Chapter 10 - Assessment of High Risk Pregnancy (Maternity) EAQ's

After reviewing the reports of a pregnant patient, the nurse infers that there might be a high risk for intrauterine growth restriction (IUGR). The reason for this could be that the amniotic fluid index (AFI) is what? 1 Less than 5 cm 2 More than 25 cm 3 Between 5 and 10 cm 4 Equal to or more than 10 cm

1 - Less than 5 cm pg 233 - An AFI less than 5 cm indicates oligohydramnios. Oligohydramnios is associated with intrauterine growth restriction and congenital anomalies. An AFI of 10 cm or greater indicates that the fetus is normal. AFI values between 5 and 10 cm are considered low normal, indicating a comparatively low risk for congenital anomalies. An AFI greater than 25 cm indicates polyhydramnios. This is associated with neural tube defects and obstruction of the fetal gastrointestinal tract.

The nurse is assessing a pregnant patient and finds that her blood pressure is 150/90 mm Hg. What procedure does the nurse recommend for this patient? 1 Doppler blood flow analysis 2 Nuchal translucency (NT) test 3 Chorionic villus sampling (CVS) 4 Percutaneous umbilical blood sampling (PUBS)

1 - Doppler blood flow analysis pg 232 - Maternal hypertension can cause serious adverse effects on the fetus. A blood pressure reading of 150/90 mm Hg indicates that the mother is hypertensive. To assess the effect of maternal hypertension on the fetus, the nurse should refer the patient for a Doppler blood flow analysis. It is a noninvasive ultrasonic technique used to study fetal blood flow. NT is a technique used to assess genetic abnormalities in the fetus. CVS is a prenatal test used to diagnose structural defects in the fetus. PUBS is used to assess the fetal circulation.

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 Drinking orange juice before the test is appropriate. 2 Vibroacoustic stimulation may be used during the test. 3 A needle biopsy may be needed to stimulate contractions. 4 After 20 minutes, a nonreactive reading indicates the test is complete. 5 Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

1 - Drinking orange juice before the test is appropriate. 2 - Vibroacoustic stimulation may be used during the test. 5 - Two sensors are placed on the abdomen to measure contractions and fetal heart tones. pg 238/239 - 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 (Greenberg, Druzin, and Gabbe, 2012). 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 (Greenberg, Druzin, and Gabbe, 2012). A needle biopsy is not part of a 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.

After reviewing the triple marker screen reports of a patient who is in the second trimester of pregnancy, the nurse concludes that the fetus has trisomy 18. What factors in the report led to the nurse's conclusion? Select all that apply. 1 Low level of unconjugated estriol in serum 2 Low level of inhibin-A in the maternal serum 3 Elevated nuchal translucency (NT) in the fetus 4 Low level of maternal serum alpha-fetoprotein (MSAFP) 5 Low level of maternal human chorionic gonadotrophin (hCG)

1 - Low level of unconjugated estriol in serum 4 - Low level of maternal serum alpha-fetoprotein (MSAFP) 5 - Low level of maternal human chorionic gonadotrophin (hCG) pg 237 - The triple marker screen measures the levels of three maternal serum markers: unconjugated estriol, hCG, and MSAFP. Low values of unconjugated estriol, hCG, and MSAFP indicate that the fetus has trisomy 18. The quad screen has an additional serum marker: inhibin-A. A low inhibin-A level indicates the possibility of Down syndrome. NT is not a serum marker protein. Moreover, elevated NT indicates that the fetus has a chromosomal abnormality but does not specifically indicate that the fetus has trisomy 18.

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including what? 1 MSAFP is a screening tool only; it identifies candidates for more definitive procedures. 2 Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. 3 Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. 4 Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects.

1 - MSAFP is a screening tool only; it identifies candidates for more definitive procedures. pg 237 - MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but 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.

What is an indicator for performing a contraction stress test? 1 Maternal diabetes mellitus and postmaturity 2 Adolescent pregnancy and poor prenatal care 3 Increased fetal movement and small for gestational age 4 History of preterm labor and intrauterine growth restriction

1 - Maternal diabetes mellitus and postmaturity pg 228 - 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, but history of a previous stillbirth (not preterm labor) is the other indicator.

The nurse is reviewing the contraction stress test (CST) reports of a pregnant patient. The nurse expects the fetus to have meconium-stained amniotic fluid. What would be the reason for that conclusion? 1 Positive CST results 2 Negative CST results 3 Suspicious CST results 4 Unsatisfactory CST results

1 - Positive CST results pg 241 - Meconium is normally stored in the infant's intestines until after birth, but sometimes (in cases of fetal distress and hypoxia) it is expelled into the amniotic fluid before birth. The amniotic fluid is then said to be meconium stained. Fewer than three contractions in 10 minutes or late decelerations occurring with 50% or more of contractions constitute positive CST results. Positive CST results are associated with meconium-stained amniotic fluid. Negative CST results indicate that the fetus is normal. Suspicious or unsatisfactory CST results are not associated with any other fetal conditions.

While reviewing the ultrasonography images of a patient in her seventh month of pregnancy, the nurse observes an enlarged renal pelvis of the fetus. Which screening test does the nurse advise the patient to undergo? 1 Quad screening 2 Coombs' screening 3 Triple marker screening 4 Cell-free DNA screening

1 - Quad screening pg 237 - Enlargement of the renal pelvis may indicate Down syndrome in the fetus, and quad screening is done to determine whether the fetus has Down syndrome. In this test, the levels of placental hormone inhibin A are monitored. Low levels of inhibin A indicate Down syndrome. Coombs' test is a screening procedure to determine Rh incompatibilities. Cell-free DNA screening is done to detect certain inherited single-gene disorders. Triple marker screening is less accurate than quad screening in screening for Down syndrome.

The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant woman to evaluate fetal structure and growth. Which instructions should the nurse include when preparing the woman for this test? Select all that apply. 1 Remain still throughout the test. 2 A full bladder is required prior to the test. 3 A lead apron must be worn during the test. 4 Jewellery must be removed before the test. 5 An intravenous line must be inserted before the test.

1 - Remain still throughout the test. 4 - Jewellery must be removed before the test. pg 234 - Magnetic resonance imaging (MRI) is a noninvasive radiologic technique used for obstetric and gynecologic diagnosis. Similar to computed tomography (CT), MRI provides excellent pictures of soft tissue. Unlike CT, ionizing radiation is not used. Therefore vascular structures within the body can be visualized and evaluated without injecting an iodinated contrast medium, thus eliminating any known biologic risk. Similar to sonography, MRI is noninvasive and can provide images in multiple planes, but no interference occurs from skeletal, fatty, or gas-filled structures, and imaging of deep pelvic structures does not require a full bladder. The woman is placed on a table in the supine position and moved into the bore of the main magnet, which is similar in appearance to a CT scanner. Depending on the reason for the study, the procedure may take from 20 to 60 minutes, during which time the woman must be perfectly still except for short respites.

The nurse is reviewing the nuchal translucency (NT) reports of a pregnant patient. The report reveals that the fluid in the nape of the fetus is more than 3 mm. What does the nurse interpret from this finding? 1 The fetus has cardiac disease. 2 The fetus has growth restriction. 3 The fetus has an organ disorder. 4 The fetus has a genetic disorder.

1 - The fetus has cardiac disease. pg 231 - 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 restriction, 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.

The nurse is preparing a patient for transvaginal ultrasonography. What information does the nurse give the patient before the test? 1 There is no pain felt during transvaginal ultrasonography. 2 There is no pressure felt during transvaginal ultrasonography. 3 The patient needs to be in the semi-Fowler position for the test. 4 The patient needs to drink lots of fluids to keep the bladder full before the test.

1 - There is no pain felt during transvaginal ultrasonography. pg 230/231 - Transvaginal ultrasonography is a painless procedure in which a transducer probe is inserted into the vagina and the pelvic anatomic features are evaluated. The patient is positioned in lithotomy position, not semi-Fowler position, for this procedure. This helps in proper insertion of the probe. Intake of large amounts of fluids is generally recommended for transabdominal ultrasonography but not for transvaginal ultrasonography. Some pressure is felt on the vaginal walls as the transducer probe is moved to get a complete view of the pelvis.

A patient in the sixth month of pregnancy expresses her wish to see the fetus. What investigation does the nurse suggest for the patient to help her see the fetus? 1 Ultrasonography 2 Nuchal translucency (NT) 3 Computed tomography (CT) 4 Magnetic resonance imaging (MRI)

1 - Ultrasonography pg 228 - Three-dimensional (3D) or four-dimensional (4D) ultrasonography is advisable for women who want to see the fetus. MRI cannot be used in this case because it requires the fetus to be still for a long period of time for a clear image. CT uses ionizing radiation for imaging, which can be harmful to the fetus. Therefore CT is contraindicated for fetal imaging. NT is a specific ultrasonography screening procedure used to test for genetic abnormalities in the fetus.

A primary health care provider is performing a transabdominal amniocentesis procedure in a pregnant patient. Arrange the steps of the amniocentesis procedure in the correct order. 1. Separate the supernatant fluid and cellular components. 2. Collect the cellular components for chromosomal studies. 3. Centrifuge the collected amniotic fluid. 4. Collect the amniotic fluid under ultrasonographic visualization. 5. Collect the supernatant for chemical analysis.

1. - Collect the amniotic fluid under ultrasonographic visualization. 2. - Centrifuge the collected amniotic fluid. 3. - Separate the supernatant fluid and cellular components. 4. - Collect the supernatant for chemical analysis. 5. - Collect the cellular components for chromosomal studies. pg 234 - Amniocentesis is performed to obtain the amniotic fluid, which contains the fetal cells. Amniotic fluid can be collected transabdominally under ultrasonographic visualization. After the amniotic fluid is collected, the fluid should be centrifuged. Centrifugation is done to separate the supernatant fluid and cellular components. Because the supernatant fluid has a lighter weight, it collects in the upper part of the centrifuge tube. This supernatant fluid is collected first and is sent for chemical analysis. Cellular components, which lie in the bottom of the centrifuge tube, are then collected to perform chromosomal analysis.

The nurse is reviewing the scanned images of an ultrasonography test of the fetus. The nurse finds that the head and abdominal circumferences of the fetus are large in proportion to other parts of the body. What should the nurse conclude about the fetus? 1 Symmetric growth restriction 2 Asymmetric growth restriction 3 Presence of congenital malformations 4 Macrosomia resulting from maternal diabetes

2 - Asymmetric growth restriction pg 231 - The difference in the head and body circumference is a sign of asymmetric growth restriction. Symmetric intrauterine growth restriction is a condition in which all fetal parts are consistently small. Macrosomia is a condition in which the infant weighs more than 4000 g. It may not lead to asymmetric growth. A larger head and abdominal circumference do not indicate congenital malformations, which are associated with more obvious physical signs.

While reviewing the ultrasonography reports of a pregnant patient, the nurse finds that there is excessive fluid collection at the nape of the neck of the fetus. Which test will the nurse recommend? 1 Oxytocin challenge test 2 Chorionic villus sampling 3 Fetal acoustic stimulation test 4 Percutaneous umbilical blood test

2 - Chorionic villus sampling pg 231/234/236 - Excessive fluid in the nape of the neck indicates a genetic abnormality in the fetus. Genetic abnormalities can be tested further by performing chorionic villus sampling. A fetal acoustic stimulation test is done to test the fetal heart rate. Oxytocin challenge is a stress-based test for measuring fetal heart rate. Percutaneous umbilical blood sampling is the procedure done for fetal blood sampling and transfusion.

The biophysical profile (BPP) testing report of a pregnant patient gives the following information: one episode of fetal breathing movement lasting for 30 seconds in a 30-minute observation; three limb movements of the fetus in 30 minutes; an amniotic fluid index greater than 5; a reactive nonstress test; and a BPP score of 1. The test is performed for 120 minutes. What does the nurse expect the primary health care provider to do? 1 Repeat the test twice a week. 2 Consider delivery of the fetus. 3 Repeat the test in 4 to 6 hours. 4 Extend the test time to 120 minutes.

2 - Consider delivery of the fetus. pg 233 - If the BPP score is less than 2, regardless of gestational age, delivery can be performed. If the BPP score is 0 to 2 and chronic asphyxia is suspected, then testing time should be extended to 120 minutes. If the BPP score is 8 to 10 and a low risk for chronic asphyxia is suspected, then the test should be repeated at twice-weekly intervals. If the fetal pulmonary test result is negative and the BPP score is 6, then the BPP profile should be repeated in 4 to 6 hours.

A patient is diagnosed as having a fetus with hemolytic anemia. What does the nurse advise the patient to do? 1 Begin an iron-rich diet. 2 Count fetal movements. 3 Undergo ultrasonography. 4 Undergo blood transfusion.

2 - Count fetal movements. pg 238 - The patient should be instructed to count the fetal movements, because fetal hypoxia may decrease fetal activity. Fetal hemolytic anemia is a disorder in which the fetal blood cells act as antigens and the maternal immune system develops antibodies. This results in hemolysis in the fetus, which may lead to low oxygen levels and low activity in the fetus. In hemolytic anemia, maternal antibodies are constantly killing the fetal cells, so an iron-rich diet may not be helpful. Blood transfusion may not be helpful in treating fetal hemolytic anemia. Plasma exchange may be useful. Ultrasonography is not used to detect hemolytic anemia in the fetus.

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 tool is useful in confirming the diagnosis? 1 Amniocentesis 2 Doppler blood flow analysis 3 Contraction stress test (CST) 4 Daily fetal movement counts

2 - Doppler blood flow analysis pg 232 - Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and placenta. It is a helpful tool in the management of high risk pregnancies because of 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, 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 who is caring for a diabetic pregnant patient finds that the weight gain pattern is poor. Which fetal factor will the nurse check in the ultrasound reports of the patient? 1 Heart activity 2 Growth pattern 3 Anatomic structure 4 Movement frequency

2 - Growth pattern pg 231 - Diabetes is known to cause decreased weight gain during pregnancy. This, in turn, causes intrauterine growth restriction. Therefore the nurse should regularly monitor the fetal growth pattern in ultrasound reports. Fetal heart activity and anatomic structure are not influenced by maternal diabetes. Alterations in the amniotic fluid levels are associated with fetal heart activity and anatomic structure. Impaired nutrition of the mother can affect the fetal activity and therefore reduce the frequency of the fetal movements. Decreased fetal movements are not associated with maternal diabetes.

On reviewing the amniocentesis reports of a pregnant patient, the nurse finds that phosphatidylglycerol (PG) is absent in the amniotic fluid. What can the nurse interpret about development in the fetus from the reports? 1 Impaired brain development 2 Impaired lung development 3 Impaired limb development 4 Impaired cardiac development

2 - Impaired lung development pg 234/235 - PG is a glycerophospholipid found in the lungs as a pulmonary surfactant. The presence of PG in amniotic fluid is an early indicator of fetal lung maturity. The PG test is used mostly to assess fetal lung maturity in late pregnancy; therefore absence of PG indicates impaired lung development. The PG test is not used to assess the heart, brain, or limb growth of the fetus. Fetal heart activity can be assessed by using transvaginal ultrasound. Magnetic resonance imaging is used to observe the growth and development of the fetal brain. Limb development of the fetus can be observed on ultrasound.

While assessing the ultrasound scan reports of a pregnant patient, the nurse observes that the fetus is at an elevated risk for trisomy 13. What findings are likely to be associated with this risk? Select all that apply. 1 Low amniotic fluid volume (AFV) 2 Low maternal serum marker levels 3 High daily fetal movement count (DFMC) 4 Elevated levels of nuchal translucency (NT) 5 Increased biophysical profile (BPP) of the fetus

2 - Low maternal serum marker levels 4 - Elevated levels of nuchal translucency (NT) pg 237 - NT screening uses ultrasound measurement of fluid in the nape of the fetal neck to identify fetal abnormalities. A low maternal serum marker level combined with elevated NT indicates a high risk for chromosomal abnormalities such as trisomy 13 in the fetus. In NT, fluid collection greater than 3 mm is considered abnormal. A low AFV is also associated with fetal disorders but not with chromosomal abnormalities. The BPP includes measurements of AFV, fetal movements, and fetal tone. Increase in BPP does not indicate chromosomal abnormalities. DFMC is measured to assess fetal well-being. High or low DFMC does not indicate chromosomal abnormalities in the fetus.

The nurse is reviewing the amniocentesis reports of a patient 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

2 - Neurologic disorder pg 234 - High AFP levels after 15 weeks of gestation indicate an open neural tube or other disorder 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-to-sphingomyelin (L/S) ratio of the amniotic fluid is a useful predictor of pulmonary disorders in the fetus.

The amniotic fluid index (AFI) of a pregnant patient is 3 cm. What clinical information related to the fetus does the nurse infer from this? 1 Fetal hydrops 2 Renal defects 3 Low activity level 4 Neural tube defect

2 - Renal defects pg 233 - The normal value of AFI is 10 cm or greater, with the upper limit of normal around 25 cm. An AFI less than 5 cm indicates oligohydramnios. This condition is associated with renal agenesis in the fetus. A high AFI indicates neural tube defects and fetal hydrops. The AFI is not directly related to fetal movement. Fetal activity can be assessed using ultrasonography.

The nurse finds that the nonstress test of a pregnant patient is nonreactive. Which factor in the report might have led the nurse to this finding? 1 No qualifying accelerations in a 20-minute period 2 Two qualifying accelerations in a 20-minute period 3 Less than two qualifying accelerations in a 20-minute period 4 More than two qualifying accelerations in a 20-minute period

3 - Less than two qualifying accelerations in a 20-minute period pg 239 - The nonstress test is the most widely used technique for prenatal evaluation of the fetus. The results are either nonreactive or reactive. In a nonreactive test, there are less than two qualifying accelerations of the fetal heart rate in a 20-minute period. Absence of fetal heart rate accelerations during the nonstress test indicates that the fetus is sleeping. In a reactive test, there are at least two qualifying accelerations in a 20-minute time period. More than two fetal heart rate accelerations within a 20-minute time period also would be considered a reactive test.

Which test does the nurse recommend for the patient to help assess fetal genetic abnormalities? 1 Fetal heart activity 2 Fetal body movements 3 Nuchal translucency (NT) 4 Amniotic fluid volume (AFV)

3 - Nuchal translucency (NT) pg 231 - The NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 and 14 weeks of gestation. Fluid volume greater than 3 mm is considered abnormal. NT is used mostly to identify possible fetal genetic abnormalities. AFV, fetal body movements, and fetal heart activity are measured to assess fetal well-being.

After reviewing the standard ultrasound scan reports of a pregnant patient, the nurse advises the patient to undergo a specialized ultrasound scan. What is the nurse's rationale for this suggestion? 1 To estimate the amniotic fluid volume 2 To identify the detailed fetal anatomy 3 To assess for physiologic abnormalities 4 To assess for fetal genetic abnormalities

3 - To assess for physiologic abnormalities pg 230 - Specialized or targeted ultrasound scans are performed only if a patient is suspected of carrying an anatomically or physiologically abnormal fetus. Limited ultrasound examination is used to estimate the amniotic fluid volume. Standard ultrasound scan is used to see the detailed anatomy of the fetus. Ultrasound scan is not used to find genetic abnormalities in the fetus.

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman indicates a 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 nauseous." 3 "This test will help to determine if the baby has Down syndrome or a neural tube defect." 4 "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

4 - "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." pg 233 - 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 is the test that requires a full bladder. An amniocentesis is the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome.

The nurse is documenting the findings of a contraction stress test in a patient. The nurse finds that late decelerations in fetal heart rate occur with 60% of contractions. What does the nurse advise the patient? 1 "Continue with the weekly testing schedule." 2 "Take the test again tomorrow at the same time." 3 "You should take the test again today after resting." 4 "You should be hospitalized and monitored continuously."

4 - "You should be hospitalized and monitored continuously." pg 242 - If late decelerations occur with more than 50% of the contractions in the contraction stress testing, this is a positive test result. In this situation, the patient must be hospitalized and evaluated further. If the fetus has no significant variable heart rate decelerations with at least three uterine contractions for a period of 10 minutes, the patient can continue with the weekly testing schedule. If late deceleration in the heart rate occurs with less than 50% of the contractions, the patient should be advised to repeat the test the next day. Repeating the test on the same day can cause fetal distress and should be avoided.

After reviewing the biophysical profile (BPP) reports of a pregnant patient close to term, the nurse advises the patient to repeat the test on a weekly basis. What BPP score did the nurse find in the report? 1 1 2 4 3 6 4 9

4 - 9 pg 233 - If the BPP score is 8 to 10, then the test should be repeated weekly or twice weekly. If the BPP score is 0 to 2, then chronic asphyxia may be suspected. In this case the testing time should be extended to 120 minutes. If the BPP score is 4 after 36 weeks' gestation, then clinical conditions exist that may lead to an eminent delivery. If the BPP score is 4 before 32 weeks of gestation, the test should be repeated. If the BPP score is 6 at 36 to 37 weeks of gestation with positive fetal pulmonary testing, then delivery can be performed. If the BPP score is 6 before 36 weeks of gestation with negative pulmonary testing, then BPP can be repeated in 4 to 6 hours, and if oligohydramnios is present, then delivery can be done. The BPP provides an insight into fetal maturity and well-being and as such should be used as a diagnostic tool to plan and evaluate management of care. Findings are related to several factors involving both maternal and fetal characteristics.

Which finding in the ultrasonography reports of a pregnant woman would indicate a normal fetus? 1 Amniotic fluid index of 6 cm 2 Amniotic fluid index of 2 cm 3 Amniotic fluid index of 30 cm 4 Amniotic fluid index of 13 cm

4 - Amniotic fluid index of 13 cm pg 233 - An amniotic fluid index of 10 cm or more is considered normal. An amniotic fluid index of 25 cm is considered above the normal range and indicates polyhydramnios. An amniotic fluid index less than 10 cm is considered below the normal range. An amniotic fluid index below 5 cm is considered oligohydramnios

A pregnant patient who has undergone a cesarean section in her previous pregnancy needs to be checked for the fetal heart rate pattern. What test will the nurse recommend? 1 Biophysical profile 2 Nipple-stimulated test 3 Oxytocin-stimulated test 4 Fetal acoustic stimulation

4 - Fetal acoustic stimulation pg 239 - Fetal acoustic stimulation is a nonstress test for monitoring the fetal heart rate pattern. It can be used in cases of previous cesarean birth because there is no stress to the fetus. A biophysical profile is done to determine the physical profile of the fetus; it cannot be used to monitor the heart rate of the fetus. An oxytocin-stimulated test is type of stress testing that is contraindicated in cases of previous cesarean birth because of the stress caused by the injected oxytocin. A nipple-stimulated test is a contraction stress test that is contraindicated in patients with previous cesarean birth. In this test, the released oxytocin may cause distress to the fetus.

After performing an amniocentesis, the primary health care provider asks the nurse to administer Rho(d) immunoglobulin to a pregnant patient with Rh-negative blood. A patient with Rh-negative blood should be administered Rho(d) immunoglobulin to prevent what? 1 Infection in the fetus 2 Pain from amniocentesis 3 Leakage of amniotic fluid 4 Fetomaternal hemorrhage

4 - Fetomaternal hemorrhage pg 235 - Fetomaternal hemorrhage may occur after amniocentesis. Administering Rho(d) immunoglobulin to a pregnant patient with Rh-negative blood is advisable to prevent fetomaternal hemorrhage. Administering Rho(d) immunoglobulin after amniocentesis will not provide pain relief. Preventing amniotic fluid leakage during amniocentesis requires expertise in the procedure; administering Rho(d) immunoglobulin does not prevent amniotic fluid leakage. Maintaining aseptic conditions while performing the procedure is helpful in preventing infection during amniocentesis; administering Rho(d) is not.

The primary health care provider advises a pregnant woman to undergo a Doppler blood flow analysis after reviewing the amniocentesis reports. What clinical condition in the fetus could be the reason for this referral? 1 Fetal hydrops 2 Down syndrome 3 Potter syndrome 4 Hemolytic anemia

4 - Hemolytic anemia pg 237 - The presence of bilirubin in the amniotic fluid indicates the possibility of hemolytic anemia in the fetus. The degree of hemolytic anemia can be determined by using Doppler blood flow analysis. The presence of the placental hormone inhibin-A in the quad screen indicates Down syndrome. The amniotic fluid index values are used to detect Potter syndrome. Fetal hydrops is caused by polyhydramnios, which can be assessed by ultrasound scanning.

A patient in the first trimester of pregnancy undergoes a screening test to detect fetal chromosomal abnormalities. On reviewing the report, the nurse infers that the fetus may have Down syndrome. What clinical findings are noted by the nurse in the test reports? Select all that apply. 1 Low levels of inhibin-A in the fetal blood 2 Low levels of unconjugated estriol in the fetal blood 3 Low levels of maternal serum alpha-fetoprotein (MSAFP) 4 High levels of beta-human chorionic gonadotropin (β-hCG) 5 Low levels of pregnancy-associated placental protein (PAPP-A)

4 - High levels of beta-human chorionic gonadotropin (β-hCG) 5 - Low levels of pregnancy-associated placental protein (PAPP-A) pg 237 - First trimester screening, which is performed in the first trimester of pregnancy, includes the measurement of two maternal biomarkers: PAPP-A and free β-hCG. High levels of free β-hCG and low levels of PAPP-A in the first trimester indicate that the fetus has Down syndrome, or trisomy 21. Inhibin-A is a placental hormone. Low levels of inhibin-A also indicate the possibility of Down syndrome, but inhibin-A levels are not measured in the triple marker screen; these levels are measured in quad screening. A low level of MSAFP and unconjugated estriol also indicate Down syndrome, but these can be measured only in the second and third trimesters.

The contraction stress test (CST) reports of a pregnant patient are positive. What will the primary health care provider recommend? 1 Repeat testing next week. 2 Repeat testing the next day. 3 Repeat testing within 24 hours. 4 Hospitalize the patient immediately.

4 - Hospitalize the patient immediately. pg 242 - Fewer than three contractions in 10 minutes or late decelerations in the heart rate that occur with 50% or more of contractions indicate a positive CST result. If CST results are positive, then the primary health care provider is likely to recommend hospitalization for further evaluation or delivery. If CST results are negative, then the patient may be advised to undergo regular weekly testing. If CST results are suspicious, equivocal hyperstimulatory, or unsatisfactory, then the patient may be advised to repeat the test within 24 hours or the next day.

What parameter does the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth? 1 Antibody titer in the blood 2 Alfa-fetoprotein (AFP) levels 3 Creatinine levels in the blood 4 Lecithin-to-sphingomyelin (L/S) ratio

4 - Lecithin-to-sphingomyelin (L/S) ratio pg 234 - The L/S ratio indicates fetal lung maturity. AFP is assessed to check for the presence of neural defects. Presence of creatinine in the amniotic fluid indicates that the patient's gestational age is more than 36 weeks. The antibody titer is used to determine Rh incompatibility in the fetus.

The nurse is reviewing the ultrasound report of a 20-week pregnant patient to find out whether the patient has placental vascular disease. What assessment parameter does the nurse check in the reports? 1 The fetal heart rate through stethoscope 2 The fluid volume in the nape of the fetal neck 3 The biophysical profile through ultrasonography 4 The systolic-to-diastolic (S/D) ratio of umbilical and uterine arteries

4 - The systolic-to-diastolic (S/D) ratio of umbilical and uterine arteries pg 232 - The velocity waveforms of the umbilical and uterine arteries can be used to determine the S/D ratios. An S/D ratio greater than 3 indicates the presence of placental vascular disease. Fetal heart rate is measured to assess fetal well-being. The fetal heart rate does not indicate placental circulation. The biophysical profile includes assessment of amniotic fluid volume, fetal body movements, and fetal tone. Fluid volume in the nape of the fetal neck is measured to assess genetic abnormalities in the fetus.

A 40-year-old woman with a high body mass index is 10 weeks pregnant. Which diagnostic tool is appropriate for her at this time? 1 Amniocentesis 2 Biophysical profile 3 Transvaginal ultrasound 4 Maternal serum alpha-fetoprotein (MSAFP)

3 - Transvaginal ultrasound pg 230 - Transvaginal ultrasound is useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age.

Which physiologic parameters does the nurse check in the ultrasound report to assess fetal well-being? Select all that apply. 1 Amniotic fluid volume (AFV) 2 Daily count of fetal movements 3 Fetal limb and head movements 4 Fetal breathing movements (FBMs) 5 Fluid volume in the nape of the fetal neck

1 - Amniotic fluid volume (AFV) 3 - Fetal limb and head movements 4 - Fetal breathing movements (FBMs) pg 232 - Assessment of physiologic parameters such as AFV, FBMs, and limb and head movements of the fetus by ultrasonography gives a reliable picture of fetal well-being. Abnormalities in the amniotic fluid volume are frequently associated with fetal disorders. Fetal breathing and limb and head movements reflect the status of the central nervous system. Daily fetal movement count is the most common method used to assess fetal activity. Ultrasound is not used to assess the daily fetal movement count. The fluid volume in the nape of the fetal neck is measured to assess structural abnormalities in the fetus.

A pregnant patient with a normal fetal kick count has come for a regular nonstress testing session. The nurse notices that there are no heart accelerations after 40 minutes of testing. What diagnostic testing will the nurse include in the plan of care? 1 Contraction stress test 2 Biophysical profile test 3 Doppler blood flow test 4 Maternal serum analysis

1 - Contraction stress test pg 238 - A normal fetal kick count is an indication of fetal activity. The patient has undergone nonstress testing, which may have high false-positive rates. Therefore, the patient may be scheduled for a contraction stress test. Biophysical profile testing allows detailed assessment of the physical and physiologic characteristics of the fetus. Because the kick count is normal, biophysical profile testing is not needed. Maternal serum analysis is done to determine fetal abnormalities. It is not advised in this case, because the fetal kick count indicates adequate fetal activity. Doppler blood flow analysis is a noninvasive test for analyzing fetal circulation. It cannot be used to assess the fetal heart rate.

When does the nurse refer the pregnant patient for ultrasonography to detect maternal abnormalities that could affect the fetus? 1 First trimester 2 Third trimester 3 Second trimester 4 Second and third trimesters

1 - First trimester pg 229 - Ultrasonography is performed in the first trimester to detect maternal abnormalities such as bicornuate uterus, ovarian cysts, and fibroids. In the second trimester, ultrasonography is usually performed to detect congenital abnormalities and conditions such as polyhydramnios and oligohydramnios. In the third trimester, ultrasonography is used for visualization during amniocentesis and to measure gestational age. In the second and third trimesters, ultrasonography is used mostly to observe the fetal growth pattern.

A pregnant patient is about to undergo magnetic resonance imaging (MRI). What information does the nurse give the patient before the procedure? 1 The patient will not have pain during the process. 2 The patient will be positioned in a lithotomy position. 3 The patient will need to take fluids to have a full bladder. 4 The patient will be able to move freely during the procedure.

1 - The patient will not have pain during the process. pg 234 - MRI is a noninvasive technique that causes little pain. Therefore the patient undergoing MRI should be advised to not worry about pain. The patient undergoing MRI should be positioned in a supine position. The lithotomy position is not suitable for this procedure. The patient need not take fluids before the scan to ensure a full bladder because this procedure enables a full pelvic view without a full bladder. The patient should be instructed not to move during the scanning process because it may blur the images obtained.

After reviewing the Doppler umbilical flow reports of a pregnant patient, the nurse advises the patient to quit smoking immediately. Which finding in the report could be the reason for this instruction? 1 High amniotic fluid volume (AFV) 2 Low amniotic fluid volume (AFV) 3 Low systolic-to-diastolic (S/D) ratio 4 High systolic-to-diastolic (S/D) ratio

4 - High systolic-to-diastolic (S/D) ratio pg 232 - Exposure to nicotine from maternal smoking has been reported to increase the fetal S/D ratio. An elevated S/D ratio indicates a poorly perfused placenta. To improve the blood supply to the placenta, the patient should quit smoking as soon as possible. The AFV cannot be assessed through Doppler umbilical blood flow study. Moreover, smoking does not affect amniotic fluid volume. Smoking increases the S/D ratio; it does not decrease it.

The health care provider is performing an ultrasound scan of a pregnant patient to assess the biophysical profile (BPP) of the fetus. During the scan, the fetus is found to be in deep sleep. What actions does the health care provider perform? Select all that apply. 1 Retest the fetus on the next day. 2 Stop the ultrasound scan immediately. 3 Record the fetal activity on the monitor. 4 Perform a nonstress test in the mother. 5 Observe the fetus for a prolonged period.

3 - Record the fetal activity on the monitor. 5 - Observe the fetus for a prolonged period. pg 233 - The BPP includes measurements of amniotic fluid volume (AFV), fetal body movements (FBM), fetal tone, and fetal heart rate reactivity. If the fetus is sleeping, fetal body movements cannot be assessed correctly. Therefore, a prolonged period of observation is needed to assess the BPP. Moreover, the BPP can be assessed accurately only if the scan is videotaped and reviewed. The fetus may awaken, so it is not necessary to stop the scan. The nonstress test is useful only for assessing the reactivity of the heart to external stimulus. It is not used for determining the complete BPP of the fetus. In a pregnant woman, ultrasound scans should be performed only a limited number of times. Scanning on consecutive days is not good for fetal health, so the health care provider should not repeat the scan the next day.

Which condition should the nurse suspect in a fetus with oligohydramnios? 1 Potter syndrome 2 Down syndrome 3 Twin-twin syndrome 4 Fetal alcohol syndrome

1 - Potter syndrome pg 228 - Oligohydramnios means that there is a low amniotic fluid volume (AFV). Oligohydramnios is known to cause Potter syndrome. Potter syndrome is the atypical physical appearance of a fetus or a neonate. Excessive alcohol intake during pregnancy may cause fetal alcohol syndrome and is not associated with oligohydramnios. Down syndrome is a genetic abnormality of the fetus and can be identified using prenatal screening tests such as triple marker screen and quad screen. Down syndrome is not associated with oligohydramnios. Twin-twin syndrome is associated mainly with polyhydramnios.

On assessment, the nurse recognizes a low fetal kick count in a pregnant patient. On reviewing the nonstress test report, the nurse finds that the there is no acceleration in the fetal heart rate within 20 minutes of the stimulation. The ultrasonography report suggests a normal placental structure. What do these reports indicate? 1 Poor fetal nutrition 2 Low fetal perfusion 3 Low fetal respiration 4 Fetal growth retardation

3 - Low fetal respiration pg 233 - Low fetal kick counts and absence of acceleration in the fetal heart rate in a 20-minute period in a nonstress test suggest low fetal oxidation. Low fetal oxidation is caused by low fetal respiration. Fetal kick counts and nonstress tests do not indicate fetal growth, perfusion, or nutrition. Also, a normal placental structure indicates that fetal growth, perfusion, and nutrition are normal.

A 4-week pregnant patient is undergoing an ultrasound. The report shows an absence of fetal heart activity. What does the nurse infer about the fetus from the report? 1 Normal finding 2 Impaired growth 3 Cardiac disorder 4 Congenital abnormality

1 - Normal finding pg 231 - Fetal heart activity begins around 6 weeks, so 4 weeks is too early to detect fetal heart activity, and this is a normal finding. Absence of fetal heart activity at an advanced gestational age may indicate congenital anomalies, impaired growth, or cardiac disorders.

The nurse is assessing environmental factors that could cause fetal damage in a pregnant patient. Which questions should the nurse ask the patient? Select all that apply. 1 Do you smoke habitually or occasionally? 2 Do you undergo radiation tests frequently? 3 How many times do you exercise in a week? 4 Do you take any medications for any condition? 5 Does your partner take alcohol or any substance?

1 - Do you smoke habitually or occasionally? 2 - Do you undergo radiation tests frequently? pg 227 - Cigarette smoke is an environmental factor that can cause fetal damage. Smoking during pregnancy increases the risk for low birth weight and miscarriage. Radiation is a detrimental environmental factor that can cause fetal damage. Repeated scans during pregnancy may expose the fetus to radiation for a longer time. Some medications can cross the placental barrier and affect the fetus; therefore it is prudent for the nurse to ask the patient about medication use during the pregnancy period. However, this question relates to environmental factors, and the use of medications is not considered an environmental factor. This is a biophysical risk, not an environmental risk. Exercise is not a risk factor. Alcohol intake of the mother can adversely affect the health of the fetus, so the mother should be advised to avoid alcohol intake. However, paternal alcohol intake does not cause fetal damage.

Arrange in the correct order the steps the nurse takes while performing transvaginal ultrasonography for a pregnant patient. 1. Cover the transducer probe with a probe cover. 2. Position the pregnant patient in the lithotomy position. 3. Position the probe for proper view of pelvic structures. 4. Lubricate the transducer probe with water-soluble gel. 5. Insert the transducer probe into the patient's vagina.

1. - Position the pregnant patient in the lithotomy position. 2. - Cover the transducer probe with a probe cover. 3. - Lubricate the transducer probe with water-soluble gel. 4. - Insert the transducer probe into the patient's vagina. 5. - Position the probe for proper view of pelvic structures. pg 230 - While performing transvaginal ultrasonography, the nurse should first position the patient in the lithotomy position to ensure the optimal view of pelvic structures. The transducer probe is then covered with a suitable probe cover. Then the probe is lubricated with a water-soluble gel to increase penetration of ultrasonic waves. The probe is then inserted into the patient's vagina. Finally, the position of the probe is adjusted for a better view of the inner pelvic structures.

The nurse is performing a nonstress test in a pregnant patient. Arrange the steps for performing the test in the correct order. 1. The Doppler transducer is applied to the patient's abdomen. 2. The fetal movement is noted in the tracing. 3. The patient is placed in a semi-Fowler position. 4. The patient is asked to depress the button of the event marker.

1. - The patient is placed in a semi-Fowler position. 2. - The Doppler transducer is applied to the patient's abdomen. 3. - The patient is asked to depress the button of the event marker. 4. - The fetal movement is noted in the tracing. pg 238 - The patient is placed in a semi-Fowler position with a slight lateral tilt. This position optimizes uterine perfusion and prevents supine hypotension. After positioning, the Doppler transducer is applied to the patient's abdomen to record uterine contractions. Last, the patient is given a handheld event marker connected to a monitor. The patient is asked to depress the button on feeling the fetal movement. Thereafter, the fetal movements can be seen as tracings on the monitor.

The nurse is performing an oxytocin-stimulated contraction test in a pregnant patient. Arrange the steps of the procedure in the correct order. 1. The patient is given an intravenous infusion of oxytocin. 2. The patient is placed in a semi-Fowler position. 3. The patient's uterine contractions are monitored. 4. An ultrasound transducer is applied to the patient's abdomen.

1. - The patient is placed in a semi-Fowler position. 2. - The patient is given an intravenous infusion of oxytocin. 3. - An ultrasound transducer is applied to the patient's abdomen. 4. - The patient's uterine contractions are monitored. pg 240 - For contraction stress testing, the patient is first placed in a semi-Fowler position. Once the patient is positioned, an intravenous infusion of oxytocin is given to stimulate uterine contractions. After the injection is given, an ultrasound transducer is used to observe uterine contractions. The final step is to monitor the uterine contractions using the ultrasound transducer.

Biochemical examination of the amniotic fluid of a pregnant patient yields the following results: lecithin-to-sphingomyelin (L/S) ratio, 2:1; surfactant-to-albumin (S/A) ratio, 60 mg/g; and phosphatidylglycerol (PG) present. What conclusions will the nurse draw from this report? 1 The gestational age is 36 weeks. 2 The fetal lungs are well developed. 3 The fetus has a neural tube defect. 4 The fetus has an open neural tube defect.

2 - The fetal lungs are well developed. pg 234 - Biochemical findings such as an L/S ratio of 2:1, an S/A ratio of 60 mg/g, and the presence of PG in amniotic fluid indicate that the fetal lungs are well developed. The gestational age can be predicted only with the help of creatinine and lipid levels in the amniotic fluid. Creatinine levels greater than 2 mg/dL in amniotic fluid indicate that the gestational age is more than 36 weeks. The presence of alpha-fetoprotein (AFP) in the amniotic fluid indicates a neural tube defect in the fetus. The nurse needs to assess AFP levels in the amniotic fluid to determine whether the fetus has an open neural tube defect. A high AFP level in amniotic fluid after 15 weeks of gestation indicates that the fetus has an open neural tube defect.

The primary health care provider has referred a pregnant patient in the first trimester for an ultrasound. What are the possible reasons for this referral? Select all that apply. 1 To detect macrosomia 2 To confirm the pregnancy 3 To detect ectopic pregnancy 4 To detect congenital anomalies 5 To detect maternal abnormalities

2 - To confirm the pregnancy 3 - To detect ectopic pregnancy 5 - To detect maternal abnormalities pg 230 - During the first trimester, ultrasound examination is used mostly to confirm the pregnancy. Maternal abnormalities such as bicornuate uterus, ovarian cysts, and fibroids can also be detected by ultrasonography during the first trimester. An ectopic pregnancy is a complication of pregnancy in which the embryo implants outside the uterine cavity. Ultrasonography during the first trimester can also be used to rule out ectopic pregnancy. Ultrasonography during the second trimester of pregnancy is used to detect congenital anomalies. During the third trimester, ultrasound examination is performed to detect macrosomia, a condition in which the baby is abnormally large before birth.

While reviewing the reports of a pregnant patient in the third trimester, the nurse finds that the patient has been referred for transvaginal and transabdominal ultrasound scanning. What is the most likely reason for referring the patient for both tests? 1 To determine genetic abnormalities 2 To determine the risk of preterm labor 3 To assess development of the embryo 4 To determine the risk of ectopic pregnancy

2 - To determine the risk of preterm labor pg 230 - Premature labor occurs when the mother's body starts preparing for childbirth too early in her pregnancy. In some instances, during the second and third trimesters, transvaginal ultrasound scan may be used along with transabdominal scanning to evaluate the preterm labor. To detect genetic abnormalities in the fetus, chorionic villus sampling (CVS) is used in the first trimester and amniocentesis is used in the second and third trimesters. Ultrasound scan is usually not used to detect genetic abnormalities in the fetus. Transvaginal ultrasound scan is used in the first trimester of pregnancy to detect ectopic pregnancies and monitor development of the embryo.

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. Which specific lab result should the nurse assess? 1 hCG level 2 Hemoglobin level 3 Indirect Coombs test 4 Maternal serum alpha-fetoprotein (MSAFP)

3 - Indirect Coombs test pg 237 - The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy.

A nurse providing care for the antepartum woman should understand what about the contraction stress test (CST)? 1 It sometimes uses vibroacoustic stimulation. 2 It is an invasive test; however, contractions are stimulated. 3 It is considered negative if no late decelerations are observed with the contractions. 4 It is more effective than nonstress test (NST) if the membranes have already been ruptured.

3 - It is considered negative if no late decelerations are observed with the contractions. pg 241 - No late decelerations indicate a negative 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.

During a prenatal checkup, the patient who is 7 months pregnant reports that she is able to feel about two kicks in an hour. The nurse refers the patient for an ultrasound. What is the primary reason for this referral? 1 To check fetal position 2 To check gestational age 3 To check for fetal anomalies 4 To check for fetal well-being

4 - To check for fetal well-being pg 228 - Fetal kick count is a simple method to determine the presence of complications related to fetal oxygenation and activity level. The fetal kick count during the third trimester of pregnancy is approximately 30 kicks an hour; a count lower than that is an indication of poor health of the fetus. Fetal anomalies may not affect the oxygenation levels of the fetus. The nurse already knows the gestational age of the fetus; therefore the nurse need not refer the woman for ultrasonography to find the gestational age. Fetal position does not affect the activity level of the fetus.

The nurse is caring for an obese pregnant patient. Which test does the nurse recommend for the patient to assess the risk for intrauterine growth restriction? 1 Daily fetal movement count 2 Abdominal ultrasonography 3 Computed tomography (CT) 4 Transvaginal ultrasonography

4 - Transvaginal ultrasonography pg 230 - Intrauterine growth restriction is poor growth of the fetus during pregnancy. Transvaginal ultrasonography allows early diagnosis of intrauterine growth restriction and detailed examination of the pelvic anatomic features. Thick abdominal layers in obese women may not allow adequate penetration during abdominal ultrasonography; therefore transvaginal ultrasonography is preferred in obese women. Daily fetal movement count is used to monitor the complications related to poor fetal oxygenation. CT is contraindicated in pregnant women because the ionizing radiation may cause adverse effects in the fetus.

The nurse reviews the ultrasound reports of a pregnant patient and finds that the images of fetal anatomic details are not clear. The nurse then prepares the patient for a magnetic resonance imaging (MRI) scan. What does the nurse administer to the patient before performing the MRI scan? 1 A diuretic 2 A sedative 3 An analgesic 4 An antipyretic

2 - A sedative pg 234 - The MRI scan may take 20 to 60 minutes. During the scan, the patient must be perfectly still. Moreover, fetal movement during the scan will obscure the anatomic details. To avoid this problem, the patient should be administered a sedative before the MRI scan. Diuretics are administered to increase the rate of urine formation. If a diuretic is given before the MRI, frequent urination may occur. Because the patient does not complain of pain, analgesics need not be administered. Antipyretics would not helpful in decreasing the patient's activity level. They should be administered only if the patient has a fever.

Which technique is used to assess genetic abnormalities in a 12-week-old fetus? 1 Amniocentesis 2 Standard ultrasonography 3 Chorionic villus sampling (CVS) 4 Magnetic resonance imaging (MRI)

3 - Chorionic villus sampling (CVS) pg 236 - CVS is a popular technique used for genetically studying the fetus in the first trimester (11-14 weeks) of pregnancy. The advantage of CVS over other techniques is that it reveals the presence of genetic abnormalities at an early stage of pregnancy very accurately. Amniocentesis can be used for diagnosing genetic abnormalities only after 14 weeks of pregnancy; before 14 weeks, the amount of amniotic fluid available is insufficient for testing. Standard ultrasonography is not used to detect genetic abnormalities in the fetus. This diagnostic technique is used only for visualizing the fetus. MRI is used mostly to evaluate the fetal structure and overall growth, the placenta, and the quantity of amniotic fluid. This technique is not useful for genetic studies.