OB Exam 3 Ch 26
What are some common maternal and fetal indications for antepartum testing? Select all that apply.
Preeclampsia Correct 3 Previous stillbirth Correct 4 Fetal growth restriction Premature rupture of membranes
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 fetal movement count helps monitor the condition of the fetus. If the fetal movements are less than 3 in one hour, it indicates a risk of abnormality. Therefore, less than 10 fetal movements in an hour may not be abnormal and the client may not need to consult the obstetrician. The client should count fetal kicks at least once a day for a period of 60 minutes because it helps to assess fetal activity. Fetal movements are usually not present during the fetal sleep cycle. The client can count the fetal kicks either after meals or before bedtime when fetal movements are typically highest.
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. 1 After 20 minutes, a nonreactive reading indicates the test is complete. 2 Vibroacoustic stimulation may be used during the test. 3 Drinking orange juice before the test is appropriate. 4 A needle biopsy may be needed to stimulate contractions. 5 Two sensors are placed on the abdomen to measure contractions and fetal heart tones.
-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. 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. 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. A needle biopsy is not part of an 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.
What is the normal range of amniotic fluid index? 1 1 to 5 cm 2 10 to 25 cm 3 25 to 40 cm 4 40 to 65 cm
10 to 25 cm Amniotic fluid index is a biophysical profile that helps to estimate the amitotic fluid volume and fetal wellbeing. An amniotic fluid index of 10 to 25 cm is a normal finding. An amniotic fluid value of 1 to 5 cm is indicative of oligohydramnios. An amniotic fluid index of greater than 25 cm is indicative of polyhydramnios. Therefore, 25 to 40 cm or 40 to 65 cm is not a normal range of amniotic fluid index.
When can the systolic/diastolic ratio be first detected in the fetus?
15th week The first systolic/diastolic ratio can be determined at 15 weeks of pregnancy, because the resistance to the blood flow in the umbilical and uterine arteries is high. The heart is not well developed during the 2nd week of pregnancy, so the systolic/diastolic ratio cannot be determined. As the pregnancy progresses the resistance to the blood flow decreases in the umbilical and uterine arteries. Therefore, the systolic/diastolic ratio decreases as the pregnancy progresses and cannot be determined during the 24th and 32nd weeks of pregnancy.
When can the systolic/diastolic ratio be first detected in the fetus? 1 2nd week of pregnancy 2 15th week of pregnancy 3 24th week of pregnancy 4 32nd week of pregnancy
15th week of pregnancy The first systolic/diastolic ratio can be determined at 15 weeks of pregnancy, because the resistance to the blood flow in the umbilical and uterine arteries is high. The heart is not well developed during the 2nd week of pregnancy, so the systolic/diastolic ratio cannot be determined. As the pregnancy progresses the resistance to the blood flow decreases in the umbilical and uterine arteries. Therefore, the systolic/diastolic ratio decreases as the pregnancy progresses and cannot be determined during the 24th and 32nd weeks of pregnancy.
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? 1 Performing the test after an interval of 2 hours 2 Performing a contraction stress test immediately 3 Administering 0.5 milliunits/min oxytocin for 20 minutes 4 Activating a stimulator for 3 seconds on the patient's abdomen
Activating a stimulator for 3 seconds on the patient's abdomen If the nurse observes a nonreactive baseline FHR, then the sound source, a laryngeal stimulator, should be activated for 3 seconds on the maternal abdomen over the fetal head. Performing the test after 2 hours would not help acquire the required test results. If the FAST test result is nonreactive, the same test is performed again a total of three times. If the test is nonreactive for all three attempts, then the contraction stress test is performed; 0.5 milliunits/minute oxytocin for 20 minutes is administered by the nurse while performing the oxytocin-stimulated contraction test.
Which are prenatal tests used for diagnosing fetal defects in pregnancy? Select all that apply.
Amniocentesis, PUBS, and CVS are prenatal tests used for diagnosing fetal defects in pregnancy. Polyhydramnios is increased amniotic fluid. AFI is a method in which the vertical depths (in centimeters) of the largest pocket of amniotic fluid in all four quadrants surrounding the maternal umbilicus are totaled. DFMC, the kick count, is frequently used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation.
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. How does the nurse prepare the client for the test?
Assist the client into a lithotomy position during the test. An ectopic pregnancy is detected using transvaginal ultrasonography. The client should be placed in a lithotomy position, because this position enables the primary health care provider to conduct the test with ease and provides comfort to the client. If abdominal and not transvaginal ultrasonography is being performed, then the client would be instructed to avoid voiding. Transvaginal ultrasonography does not cause pain; the client would only feel a slight pressure due to insertion of the probe. The client 's head and knees are elevated using pillows while performing abdominal ultrasonography. While performing transvaginal ultrasonography, the nurse should place a pillow to elevate the client 's pelvis.
When would the best timeframe to establish gestational age based on ultrasonography? 1 At term 2 8 weeks 3 Between 14 and 22 weeks of gestation 4 36 weeks
Between 14 and 22 weeks of gestation is the period of time in which US is the most reliable in determining gestational age. It is less reliable after that period because of variability in fetal size. A standard set of measurements relative to gestational age is noted from around 10 to after 12 weeks, and includes crown-rump length (after 10 weeks), biparietal diameter (after 12 weeks), femur length, head and abdominal circumference.
The nurse is helping a pregnant client monitor the daily fetal movement. Which finding should be reported to the primary health care provider? 1 Fetal movement was not detected for 12 hours. 2 An episode of limb straightening was observed. 3 One episode of fetal breathing was seen in 30 minutes. 4 An amniotic fluid index value of more than 5 cm.
Fetal movement was not detected for 12 hours. The presence of fetal movements is a reassuring sign of fetal health. If fetal movements are not felt by the mother for 12 hours, then it is reported as the fetal alarm signal. Limb straightening, breathing movement, and amniotic fluid index do not indicate the fetal alarm signal. One episode of limb straightening is also a normal finding. One episode of fetal breathing movement seen in 30 minutes is a normal finding. An amniotic fluid index greater than 5 cm is a normal finding.
The nurse is caring for a pregnant client who is scheduled for cordocentesis. What could be the consequences of the test on the fetus? 1 Destruction of red blood cells 2 Fetal hyperbilirubinemia 3 Fetomaternal hemorrhage 4 Deformity of extremities
Fetomaternal hemorrhage Cordocentesis is an invasive procedure also known as percutaneous umbilical blood sampling (PUBS). In this procedure, the fetal umbilical vessel is punctured. Therefore, there is a direct risk of fetomaternal hemorrhage. Fetal anemia is diagnosed using cordocentesis; it does not cause destruction of red blood cells. The test may not cause hyperbilirubinemia as there is no destruction of the red blood cells. Deformity of extremities is caused by certain medications like thalidomide (Thalomid). It is not caused by cordocentesis.
A nurse providing care for the antepartum woman should understand what about the contraction stress test (CST)? 1 Sometimes uses vibroacoustic stimulation 2 Is an invasive test; however, contractions are stimulated 3 Is considered negative if no late decelerations are observed with the contractions 4 Is more effective than nonstress test (NST) if the membranes have already been ruptured
Is considered negative if no late decelerations are observed with the contractions No late decelerations indicate a positive CST. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. CST is contraindicated if the membranes have ruptured.
What is the primary test performed to determine fetal lung maturity?
Lamellar body count (LBC) Lamellar bodies are surfactant-containing particles secreted by type II pneumocytes. Therefore, lamellar body count (LBC) is used to determine fetal lung maturity. TDx FLM assay is no longer available in United Sates as a primary test for determining fetal lung maturity. Amniocentesis is used as a secondary test if simpler and less expensive processes indicate lung immaturity. Doppler velocimetry is used to assess fetal blood supply.
Which risk is a fetus subject to if chorionic villus sampling (CVS) is conducted in the 7th week of gestation? 1 Reduced heart rate 2 Limb reduction defects 3 Decreased lung maturity 4 Neural tube defect
Limb reduction defects Chorionic villus sampling (CVS) can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. Studies indicate that the fetus may be at increased risk for limb reduction defects when the test is performed before the ninth completed week of gestation. Ultrasonography is used to monitor the fetal heart rate. CVS does not affect the fetal heart rate. Fetal lung maturity is detected by amniocentesis. CVS does not impair fetal lung maturity. Neural tube defects are caused by improper folic acid supply to the fetus. CVS does not cause neural tube defects.
On reviewing the results of the Doppler umbilical flow analysis of a pregnant client, the nurse finds that the client has an elevated S/D ratio. Which does this finding signify in the client? 1 Trisomy 13 2 Potter syndrome 3 Down syndrome 4 Lupus erythematosus
Lupus erythematosus Lupus erythematosus is an autoimmune disorder that affects different body systems. An elevated S/D ratio indicates a poorly perfused placenta, which may be due lupus erythematosus. An elevated S/D ratio is not indicative of trisomy 13, which is a chromosomal abnormality. Potter syndrome is an atypical physical appearance of the fetus. Oligohydramnios may result in Potter syndrome, but an elevated S/D ratio is not indicative of Potter syndrome. Down syndrome is a chromosomal abnormality. An elevated S/D ratio does not indicate Down syndrome.
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? 1 "The client should stay completely still during the scan." 2 "MRI shows accurate fetal anatomic details." 3 "MRI provides both a biophysical and a biochemical profile of the mother and fetus." 4 "The patient will not be exposed to any ionizing radiation or injected iodine dye during the scan."
MRI shows accurate fetal anatomic details MRI takes 20 to 60 minutes, depending on the reason for study. Accurate anatomic details would not be obtained, because there is a possibility of fetal movement. Theclient should be completely still during the procedure, with short breaks, because physical movement would alter the effectiveness of the scan. MRI helps evaluate the fetal structure, overall growth, biochemical status, and the placenta. MRI is a noninvasive procedure. Unlike with a computed tomography (CT) scan, iodine dye would not be injected, and MRI does not use ionizing radiation.
What is an appropriate indicator for performing a contraction stress test?
Maternal diabetes mellitus and postmaturity Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Although adolescent pregnancy and poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; history of a previous stillbirth, not preterm labor, is another indicator.
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including what? 1 Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. 2 Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. 3 Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. 4 Maternal serum alpha-fetoprotein (MSAFP) is a screening tool only; it identifies candidates for more definitive procedures.
Maternal serum alpha-fetoprotein (MSAFP) is a screening tool only; it identifies candidates for more definitive procedures. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, and 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.
The nurse is reviewing the amniocentesis reports of a client who has completed 20 weeks of pregnancy. The reports reveal the presence of high alpha-fetoprotein (AFP) levels. What can the nurse infer from this information related to the clinical condition of the fetus? 1 Cardiac disorder. 2 Neurologic disorder. 3 Circulatory disorder. 4 Pulmonary disorder
Neurologic disorder High AFP levels after 15 weeks of gestation indicate an open neural tube or other disorders relating to the central nervous system. AFP levels in amniotic fluid cannot test cardiac disorders. Doppler blood flow analysis can be used to assess circulatory disorders in the fetus. The lecithin/sphingomyelin [L/S] ratio of the amniotic fluid is a useful predictor of pulmonary disorders in the fetus.
A client has undergone an amniocentesis for evaluation of fetal well-being. Which intervention 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 client should be observed postprocedure for possible onset of uterine contractions. A client who is Rh negative will require a Rhogam injection postprocedure. Ultrasound is used prior to the procedure as a visualization aid to assist with insertion of the transabdominal needle. There is no need to perform a minicatherization to obtain a urine specimen to assess for bleeding, because this is not considered a typical presentation or complication. Vitamin K is not administered and is not associated with infection risk, but with clotting.
The nurse is supervising a student nurse while performing a non-stress test. Which action of the student nurse indicates the need for further teaching? 1 Placing the client in the left side-lying position 2 Instructing the client to press the handheld marker 3 Offering glucose water prior to the test 4 Applying a tocodynamometer with Doppler transducer
Placing the client in the left side-lying position The client should be assisted to a semi-Fowler position with a slight tilt to prevent supine-hypotension. In order to assess the number of fetal movements, the nurse should instruct the client to press the handheld event marker whenever a fetal movement is experienced. Glucose water or orange juice may be is offered to increase fetal activity, if there is no fetal movements after 20 minutes. A tocodynamometer is applied with Doppler transducer to monitor fetal movement or detect uterine contraction
Which condition is associated with oligohydramnios?
Potter syndrome Oligohydramnios is characterized by the presence of amniotic fluid volume of less than 5 cm. It is associated with an absence of fluid pockets in the uterine cavity, and may cause Potter syndrome. Fetal hydrops, neural tube defects, and fetal gastrointestinal obstruction are associated with polyhydramnios due to the presence of large pockets of fluids.
A client has elevated nuchal translucency and low maternal serum marker levels. Which abnormality would be likely in the client's newborn? 1 Pyelectasis 2 Oligohydramnios 3 Neural tube defect 4 Fetal cardiac disease
Pyelectasis is the enlargement of the renal pelvis and is considered a "soft marker" for Down syndrome. Elevated nuchal translucency and low maternal serum marker levels are indicative of pyelectasis. Oligohydramnios is a decrease in amniotic fluid. Elevated nuchal translucency and low maternal serum marker levels do not indicate oligohydramnios. Neural tube defects may be caused by reduced folic acid availability; they cannot be identified by elevated nuchal translucency and low maternal serum marker levels. Elevated nuchal translucency alone indicates an increased risk of fetal cardiac disease and chromosomal abnormalities.
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 The quad-screen is performed in the second trimester using four different serum markers: maternal serum alpha-fetoprotein (MSAFP), unconjugated estriol, human chorionic gonadotropin (hCG), and inhibin A. Low levels of MSAFP, unconjugated estriol, and inhibin A, and high levels of hCG, indicate Down syndrome. The triple-marker screen is similar to the quad-screen but does not include assessment of inhibin A. The triple-marker screen is performed at 16 to 18 weeks of gestation and consists of three maternal serum markers: MSAFP, unconjugated estriol, and hCG. The fetal nasal bone is assessed in the first trimester of pregnancy. Nuchal translucency would be used in combination with different serum markers to identify Down syndrome. Nuchal translucency is measured in the first trimester of pregnancy. Pregnancy-associated placental protein (PAPP-A) is measured in the first trimester of pregnancy to detect Down syndrome.
The nurse is caring for a client who has undergone a contraction stress test. The test results were found to be equivocal. What intervention should the nurse perform based on the test results? 1 Perform a non-stress test 2 Repeat the contraction stress test next day 3 Resume the weekly testing schedule 4 Prepare to admit the client
Repeat the contraction stress test next day If the results of contraction stress test are equivocal, it indicates decelerations that occur in the presence of contractions are more frequent than every 2 minutes. Therefore, the primary health care provider would ask the nurse to repeat the test the next day. The contraction stress test is prescribed after a non-stress test if the test results are nonreactive. If the contraction stress test is negative, then the primary health care provider would ask the client to resume the weekly testing schedule. If the contraction stress test is positive, then the primary health care provider would instruct the nurse to admit the client to the hospital.
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. Which instruction would the nurse expect to receive from the primary health care provider? 1 "Repeat the test in the client the next day." 2 "Administer intravenous fluids to the client." 3 "Immediately admit the client to the hospital." 4 "Resume a routine weekly testing schedule for the client."
Resume a routine weekly testing schedule for the client." A contraction stress test helps determine fetal heart rate during uterine contraction. If the client has three uterine contractions within 10 minutes, with no significant deceleration, it indicates normal or negative results and the fetus is doing well. Therefore, the primary health care provider would resume a routine weekly testing schedule for the client. If three contractions are not produced within 10 minutes and no fetal heart rate is heard, then the test will be repeated the next day. Presence of uterine contractions is a normal finding, and it does not indicate risk of dehydration. Therefore, the primary health care provider will not instruct the nurse to administer intravenous fluids to the client. If the client has late decelerations with 50% or more of contractions, then the primary health care provider would instruct the nurse to admit the client for further evaluation.
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). Which type of ultrasound helps detect VSD? 1 Limited examination 2 Nonmedical examination 3 Standard or basic examination 4 Specialized or targeted examination
Specialized or targeted examination Specialized or targeted examinations are performed if a client is suspected to be carrying an anatomically or physiologically abnormal fetus. AVSD is an anatomic defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. Therefore, a specialized or targeted ultrasound examination of the heart is performed to detect a VSD. A limited ultrasound examination is performed to determine the fetal position during delivery. A nonmedical examination is used to obtain 3D pictures of the fetus. However, these examinations may have associated risk and should be used with discretion. A standard or basic examination helps determine the fetal heart rate and position and the amniotic fluid volume in the client.
On reviewing the medical history of a pregnant client, the nurse finds that the client is taking carbamazepine (Tegretol). What consequence of the drug on the fetus should the nurse be aware of? 1 Pyelectasis 2 Spina bifida 3 Omphalocele 4 Lupus erythematosus
Spina bifida Carbamazepine (Tegretol) is a teratogenic drug that may cause neural tube defects. Therefore, the fetus may be at risk for spina bifida. Pyelectasis is enlargement of the renal pelvis, which is observed in Down syndrome. Omphalocele is an abdominal wall defect but not a neural tube defect. Lupus erythematosus is a collection of autoimmune diseases, seen in the mother but not in the fetus.
A nurse is providing instruction for an obstetric client to perform a daily fetal movement count (DFMC). Which instructions could 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. Correct 3 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. Correct 4 Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. Client monitoring of fetal activity once daily for a 60-minute period, and noting the activity is a protocol that can be used to perform DFMC. Monitoring fetal activity two times a day either after meals or before bed for a period of two hours or until 10 fetal movements are noted is a protocol that can be used to perform DFMC. Counting all fetal movements in a 12-hour period daily until 10 fetal movements are noted is a protocol that can be used to perform DFMC. The fetal alarm signal is noted when there are no fetal movements noted for a period of 12 hours. That the test must be done in a clinic or hospital under the supervision of a nurse or physician is incorrect. It is assessed at home and does not interfere with a woman's daily routine.
The amniotic fluid index (AFI) in a client is 15. What should the nurse interpret form this finding? 1 The client has normal AFI. 2 The fetus has intrauterine growth restriction. 3 The fetus has congenital abnormalities. 4 The fetus has neural tube defects.
The client has normal AFI. AFI values between 10 and 25 cm are considered normal. Therefore, a 15 cm amniotic fluid index is normal and does not indicate any fetal abnormality. An AFI of less than 5 cm indicates that the patient has oligohydramnios, which is characterized by intrauterine growth restriction and congenital abnormalities. If the client has an AFI above 25 cm, it indicates that the client has polyhydramnios, which would put the fetus at risk of neural tube defects
The nurse is reviewing the nuchal translucency (NT) reports of a pregnant client. The report reveals that the fluid in the nape of the fetus is more than 3 mm. What is the nurse's best interpretation from this finding? 1 The fetus has an organ disorder. 2 The fetus has growth retardation. 3 The fetus has a genetic disorder. 4 The fetus has cardiac disease.
The fetus has cardiac disease NT is a type of ultrasound screening technique done to assess genetic disorders in the developing fetus. If the fluid in the nape of the fetus is more than 3 mm, it indicates that the child has a cardiac disorder. Organ disorders, growth retardation, and genetic disorders cannot be assessed using the NT screening technique only. Fetal organ disorders are identified by transvaginal ultrasound. Growth disorders can be diagnosed by normal ultrasonography. Elevated NT along with maternal serum markers indicates the presence of genetic disease
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 low. What does the nurse infer from this finding?
The fetus may have risk of Down syndrome Inhibin A is the hormone that is secreted by the placenta. Low levels of inhibin A indicate that the fetus has a chromosomal abnormality, which indicates a risk of Down syndrome. A L/S ration of 2:1 is a normal finding and does not indicate fetal lung immaturity. The normal amniotic fluid index is 10 to 25 cm. If the amniotic fluid index is more than 25, the fetus has a risk of Potter syndrome. If the amniotic fluid index is less than 5 cm, the fetus has chromosomal abnormalities and a neural tube defect. Therefore, the nurse does not anticipate that the fetus has a risk of Potter syndrome or neural tube defect.
woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? 1 "I will need to have a full bladder for the test to be done accurately." 2 "I should have my husband drive me home after the test because I may be nauseated." 3 "This test will help to determine if the baby has Down syndrome or a neural tube defect." 4 "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements. An ultrasound requires a full bladder. An amniocentesis is a test after which a pregnant woman should be driven home. A maternal serum alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome.
The primary health care provider orders a specialized ultrasonography test for a client. What is the objective of performing the test? 1 To determine fetal cardiac activity 2 To assess the amniotic fluid volume 3 To determine the presence of polyhydramnios 4 To assess the fetal position during delivery
To determine the presence of polyhydramnios Specialized ultrasonography is used to detect physiologic and anatomic abnormalities in the fetus. Polyhydramnios, or an increased amount of amniotic fluid in the fetal sac, is a physiologic abnormality that can be assessed by specialized ultrasonography. Fetal cardiac activity is checked in a standard ultrasonographic test. Amniotic fluid volume is measured in a standard ultrasonographic test. Fetal position during delivery is determined using limited ultrasonography.
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? 1 Biophysical profile 2 Amniocentesis 3 Maternal serum alpha-fetoprotein (MSAFP) 4 Transvaginal ultrasound
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? 1 Two-dimensional (2D) 2 Three-dimensional (3D) 3 Four-dimensional (4D) 4 Five-dimensional (5D)
Two-dimensional (2D) A two-dimensional (2D) ultrasound is the standard medical scan used in pregnancy. A three-dimensional (3D) ultrasound is the ultrasound test in which sound waves are sent out at different angles. A four-dimensional (4D) ultrasound adds a fourth dimension (time) to the 3D scan. There is no five-dimensional (5D) ultrasound.
After a woman with blood type Rh negative undergoes amniocentesis, the most appropriate nursing intervention is to: 1 administer RhoD immunoglobulin. 2 administer anticoagulant. 3 send the patient for a computed tomography (CT) scan before the procedure. 4 assure the mother that short-term radiation exposure is not harmful to the fetus.
administer RhoD immunoglobulin Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered because this can increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.
What clinical significance does a maternal blood Coombs test with a titer of 1:8 and increasing indicate? 1 Fetal lung maturity 2 Significant Rh compatibility 3 Significant Rh incompatibility 4 Fetus with trisomy 13, 18, or 21
Significant Rh incompatibility The clinical significance of a maternal blood Coombs test with a titer of 1:8 and increasing indicates significant Rh incompatibility. Fetal lung maturity and fetus with trisomy 13, 18, or 21 are not clinically significant of a Coombs test with a titer of 1:8.
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. What is the primary reason for this referral?
To check for fetal well-being
Which parameter is measured to detect neural tube defects in a fetus? 1 Acetylcholinesterase 2 Phosphatidylglycerol (PG) 3 Lecithin-to-sphingomyelin (L/S) ratio 4 Surfactant-to-albumin (S/A) ratio
Acetylcholinesterase Acetylcholinesterase and amniotic fluid alpha-fetoprotein (AFP) measurement are used to diagnose neural tube defects. The presence of Phosphatidylglycerol (PG) is used in amniocentesis to determine fetal lung maturity. The lecithin-to-sphingomyelin (L/S) ratio is used in amniocentesis to determine fetal lung maturity. The surfactant-to-albumin (S/A) ratio helps determine fetal lung maturity in the TDx FLM assay.
Which diagnostic test would be used by the health care team to detect anencephaly in the fetus?
Amniocentesis Anencephaly is a neural tube defect, indicated by elevated levels of alpha-fetoprotein, which results in leakage of cerebrospinal fluid. This abnormality is detected by performing amniocentesis, which detects any abnormal finding in the amniotic fluid. Doppler blood flow analysis is used to study blood flow and muscle motion. It detects trisomy 13 or 18 in the fetus. Nonstress test and contraction stress tests are used to determine fetal well-being in relation to the fetal activity. These tests may not be helpful in detecting anencephaly.
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. How does the nurse prepare the client for the test? 1 Instruct the client not to void prior to the test. 2 Assist the client into a lithotomy position during the test. 3 Inform the client that moderate pain will be felt during the test. 4 Use pillows to elevate the client's head and knees during the test.
Assist the client into a lithotomy position during the test An ectopic pregnancy is detected using transvaginal ultrasonography. The client should be placed in a lithotomy position, because this position enables the primary health care provider to conduct the test with ease and provides comfort to the client. If abdominal and not transvaginal ultrasonography is being performed, then the client would be instructed to avoid voiding. Transvaginal ultrasonography does not cause pain; the client would only feel a slight pressure due to insertion of the probe. The client 's head and knees are elevated using pillows while performing abdominal ultrasonography. While performing transvaginal ultrasonography, the nurse should place a pillow to elevate the client 's pelvis.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? 1 Doppler blood flow analysis 2 Contraction stress test (CST) 3 Amniocentesis 4 Daily fetal movement counts
Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, but not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.
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? 1 Spina bifida 2 Down syndrome 3 Potter syndrome 4 Fetal cardiac disease
Down syndrome is a chromosomal abnormality. It is characterized by decreased pregnancy-associated placental protein (PAPP-A) and elevated human chorionic gonadotropin (hCG) and nuchal translucency. It can be detected in the first trimester with multiple markers in the serum. Spina bifida is a neural tube defect, which is identified by amniocentesis. Potter syndrome is the typical appearance of the fetus as a result of oligohydramnios, which is detected by amniocentesis. PAPP-A, hCG, and NT do not identify the presence of fetal cardiac disease.
