Ch 26

Which assessments are included in the fetal BPP? (Select all that apply.)

- Fetal movement - Fetal tone - Fetal heart rate - AFI

IUGR is associated with which pregnancy-related risk factors? (Select all that apply.)

- Poor nutrition - Maternal collagen disease - Gestational hypertension - Smoking

Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal testing (NIPT) that has recently become available in the clinical setting. This technology can provide a definitive diagnosis of which findings? (Select all that apply.)

- Fetal Rh status - Fetal gender - Paternally transmitted gene disorder - Trisomy 21

Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (Select all that apply.)

- Multifetal gestation - Obesity - Fetal abnormalities - Ectopic pregnancy

How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period?

Reactive

With regard to amniocentesis, nurses should be aware that:

The shake test, or bubble stability test, is a quick means of determining fetal maturity.

A 39-year-old primigravida woman believes that she is approximately 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; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time?

Ultrasound examination

An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and again the level is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus?

Ultrasound for fetal anomalies

The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis?

Doppler blood flow analysis

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:

Encouraging her and urging her to continue with childbirth classes

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 occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. 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 places this client in a high-risk category?

Family history, BMI, drug and alcohol abuse

The nurse providing care for the antepartum woman should understand that contraction stress test (CST):

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

In the first trimester, ultrasonography can be used to gain information on:

Location of gestational sacs

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate?

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

A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client?

Maternal serum alpha-fetoprotein (MSAFP) screening

The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding?

Polyhydramnios

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? What is the nurses best response?

Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning

Which clinical finding is a major use of ultrasonography in the first trimester?

Presence of maternal abnormalities

While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)?

10 weeks

The indirect Coombs test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step.

1:8

A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan?

Administration of Rho(D) immunoglobulin may be necessary

At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time?

Amniocentesis for fetal lung maturity

Which information is the highest priority for the nurse to comprehend regarding the BPP?

BPP is an accurate indicator of impending fetal well-being

A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus?

Biophysical profile (BPP)

In the past, factors to determine whether a woman was likely to develop a high-risk pregnancy were primarily evaluated from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should not be included in this group?

Geographic

Which nursing intervention is necessary before a first-trimester transabdominal ultrasound?

Instruct the woman to drink 1 to 2 quarts of water

Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?

Moderate coffee consumption

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?

Multiple-marker screening

A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test?

Negative

Which information is an important consideration when comparing the CST with the NST?

The NST has no known contraindications

Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)?

The fetal alarm signal should go off when fetal movements stop entirely for 12 hours

A pregnant womans BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time?

The test results are within normal limits

In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client?

The transvaginal examination allows pelvic anatomy to be evaluated in greater detail

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?

Transvaginal ultrasound