Maternal 9

Which conditions are associated with elevated levels of serum alpha-fetoprotein? (Select all that apply.) A. open neural tube defects B. abdominal wall defects C. chromosomal trisomies D. gestational trophoblastic disease E. fetal demise

A. open neural tube defects B. abdominal wall defects E. fetal demise Conditions associated with elevated levels of AFP include: (1) underestimation of gestational age, (2) undiagnosed multiple gestation, (3) fetal demise, (4) conditions associated with fetal edema such as cystic hygroma, and (5) other anomalies, specifically abdominal wall defects like gastroschisis.

The physician has ordered a chorionic villus sampling to be done on a patient. The nurse knows to schedule the test to be done between which weeks of gestation? A. 4 and 6 weeks B. 6 and 8 weeks C. 8 and 10 weeks D. 10 and 12 weeks

D. 10 and 12 weeks CVS is normally performed between 10 and 13 weeks gestation to diagnose fetal chromosomal, metabolic, or deoxyribonucleic acid (DNA) abnormalities.

An 8-month-pregnant patient comes to the clinic complaining that she has not felt the baby move for the past 48 hours. Other than checking the fetal heart tones, the nurse can also anticipate which fetal study? A. amniocentesis B. multiple-marker study C. blood flow assessment D. ultrasonography

D. ultrasonography Ultrasonography is used in the last two trimesters to confirm fetal viability.

A patient is to have an ultrasound to do a general survey of the fetus, placenta, and amniotic fluid. This type of ultrasound level is termed

standard or basic

An ultrasound is done prior to an amniocentesis to A. determine fetal age B. locate fetal and placental position C. determine maternal blood pressure D. determine amount of fetal movement

B. locate fetal and placental position Determining fetal and placental position is important prior to amniocentesis to prevent damage by the needle.

In preparing a pregnant patient for a nonstress test, the nurse should A. ask the patient if she smokes and when she had her last cigarette B. have the patient drink four glasses of water C. ask the patient when was the last time she had anything to eat or drink D. ask the patient for a urine sample to check for glucose levels

A. ask the patient if she smokes and when she had her last cigarette For the greatest accuracy of a nonstress test, the woman should not have smoked recently because smoking affects the perception of fetal movement. In addition, smoking causes vasoconstriction, which may alter the results.

Which one(s) of the following complications may be associated with percutaneous umbilical blood sampling (PUBS) (Select all that apply.) A. fetal bradycardia B. vaginal hemorrhage C. infection D. preterm labor E. umbilical cord prolapse

A. fetal bradycardia C. infection D. preterm labor Complications of PUBS include fetal bradycardia or bleeding, umbilical cord laceration, umbilical cord hematoma, thrombosis, infection, preterm labor resulting in an emergent preterm delivery of a compromised fetus, preterm premature rupture of membranes, or pregnancy loss.

The patient has a biophysical profile done. The nurse notes that the NST test was reactive, the fetal breathing movements were absent, there was one gross body movement in 30 minutes, the fetal tone showed fetal extremity extension and return to flexion, and one pocket of amniotic fluid measured 3 cm. The nurse anticipates that next action by the physician will be A. further study because a score of 6 is not normal B. no further study because a score of 9 is normal. C. further study because a score of 3 is not normal D. no further study because a score of 10 is perfect

A. further study because a score of 6 is not normal A score of 8 to 10 is normal for a biophysical profile. To determine the score, five categories are used. The reactive NST gives a score of 2; absent fetal breathing movements is 0; one gross body movement is 0; the fetal tone of extension and flexion is 2; and one pocket of amniotic fluid is 2 points. This gives a total of 6 points, which is not within normal limits, and further studies are indicated.

The nurse notices that during the nonstress test, the fetal heart rate accelerated 20 beats/minute above baseline three times with fetal movement. Each acceleration lasted about 15 seconds before returning to baseline. This result is classified as A. reactive B. nonreactive

A. reactive A reactive (reassuring) nonstress test shows at least two fetal heart accelerations, with or without fetal movement, within a 20-minute period. The accelerations peak at least 15 beats/minute above baseline and last 15 seconds from baseline to baseline.

An ultrasound is ordered for a patient who is 8½ months pregnant. It is important for the nurse to A. instruct the patient to drink several glasses of clear fluid 1 hour before the examination and not to void B. place a wedge under one hip when placing her on the examination table C. place the patient in the lithotomy position for the examination D. instruct the patient to bring someone with her to the examination to drive her home

B. place a wedge under one hip when placing her on the examination table When lying supine, the patient is at risk for supine hypotension. Placing a wedge or rolled blanket under one hip will move the gravid uterus over to the side away from the vena cava and aorta. Drinking several glasses of clear fluid is needed during the second trimester prior to an ultrasound. A vaginal ultrasound is done during the first trimester.

During a contraction stress test, the nurse notices late decelerations with three of the six contractions. These results are classified as A. negative B. positive C. equivocal D. unsatisfactory

B. positive Positive results are when late decelerations accompany at least 50% of the contractions.

A patient's maternal serum alpha-fetoprotein (MSAFP) levels are elevated. The nurse can anticipate that the next test done will be A. amniocentesis B. ultrasound C. biophysical profile D. chorionic villus sampling

B. ultrasound The MSAFP is a screening test, not a diagnostic test. If the levels are elevated, an ultrasound is offered to determine whether the abnormal concentration results from inaccurate gestational age, multifetal gestation, or fetal demise.

A pregnant patient has a 2-year history of uncontrolled hypertension. The nurse can anticipate that which fetal study to be ordered? A. amniocentesis B. chorionic villus sampling C. doppler ultrasound blood flow assessment

C. doppler ultrasound blood flow assessment Pregnancies complicated by hypertension may have a Doppler ultrasound assessment of blood flow through the umbilical artery done to identify abnormalities in the diastolic flow.

An amniocentesis is ordered for an 8-month-pregnant patient. The nurse is aware that the most common reason for this test at this time is to test for A. fetal demise B. fetal chromosome abnormalities C. fetal lung maturity D. amniotic fluid amount

C. fetal lung maturity A common indication for amniocentesis during the third trimester is to determine fetal lung maturity. Amniocentesis may be done midtrimester to determine chromosomal abnormalities. Amniocentesis is not done to determine fetal demise or amniotic fluid amount.

A patient comes to the clinic requesting an ultrasound to confirm a pregnancy. Her last menstrual period was 15 days ago. The nurse's best response would be to A. make an appointment B. ask the reason for needing a confirmation this soon in the pregnancy C. inform her that an ultrasound cannot confirm a pregnancy this early D. refer her to a specialist who is trained in confirming early pregnancies

C. inform her that an ultrasound cannot confirm a pregnancy this early The embryo is not visualized until 5 to 6 weeks after the last menstrual period.

A 36-year-old primigravida is in the clinic for her first prenatal appointment. The nurse can anticipate that the multiple-marker screening may be done on this patient to screen for A. gestational diabetes B. hypertensive disease of pregnancy C. trisomy disorders D. placenta previa

C. trisomy disorders The multiple-marker screening test (MSAFP, hCG, unconjugated estriol, inhibin A) is used to screen for trisomies in the fetus. Older primigravidas are at higher risk for these defects.