosocial Environmental Sociodemographic

Which maternal marker screening would the nurse anticipate to assess the risk of the fetus for a client who is at 10 weeks of gestation and is a carrier for a balanced translocation of trisomy 18?

Cell-free DNA (cfDNA)

Which testing would be available for a client at 11 weeks of gestation who requests a fetal genetic assessment?

Chorionic villus sampling

Which describes the uses for ultrasonography in the third trimester of pregnancy? Select all that apply. One, some, or all responses may be correct.

Detects congenital anomalies

The nurse sees a primagravida at 30 weeks gestation for the first time. The nurse notes the client has smoked throughout the pregnancy, and fundal height measurements are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, the nurse knows which other tool is useful in confirming this condition?

Doppler blood flow analysis

The nurse is teaching a pregnant client regarding the monitoring of daily fetal movement. Which finding should be reported to the primary health care provider?

Fetal movement was not detected for 12 hours.

A nurse is providing instruction for an obstetric client to perform a daily fetal movement count (DFMC). Which instructions should be included in the plan of care? Select all that apply.

The client can monitor fetal activity once daily for a 60-minute period and note activity. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted.

After reviewing the medical history and dietary habits of a pregnant client, the nurse suspects that the client's newborn may have risk of hyperactivity and learning disabilities, due to which factor?

The client consumed alcohol during the pregnancy.

The amniotic fluid index (AFI) in a client is 15 cm. Which should the nurse interpret from this finding?

The client has normal AFI.

The nurse is caring for a client who has undergone a contraction stress test. What intervention should the nurse perform based on the test results of equivocal findings?

Repeat the contraction stress test next day

A 40-year-old woman with a body mass index over 30 is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?

Transvaginal ultrasound

Which tests are noninvasive and performed to detect chromosomal abnormalities in the fetus? Select all that apply.

Triple-marker test Cell-free deoxyribonucleic acid (DNA) screen

Which type of ultrasound is the standard medical scan used in pregnancy?

Two-dimensional (2D)

The nursing instructor is teaching nursing students about the daily fetal movement count. Which statement by a student indicates a need for further teaching?

"Fetal movements decrease 1 week before the expected date of delivery."

Which biophysical assessment is anticipated for a client after reviewing the health care provider's documented assessment in the electronic health record (EHR)?

A fundal height greater than the gestational age, and a ballotable or nonpalpable fetus are clinical findings associated with polyhydramnios. Polyhydramnios can be associated with fetal disorders such as gastrointestinal and central nervous system abnormalities, hydrops, or multiple fetuses. It is also essential to evaluate the quantity of the amniotic fluid, as it is an indicator of placental function over a long period. A modified BPP would allow for assessment of the current fetal condition and measurement of the quantity of amniotic fluid. A nonstress test would not allow for evaluation of the amniotic fluid. Ultrasonography would not provide as thorough of information about fetal well-being that a modified BPP would, and it does not include a nonstress test. Doppler blood flow analysis is used to evaluate blood flow in the various arteries such as the fetal umbilical and middle cerebral arteries and the maternal uterine arteries.

The nurse is reviewing the biophysical profile (BPP) of a client with the technician. The nurse observes no fetal breathing movements for 30 minutes, fewer than three episodes of limb movements, an amniotic fluid index (AFI) greater than 5 cm, and a reactive nonstress test. The fetal limb has no extension or flexion movements. What is the client's BPP score? Record your answer using a whole number. ________

The nurse observes no fetal breathing movements for 30 minutes. Therefore the score for fetal breathing movements would be 0. Fewer than three episodes of limb movements also equals a fetal movements score of 0. An amniotic fluid index (AFI) greater than 5 cm indicates a score of 2. A reactive nonstress test receives a score of 2. No movement of the fetal limb is scored 0. Therefore the total score would be 0 + 0 + 2 + 2 + 0 = 4.

While performing a contraction stress test in a pregnant client, the nurse finds that the client 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, and which instruction would the nurse expect to receive?

"Resume a routine weekly testing schedule for the client."

The nurse is reviewing the amniocentesis reports of a client at 20 weeks gestation and notes the presence of high alpha-fetoprotein (AFP) levels. Which should the nurse infer from this information related to the clinical condition of the fetus?

Neurologic disorder.

Which is the normal range of amniotic fluid index?

10 to 25 cm

The nurse is explaining a Doppler flow analysis screening to a pregnant client. In describing the test, the nurse states at which stage of the pregnancy can the systolic/diastolic ratio be first detected in the fetus?

15th week of pregnancy

Which is the most commonly used antenatal testing for a client at 39 weeks gestation who requires fetal assessment for decreased fetal movement?

Nonstress test

A client has elevated nuchal translucency and low maternal serum marker levels. The nurse is aware of which abnormality would be likely in the client's newborn?

Pyelectasis

The nurse is caring for a pregnant client who is scheduled for cordocentesis. Which could be a complication of the test?

Fetomaternal hemorrhage

A nurse providing care for the antepartum woman should understand what about the contraction stress test (CST)?

Is considered negative if no late decelerations are observed with the contractions

The nurse knows which is the primary test performed to determine fetal lung maturity?

Lamellar body count (LBC)

Which risk is a fetus subject to if chorionic villus sampling (CVS) is conducted in the 7th week of gestation?

Limb reduction defects

Which strengths and limitations of various biochemical assessments during pregnancy should a nurse be aware of?

MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

Which factor is appropriate to identify when providing client instructions about daily monitoring of fetal kick counts?

Obesity

A client has undergone an amniocentesis for evaluation of fetal well-being. Which interventions would be included in the nurse's plan of care postprocedure? Select all that apply.

Observe the client for possible uterine contractions. Administer Rhogam to the client if she is Rh negative

The nurse is supervising a student nurse while performing a nonstress test. Which action of the student nurse indicates the need for further teaching?

Placing the client in the left side-lying position

The nurse knows which condition is associated with oligohydramnios?

Potter syndrome

Which medications can cause neural tube defects in the fetus? Select all that apply.

Valproic acid Carbamazepine

A nonstress test (NST) is ordered on a pregnant woman at 37 weeks of gestation. Which are the most appropriate teaching points to include when explaining the procedure to the client? Select all that apply.

Vibroacoustic stimulation may be used during the test. Drinking orange juice before the test is appropriate. Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

Which tests help detect the presence of Down syndrome in the fetus of a patient in the second trimester of pregnancy? Select all that apply.

Quad-screen Triple-marker screen

On reviewing the medical history of a pregnant client, the nurse finds that the client is taking carbamazepine. What consequence of the drug on the fetus should the nurse be aware of?

Spina bifida

The nurse is teaching a client in the second trimester about fetal kick count. Which statement by the client needs correction?

"I should consult an obstetrician if the fetal movements are less than 10 in one hour."

The nursing instructor is teaching a group of students about the magnetic resonance imaging (MRI) scan. Which statement made by a student indicates the need for further teaching?

"MRI shows accurate fetal anatomic details of the mother and fetus."

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?

"This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

Which nursing explanation is appropriate to include when preparing a client for a nonstress test?

"You can recline a bit with a slight tilt to the side."

Which test would the nurse anticipate when evaluating the laboratory results for a client who is at 8 weeks of gestation, has a B-negative blood type, and has indirect Coombs results of 1?

Doppler velocimetry

The nurse is caring for a client in the first trimester of pregnancy. The client's laboratory reports indicate a reduction in the levels of pregnancy-associated placental protein (PAPP-A) and an elevation in the levels of human chorionic gonadotropin (hCG) and nuchal translucency (NT). Based on these findings, which condition does the nurse suspect in the fetus?

Down syndrome

Which are appropriate indicators for performing a contraction stress test?

Maternal diabetes mellitus and postmaturity

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including which items?

Maternal serum alpha-fetoprotein (MSAFP) is a screening tool only; it identifies candidates for more definitive procedures.

The nurse knows which parameter is measured to detect neural tube defects in a fetus?

Acetylcholinesterase

The nurse is performing a fetal acoustic stimulation test (FAST) in conjunction with a nonstress test. The nurse observes a nonreactive baseline fetal heart rate (FHR) after 5 minutes. What is the best nursing intervention in this situation?

Activating a stimulator for 3 seconds on the patient's abdomen

After a woman with blood type Rh negative undergoes amniocentesis, what is the most appropriate nursing intervention?

Administer RhoD immunoglobulin.

Which diagnostic test would be used by the health care team to detect anencephaly in the fetus?

Amniocentesis

Which are prenatal tests used for diagnosing fetal defects in pregnancy? Select all that apply.

Amniocentesis Chorionic villus sampling (CVS) Percutaneous umbilical blood sampling (PUBS)

During a prenatal check-up a client who is 7 months pregnant reports that she is able to feel about two kicks in an hour. The nurse refers the client for an ultrasound, and which is the primary reason for this referral?

To check for fetal well-being

The primary health care provider orders a specialized ultrasonography test for a client. Which is the objective of performing the test?

To determine the presence of polyhydramnios