Durham, Chapter 6: Antepartal Tests

The nurse is performing an NST along with a biophysical profile scoring (BPP) on a patient at 39 weeks gestation. The nurse determines the fetus has a nonreactive NST. The fetus has trunk or limb movement two times; is noted to be opening and closing hands; has a 45-second breathing episode; and has two 2-cm pockets of amniotic fluid. The nurse should assign a BPP score of ____________________/10.

6 Feedback: The nurse assigns 2 points for tone, breathing, and amniotic fluid. Zero points are assigned for motion and NST results. The total score is 6/10

The nurse is providing care for a 45-year-old patient who has just learned she is in the second trimester of pregnancy. The patient thought she was experiencing manifestations of menopause until she recognized fetal movement. Which diagnostic test does the nurse expect to be prescribed for this patient? 1. Amniocentesis 2. Ultrasonography 3. Daily fetal movement count 4. Chorionic villi sampling

ANS 1 Feedback 1 This is correct. Due to the age of the patient and the period of gestation, the nurse expects amniocentesis to be performed. The test is appropriate between 15 and 20 weeks of gestation and for detection of genetic disorders in mothers older than age 35 years. 2 This is incorrect. Ultrasonography is considered both a screening and diagnostic test; however, because of the patient's age, a test for genetic disorders is expected by the nurse. This test does not specifically identify genetic issues. 3 This is incorrect. A daily fetal movement count is a screening test to monitor for fetal well-being. This screening does not address concerns caused by maternal age. 4 This is incorrect. Chorionic villa sampling is a diagnostic test used for chromosomal analysis between 10 and 12 weeks gestation to detect fetal abnormalities caused by genetic disorders. The patient is past this time parameter.

An adolescent patient who is 15 weeks pregnant refuses to have an alpha-fetoprotein test performed because, "I don't like needles." Which initial approach does the nurse take to achieve the testing? 1. Insist that testing will be done with or without her cooperation. 2. Explain the testing is important in detecting serious birth defects. 3. Ask an accompanying parent to help persuade the patient. 4. Notify the health care provider of the patient's refusal.

ANS 2 Feedback 1 This is incorrect. Insisting the testing will be done with or without the patient's cooperation is inappropriate and exemplifies disregard for the patient's rights to refuse medical care. 2 This is correct. The initial approach for the nurse to take is to appeal to the patient about the importance of ensuring that her baby is healthy. 3 This is incorrect. When an adolescent patient is pregnant, she becomes independent and able to make her own decisions. Asking the parent to intervene is not appropriate and may not be effective. 4 This is incorrect. The nurse's second action will be to notify the health care provider that the patient is refusing the test. As always, the event needs to be documented.

A patient is scheduled for a contraction stress test (CST) at 36 weeks gestation. The nurse is aware that a successful testing is dependent on which factor? 1. Whether Braxton-Hicks contractions are occurring 2. Whether uterine contractions can be stimulated 3. If the mother is not overly tired or anxious 4. If the fetus is in an awake cycle and active

ANS 2 Feedback 1 This is incorrect. The success of a CST is not dependent on the presence of Braxton-Hicks contractions at the time of the testing. 2 This is correct. The success of a CST is dependent on the ability to stimulate uterine contractions. Contractions can be stimulated with careful administration of IV oxytocin or by having the mother brush her nipples for 10 minutes. 3 This is incorrect. The success of a CST is not affected if the mother is overly tired or anxious. 4 This is incorrect. The success of a CST is not dependent on the fetus being awake and active.

A patient who is at 30 weeks gestation is involved in a car crash. The nurse recognizes that which initial testing will be used to assess fetal well-being? 1. Ultrasonography 2. Nonstress testing 3. Contraction stress test 4. Fetal movement counting

ANS 2 Feedback 1 This is incorrect. Ultrasonography is useful for assessing the uterine and fetal structures; however, this test does not specifically indicate fetal well-being. 2 This is correct. Initially, nonstress testing is used to monitor fetal heart rate patterns and accelerations as an indication of fetal well-being. The heart rate of a physiologically normal fetus with adequate oxygenation and an intact autonomic nervous system accelerates in response to movement. This test is the most widely accepted method to assess fetal well-being after maternal trauma, among other conditions. 3 This is incorrect. A contraction stress test is used to ascertain fetal well-being in response to uterine contractions. This testing is primarily used at term pregnancy if the mother has a nonreactive NST. 4 This is incorrect. Fetal movement counting is a procedure used to routinely check for fetal well-being by measuring fetal movement in a specific time frame. This test is for general well-being and does not monitor fetal heart rate, which may be compromised due to trauma.

The nurse is providing pre-amniocentesis teaching for a patient who is at 18 weeks gestation. Which information does the nurse provide? Select all that apply. 1. Positioning on the left side will avoid injury to the fetus. 2. A full bladder will assist in ultrasound visualization. 3. Discomfort will be minimized with a local anesthetic. 4. Avoid lifting heavy objects for a period of 2 weeks. 5. Abdominal cramping and bleeding is normal for 24 hours.

ANS 2, 3 Feedback 1 This is incorrect. Injury to the fetus and placenta is avoided through the use of ultrasonography during needle insertion. Placing the patient on her left side is not sufficient. 2 This is correct. Because the patient is less than 20 weeks gestation, a full bladder will assist with ultrasound visualization. 3 This is correct. To minimize discomfort as the needle is inserted, the patient will receive local anesthesia. 4 This is incorrect. The nurse will instruct the patient to avoid heavy lifting for a period of 2 days following the procedure. 5 This is incorrect. The nurse teaches the patient to report abdominal pain or cramping, fluid leakage, bleeding, decrease in fetal movement, fever, or chills to the HCP. The listed manifestations are not expected or normal

A patient is scheduled for transvaginal ultrasound testing. Which preparation by the nurse is appropriate? 1. Place the patient supine with a pillow beneath her head. 2. Explain that pain at 4 or less on a 0 to10 scale is expected. 3. Ascertain whether the patient has a latex or banana allergy. 4. Request that the patient's partner leave the testing room.

ANS 3 Feedback 1 This is incorrect. For a transvaginal ultrasound, the patient must be in a lithotomy position in order to insert the probe into the vagina. A pillow beneath the patient's head is appropriate. 2 This is incorrect. The nurse should tell the patient that she may feel some pressure when the ultrasound probe is inserted into the vagina, but pain is not expected. 3 This is correct. Because the transvaginal ultrasound probe is covered by a latex sheath, the nurse needs to ascertain whether the patient has a latex allergy or has exhibited an allergic response to specific foods such as bananas. 4 This is incorrect. Unless it is the patient's wish, there is no need for the nurse to ask the patient's partner to leave the testing room

A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety? 1. "Multiple screening tests are ordered for every pregnancy." 2. "It is better to identify problems before birth than afterward." 3. "Screening tests are primarily to identify those without disease or abnormality." 4. "Diagnostic testing is a reason for worry because they indicate fetal problems."

ANS 3 Feedback 1 This is incorrect. Telling the patient multiple screening tests are ordered for every pregnancy may reduce the patient's anxiety, but it is not totally true. Nurses need to be truthful. 2 This is incorrect. Telling the patient that it is better to identify problems before birth than afterward will not reduce the patient's anxiety. The nurse's comment is not therapeutic or sensitive. 3 This is correct. The truthful statement that screening tests are primarily to identify those without disease or abnormality will alleviate the patient's anxiety. 4 This is incorrect. Telling the patient diagnostic testing is a reason for worry because they indicate fetal problems may alleviate the patient's anxiety over screening tests, but it is not necessarily truthful. The patient's anxiety will be worse if additional screening or diagnostic testing is needed.

The nurse is assessing a patient who just received confirmation of pregnancy. While collecting information about the patient's medical history, which information alerts the nurse to biophysical risk factors? Select all that apply. 1. The patient is primip who is 38 years of age. 2. The patient smokes two packs of cigarettes weekly. 3. The patient has been a strict vegetarian for 25 years. 4. The patient works as a nuclear medicine technician. 5. The patient is medically treated for rheumatoid arthritis

ANS 3, 5 Feedback 1 This is incorrect. Age and parity are sociodemographic factors that place this patient and/or her fetus at risk for adverse outcomes. 2 This is incorrect. Smoking is a psychosocial factor that places this patient and/or her fetus at risk for adverse outcomes. 3 This is correct. Nutritional practices are a biological factor that can place this patient and/or her fetus at risk for adverse outcomes. Special considerations are needed to make sure iron and protein requirements are met. 4 This is incorrect. Environmental factors can place this patient and/or her fetus at risk for adverse outcomes. Risk factors include exposure to chemicals, radiation, and pollutants. 5 This is correct. A patient with a diagnosis of rheumatoid arthritis who is medically treated has biological factors that place this patient and/or her fetus at risk for adverse outcomes.

The ____________________ in conjunction with NST is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia.

amniotic fluid index Feedback: The amniotic fluid level is based on fetal urine production, which is the predominate source of amniotic fluid and is directly dependent on renal perfusion. In prolonged fetal hypoxemia, blood is shunted away from fetal kidneys to other vital organs. Persistent decreased blood flow to the fetal kidneys results in reduction of amniotic fluid production and oligohydramnios. The volume of amniotic fluid is measured using ultrasound.

The nurse is aware that some ____________________ tests, such as multiple marker screening and ultrasound, are offered to all pregnant women.

screening Feedback: The nurse is aware that some screening tests are offered to all pregnant women. Screening tests such as multiple marker screening and ultrasound are performed to identify those who are not affected by a disease or abnormality, and can be referred to as a "rule out" process. Abnormal results on a screening test will warrant diagnostic testing.

A patient who is at 20 weeks gestation is being prepared for an MRI after a nonconclusive ultrasound testing for suspected brain abnormality related to possible zika virus exposure. Which nursing actions are appropriate for this patient? Select all that apply. 1. Provide information regarding the test. 2. Allow patient to express feelings about her high-risk pregnancy. 3. Promote open communication with her primary health care providers. 4. Encourage patient to think about resolutions for negative testing. 5. Provide psychological support to the patient and her partner.

ANS 1, 2, 3, 5 Feedback 1 This is correct. A nursing responsibility related to antenatal testing is to inform the patient of what to expect during the testing. 2 This is correct. A nursing responsibility related to antenatal testing because of a high-risk pregnancy is to provide the patient and her partner with psychological support. The patient is likely to be anxious and should be allowed to express feelings. 3 This is correct. A nursing responsibility related to antenatal testing is always to promote open communication with the patient's primary health care providers. This nursing action is especially important in the event of a high-risk pregnancy. 4 This is incorrect. In this scenario, the nurse needs to refrain from encouraging the patient from thinking of resolutions if the MRI test results indicate manifestations of zika virus. The nurse needs to encourage the patient to make informed decisions when all factors are available. 5 This is correct. All antenatal testing related to high-risk factors causes anxiety and distress; the nurse needs to provide psychological support

A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule? 1. Doppler flow studies 2. Nonstress testing 3. Magnetic resonance imaging 4. Ultrasonography studies

ANS 4 Feedback 1 This is incorrect. Doppler flow studies are performed to evaluate placental profusion. The study does not validate placental placement. 2 This is incorrect. Nonstress testing is used to determine fetal well-being and measures cardiac function during fetal movement or contractions. 3 This is incorrect. Magnetic resonance imaging (MRI) is performed to obtain detailed imaging when screening tests indicate possible abnormalities. It is most commonly performed for suspected brain abnormality. 4 This is incorrect. Ultrasonography studies are appropriate in determining placental placement and possible abnormalities.

A patient in the second trimester of pregnancy is scheduled for a Doppler flow study because the health care provider (HCP) is concerned about an assessment finding during a routine prenatal visit. Which finding of concern does the nurse suspect? 1. Fetal movement count is less than 8 per hour. 2. Patient shows no weight gain in 2 weeks. 3. Patient exhibits mild lower extremity edema. 4. Fetal growth is below expectation for gestational age.

ANS 4 Feedback 1 This is incorrect. Fetal count of less than 8 per hour is not a concern that would prompt a Doppler flow study. Four fetal kicks in 1 hour is considered reassuring. 2 This is incorrect. There are many variables that can cause a patient not to gain weight in a 2-week period: preexisting obesity or patient actions to maintain a normal weight gain. This finding would not cause the HCP to order a Doppler flow study. 3 This is incorrect. Mild lower extremity edema is not a concern; the patient needs to elevate legs periodically during the day. This finding does not warrant a Doppler flow study. 4 This is correct. A Doppler flow study is used in combination with other diagnostic tests to assess fetal status when fetal growth is below the expectation for gestational age (IUGR). Evaluating fetal circulation and uteroplacental blood flow with Doppler flow provides critical information regarding fetal reserves and adaptation.

The nurse is assisting a patient who is pregnant to prepare for an MRI scheduled to assess fetal brain development. Which situation causes the nurse to notify the radiology department personnel? 1. The patient had breakfast before the test. 2. The patient reports having an iodine allergy. 3. The patient expresses concern about pain. 4. The patient has a permanent body piercing.

ANS 4 Feedback 1 This is incorrect. Patients do not need to be NPO prior to MRI testing. This is not a reason for the nurse to notify the radiology department. 2 This is incorrect. An MRI can be performed without the injection of iodinated contrast. The patient's allergy to iodine is not a reason for the nurse to notify the radiology department. 3 This is incorrect. Pain is not associated with MRI testing. There is no reason to notify the radiology department; however, the nurse needs to provide patient teaching. 4 This is correct. Part of the preparation for an MRI is to have the patient remove all metallic objects before the testing. The fact that the patient has a permanent body piercing will present a problem. The nurse needs to notify the radiology department for the situation

____________________ stimulation may be effective in eliciting a change in fetal behavior, fetal startle movements, and increased FHR variability.

Vibroacoustic Feedback: Vibroacoustic stimulation (VAS) is a screening tool that uses auditory stimulation (with an artificial larynx) to assess fetal well-being with EFM when NST is nonreactive. VAS is only used when the baseline rate is determined to be within normal limits. When deceleration or bradycardia is present, VAS is not an appropriate intervention

A patient in the third trimester of pregnancy is instructed on how to perform daily fetal movement count. The nurse needs to inform the patient what to do if fetal movement is decreased. Which patient actions are appropriately recommended by the nurse? Select all that apply. 1. Eat something. 2. Recount movements the next morning. 3. Arrange for a period of rest. 4. Focus on movement for 1 hour. 5. Exercise or take a walk.

ANS 1, 3, 4 Feedback 1 This is correct. If the fetal movement is decreased from previous counts, the nurse should instruct the patient to eat something, which may stimulate the fetus. 2 This is incorrect. Fetal movement is an indicator of fetal well-being. If the patient notices a decrease in fetal movement, measures need to be taken to stimulate and/or reassess movement. Persistent decreased movement or lack of movement needs to be reported immediately to the HCP. 3 This is correct. If the fetal movement is decreased from previous counts the nurse should instruct the patient to arrange for a period of rest. If the patient is busy or distracted, the fetal movements may not be noticed. 4 This is correct. If the fetal movement is decreased from previous counts the nurse should instruct the patient to focus on fetal movement for a period of 1 hour. Four movements in an hour is reassuring 5 This is incorrect. If the fetal movement is decreased from previous counts, the nurse should instruct the patient to rest, not exercise or take a walk

The nurse is reviewing the purpose of a modified BPP for a patient at 38 weeks gestation. The nurse recognizes which determinations can be made through a modified BPP regarding fetal well-being? Select all that apply. 1. The NST is an indicator of short-term fetal well-being. 2. The test is normal if NST is considered to be nonreactive. 3. The test is considered most predictive for perinatal outcomes. 4. The AFI is an indicator of long-term placental function. 5. An AFI of 5 cm is indicative of fetal asphyxia.

ANS 1, 3, 4, 5 Feedback 1 This is correct. The nurse recognizes the NST indicates short-term fetal well-being. 2 This is incorrect. The nurse recognizes that modified BPP is considered normal if the NST is noted to be reactive, not nonreactive. 3 This is correct. The nurse recognizes a modified BPP is considered to be the most predictive testing for perinatal outcomes; the test measures the two most sensitive indicators (NST and AFI) for fetal well-being. 4 This is correct. The nurse is aware a modified BPP uses the AFI to determine the long-term functionality of the placenta. 5 This is correct. The nurse understands oligohydramnios is associated with increased perinatal mortality, and decreased amniotic fluid may reflect acute or chronic fetal asphyxia. The finding is related to a decrease in renal output as blood is shifted away from the kidneys to other more vital organs in response to asphyxia. Normal AFI is greater than 5 cm

An Eastern European Jewish couple had two children who died from Tay-Sachs disease. The couple is currently pregnant and have asked for genetic confirmation about this fetus with the intention of early termination if the fetus tests positively. For which reason does the nurse expect chorionic villa sampling to be prescribed? 1. The test is performed as early as 10 weeks gestation. 2. Risks to the fetus and mother are less than other tests. 3. A positive result allows termination during the test. 4. This is the only testing that is disease specific.

ANS 1 Feedback 1 This is correct. Chorionic villa testing can be performed as early as 10 weeks gestation. Given the reproductive history of the couple and their expectations, this is the test the nurse should expect to be prescribed. 2 This is incorrect. The risks are higher for chorionic villa testing than for amniocentesis; there is a 7% fetal loss related to bleeding, infection, and rupture of membranes. However, amniocentesis is not performed until at least 15 weeks gestation. 3 This is incorrect. Results of chromosomal studies from a chorionic villa testing are available within 1 week. It is not possible to perform a termination during the initial testing. 4 This is incorrect. Chorionic villa testing is not specific to Tay-Sachs disease; detailed information is provided on any specific chromosomal abnormality detected. The testing is effective in detecting DNA or metabolic disorders.

A patient is in her first trimester of her second pregnancy. The patient's first child was born with a trisomy 21 defect. The patient is requesting testing to determine whether the current fetus has the same defect. Which initial testing does the nurse expect the HCP to prescribe? 1. Fetal ultrasound 2. Magnetic resonance imaging 3. Chorionic villa sampling 4. Amniocentesis

ANS 1 Feedback 1 This is correct. Fetal ultrasound in the first trimester of pregnancy can be performed for nuchal translucency, which measures the midsagittal plane with the neck of the fetus to assess the amount of fluid behind the neck. An elevated measurement is associated with trisomy 21. This is the initial test the nurse can expect; results may require further diagnostic testing. 2 This is incorrect. Magnetic resonance imaging (MRI) is primarily done to identify issues with brain development abnormalities. Trisomy 21 cannot specifically be detected with this test. 3 This is incorrect. Chronic villa sampling may be considered if the nuchal translucency test indicates a possibility of trisomy 21. This test is invasive and carries a 7% chance of interrupting the pregnancy; therefore, other initial screening is expected. 4 This is incorrect. Amniocentesis performed in the second trimester is effective in diagnosing genetic disorders. However, the test is invasive and involves some risk to the pregnancy. Initially, the screening test for nuchal translucency is expected.