Fetal Assessment for Risk Factors (Exam 3)

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? a) The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. b) The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. c) The BPP is a blood test to detect placental problems. d) The BPP is a screening for neural tube defects.

a) The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

A 40-year-old client is in her 10th week of pregnancy. So far, her pregnancy appears to be healthy, with no abnormal results from standard diagnostic tests. Because of her age, however, the client is a candidate for which diagnostic tests? Select all that apply. a) chorionic villi sampling b) amniocentesis c) nuchal translucency screening d) maternal serum screening

a) chorionic villi sampling b) amniocentesis Chorionic villi sampling (CVS) and amniocentesis are both techniques that may be offered to women who are older than 35 years of age, or to those whose triple/quadruple screen is abnormal, to further screen for genetic disorders. CVS is generally performed 10 to 13 weeks after the LMP. Women of all ages are offered routine sonogram screening (a nuchal translucency scan) and analysis of maternal serum levels of alpha-fetoprotein (MSAFP) by a quadruple screen early in pregnancy to evaluate for neural tube, abdominal wall, or chromosomal disorders in the fetus.

A child with a diagnosis of Down syndrome has had which of the following chromosome abnormalities occur? a) 1 copy of the chromosome 8 has occurred instead of 2 copies. b) 3 copies of trisomy 21 has occurred instead of 2 copies. c) 3 copies of trisomy 18 has occurred instead of 2 copies. d) 3 copies of trisomy 13 has occurred instead of 2 copies.

b) 3 copies of trisomy 21 has occurred instead of 2 copies. A child with Down syndrome has trisomy 21, which means 3 copies of chromosome 21 has occurred instead of 2 copies. If this occurs with chromosome 18, it leads to Edward's syndrome, and if it occurs with chromosome 13, it leads to Patau syndrome.

A pregnant woman is to undergo testing to evaluate for chromosomal abnormalities. Which test would the nurse expect to be done the earliest? a) Amniocentesis b) Chorionic villi sampling c) Triple screen d) Fetal nuchal translucency

b) Chorionic villi sampling Chorionic villi sampling is performed at 7 to 11 weeks' gestation. Amniocentesis usually is performed after 15 weeks' gestation. A triple screen is usually done between 16 and 19 weeks' gestation. Fetal nuchal translucency must be performed between 11 and 14 weeks.

Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client? a) Inform the client that she may feel hot initially. b) Instruct the client to refrain from emptying her bladder. c) Instruct the client to report the occurrence of fever. d) Obtain and record vital signs of the client.

b) Instruct the client to refrain from emptying her bladder. When assessing fetal well-being through abdominal ultrasonography, the nurse should instruct the client to refrain from emptying her bladder. The nurse must ensure that abdominal ultrasonography is conducted on a full bladder and should inform the client that she is likely to feel cold, not hot, initially in the test. The nurse should obtain the client's vital records and instruct the client to report the occurrence of fever when the client has to undergo amniocentesis, not ultrasonography.

A nonstress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which statement by the client indicates understanding of the test results? a) There is no evidence of congenital anomalies or deformities. b) The fetal heart rate increases with activity and indicates fetal well-being. c) The test is nonreactive, which is reassuring. d) The results indicate a contraction stress test is needed for evaluation.

b) The fetal heart rate increases with activity and indicates fetal well-being. A reactive NST for nonstress test is a noninvasive way to monitor fetal well-being. A reactive NST is a positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity and indicating fetal well-being.

The nurse should administer Rho(D) immune globulin to the pregnant woman who is Rho(D)-, after which test? a) CST (contraction stress test) b) amniocentesis c) NST (nonstress test) d) biophysical profile

b) amniocentesis Amniocentesis is an invasive procedure whereby a needle inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with RhD-negative blood, and she should receive RhoGam after the procedure. The CST, NST, and a biophysical profile are noninvasive tests.

Several laboratory tests are performed during the first prenatal visit. What is one of those lab tests? a) basic metabolic panel b) hepatitis screen c) potassium level d) rubeola titer

b) hepatitis screen Other tests screen for the presence of infection. The woman will undergo tests for hepatitis B, HIV, syphilis, gonorrhea, and chlamydia. Each of these infections can cause serious fetal problems unless they are treated.

A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which condition? a) fetal hypoxia b) open spinal defects c) Down syndrome d) maternal hypertension

b) open spinal defects Elevated MSAFP levels are associated with open neural tube defects. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing. MSAFP in conjunction with marker screening tests would be more reliable for detecting Down syndrome. Maternal hypertension would be noted via serial blood pressure monitoring.

A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. What statement would the nurse include when describing this test to the woman? a) "An intravaginal ultrasound measures fluid in the space between the skin and spine." b) "A small amount of amniotic fluid will be withdrawn and collected for analysis." c) "A small piece of tissue from the fetal placenta will be removed and analyzed." d) "A needle will be inserted directly into your fetus's umbilical vessel to collect blood for testing."

c) "A small piece of tissue from the fetal placenta will be removed and analyzed." Percutaneous umbilical cord sampling involves the insertion of a needle into the umbilical vessel. An amniocentesis involves the collection of amniotic fluid from the amniotic sac. Fetal nuchal translucency involves the use of intravaginal ultrasound to measure fluid collected in the subcutaneous space between the skin and cervical spine of the fetus. Chorionic villus sampling involves the removal of a small tissue specimen from the fetal portion of the placenta.

A 38-year-old client has one child with Tay-Sachs disease. She and her partner both carry the Tay-Sachs gene and did not intend to have more children, but she has just discovered that she is pregnant. She plans to have an abortion if tests show that the fetus has the Tay-Sachs gene. Which test will the primary care provider likely prescribe? a) a multiple marker screening test b) amniocentesis c) chorionic villus sampling d) percutaneous umbilical blood sampling

c) chorionic villus sampling CVS is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Given the disease in question, she would be able to determine the course of the pregnancy early in gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood and is not the best source for chromosomal studies.

Which couple would the nurse document as being at highest risk for having a child with a trisomy 21 disorder? a) An African American couple b) An unemployed couple receiving welfare c) A teenage couple with limited prenatal care d) A couple in their late 40s

d) A couple in their late 40s Race and socioeconomic status are not related to increased trisomy disorders. Although lack of prenatal care can contribute, advanced maternal age (older than age 35) introduces the highest risk for a trisomy disorder.

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function? a) Fetal reactivity b) Fetal heart rate c) Fetal breathing record d) Amniotic fluid volume

d) Amniotic fluid volume A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function.

A client's maternal serum alpha-fetoprotein (MSAFP) screening results show that her MSAFP levels are high. What is the best response by the nurse? a) Her child is at risk for Down syndrome. b) Her child is at risk for neural tube defects. c) The test may have been run during the wrong weeks gestation. d) Further test are required based on the results.

d) Further test are required based on the results. Alpha-fetoprotein is a protein manufactured by the fetus. The woman's blood contains small amounts of this protein during pregnancy. The blood test is run between 16 and 20 weeks' gestation; an abnormal level indicates a need for further testing to determine the risks her fetus may face.

A nurse is assigned to care for a pregnant client as she undergoes a nonstress test. Place the steps involved in conducting the nonstress test in the correct order from first to last. All options must be used. 1 External electronic fetal-monitoring device applied. 2 Client placed in left lateral recumbent position. 3 Client consumes a meal. 4 Fetal monitor strip marked for fetal movement 5 Client is handed an event marker.

3, 2, 1, 5, 4 The client who is to undergo a nonstress test should have a meal before the procedure. The client is then placed in a lateral recumbent position to avoid supine hypotension syndrome. An external electronic fetal monitoring device is applied to her abdomen. The client is handed an "event marker" with a button that she pushes every time she perceives fetal movement. When the button is pushed, the fetal monitor strip is marked to identify that fetal movement has occurred.

There are many steps in the process of genetic counseling and testing. Put these steps in the correct chronological order from first to last. All options must be used. 1 physical examination of parents 2 support couple in adjusting to diagnosis 3 amniocentesis 4 assessment of family history 5 nuchal translucency screening 6 explain results of genetic testing

4 assessment of family history 1 physical examination of parents 5 nuchal translucency screening 3 amniocentesis 6 explain results of genetic testing 2 support couple in adjusting to diagnosis

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus? a) rubella b) hepatitis A and B c) measles d) diphtheria, tetanus, and pertussis

a) rubella Maternal exposure to rubella during pregnancy poses a particular fetal risk that supersedes the significance of hepatitis, measles, diphtheria, tetanus, or pertussis.

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: a) variable decelerations. b) fetal tachycardia. c) a nonreactive pattern. d) reactive pattern.

d) reactive pattern. A reactive nonstress test indicates fetal activity, as evidenced by acceleration of the fetal heart rate by at least 15 bpm for at least 15 seconds within a 20-minute recording period. If this does not occur, the test is considered nonreactive. An increase in the fetal heart rate does not indicate variable decelerations. Fetal tachycardia would be noted as a heart rate greater than 160 bpm.

The nurse is caring for a couple who is having a triple screen done. The nurse would least likely expect what level to be tested? a) α-Fetoprotein b) Human chorionic gonadotropin c) Unconjugated estriol d) Testosterone

d) Testosterone A triple screen tests α-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3). Testosterone is not included.

A woman and her partner present at her first antenatal obstetrics appointment. She is 6 weeks pregnant. Her blood tests show that she is Rh negative, although she has not previously known this. She has no other children but suspects that she miscarried early in a pregnancy 2 years before. She felt fine afterward, so she never received medical attention for that suspected episode. Her partner reports that he is also Rh negative. What action will the nurse be likely to take? a) If an antibody screen is negative, the nurse will administer Rho(D) immune globulin to the client. b) If an antibody screen is positive, the nurse will administer RhoGAM to the client. c) The nurse will arrange for an amniocentesis to assess hemolytic disease in the fetus. d) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the client and the child are not a concern at this time.

d) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the client and the child are not a concern at this time. If the woman is Rh negative and her partner is Rh negative, the fetus will also be Rh negative, and the woman will not require treatment with Rho(D) immune globulin. Therefore, the remaining options are incorrect.

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? a) hemoglobin and hematocrit b) urine for culture c) fetal ultrasound d) fundal height measurement

d) fundal height measurement On every follow-up visit, fundal height measurements are performed to evaluate fetal growth and gestation. Hemoglobin and hematocrit, as part of a complete blood count, would be done on the initial visit and then repeated if the woman's status indicates a need for doing so. Urine is checked for protein, glucose, ketones, and nitrites. A culture would be done if there are signs and symptoms of an infection. Fetal ultrasound can be done at any time during the prenatal period, but it is not done at every visit.