Chapter 10 Practice Questions
What score do you want to see on a patient's Biophysical Profile (BPP)?
10/10 if NST is done. If not then an 8/8
A non stress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The physician then prescribes a contraction stress test, and the results are documented as negative. A nurse interprets the findings of the CST as indicating: what?
A normal test result
Prenatal diagnostic test that is performed to obtain amniotic fluid to examine the fetal cells it contains.
Amniocentesis
Noninvasive dynamic assessment of the fetus and its environment that is based on acute and chronic markers of fetal disease. It uses real-time ______. This test includes assessment of five variables, namely ________, ________, ________, ________, and _______.
Biophysical Profile (BPP); Ultrasound; Fetal breathing movements, fetal body movements, fetal tone, non-stress test, amniotic fluid volume
Procedure that involves the removal of a small tissue specimen from the fetal portion of the placenta. Because this tissue originates from the zygote, it reflects the genetic makeup of the fetus and is performed between 10 and 13 weeks of gestation.
Chorionic villus sampling (CVS)
Test used to identify the jeopardized fetus that is stable at rest but shows evidence of compromise when exposed to the stress of uterine contractions. If the resultant hypoxia of the fetus is sufficient, a deceleration of the FHR will result. Two methods used for this test are the ____ test and the ____ test.
Contraction stress test; nipple-stimulated contraction stress, oxytocin-stimulated contraction stress
Screening test for Rh incompatibility by examining the serum of Rh-negative women for Rh antibodies.
Coombs (indirect)
Assessment of fetal activity by the mother is a simple yet valuable method for monitoring the condition of the fetus.
Daily fetal movement count (DFMC) or kick count;
Noninvasive study of blood flow in the fetus and placenta with ultrasound
Doppler blood flow analysis
Term used to refer to the cessation of fetal movements entirely for 12 hours.
Fetal alarm signal (FAS)
A pregnancy in which the life or health of the mother or her fetus is jeopardized by a disorder coincidental with or unique to pregnancy.
High risk pregnancy
Noninvasive radiologic technique used for obstetric and gynecologic diagnosis by providing excellent picture of soft tissue without the use of ionizing radiation.
Magnetic resonance imaging (MRI)
Test used as a screening tool for neural tube defects in pregnancy. The test is ideal performed between 16 and 18 weeks of gestation.
Maternal serum alpha-fetoprotein (MSAFP)
Test based on the fact that the heart rate of a healthy fetus with an intact central nervous system will usually accelerate in response to its own movement.
Nonstress test
State two risk factors for each of the following pregnancy-related problems: Polyhydramnios Intrauterine growth restriction Oligohydramniosk Chromosomal abnormalities.
See box 10.2, which lists risk factors for each pregnancy-related problem identified
Prenatal diagnostic test that provides direct access to the fetal circulation during the second and third trimesters.
Percutaneous umbilical blood sampling (PUBS)
Mary is at 42 weeks of gestation. Her physician has ordered a biophysical profile (BPP). She is very upset and tells the nurse, "All my doctor told me is that this test will see if my baby is okay. I do not know what is going to happen and if it will be painful to me or harmful for my baby." a. State a nursing diagnosis that reflects this situation. b. Describe how the nurse should respond to Mary's concerns. c. Mary receives a score of 8 for the BPP. List the factors that were evaluated to obtain this score and specify the meaning of Mary's test results of 8.
See Biophysical Profile section and Table 10.2 and 10.3 for identification of variables tested; scoring: a. anxiety related to unexpected need to undergo a biophysical profile b. describe how the test will be performed using ultrasound and external electronic fetal monitoring; explain that the purpose of the test is to view the fetus within its environment, to determine the amount of amniotic fluid,, and assess the FHR response to fetal activity c. a score of 8-10 is a normal result
Identify factors that would place the pregnant woman and fetus/neonate at risk, for Biophysical factors
See Box 10.1 and Assessment of Risk Factors section
Identify factors that would place the pregnant woman and fetus/neonate at risk, for Environmental factors
See Box 10.1 and Assessment of Risk Factors section
Identify factors that would place the pregnant woman and fetus/neonate at risk, for Psychosocial factors
See Box 10.1 and Assessment of Risk Factors section
Identify factors that would place the pregnant woman and fetus/neonate at risk, for Sociodemographic factors
See Box 10.1 and Assessment of Risk Factors section
Susan, who has diabetes and is in week 36 of pregnancy, has been schedule for a non stress test. a. Discuss what you would tell Susan about the purpose of this test and what will be learned about her baby's well-being. b. Describe how you would prepare Susan for this test. c. Discuss how you would conduct the test. d. indicate the criteria you would used to determine whether the result of the test was: - Reactive: - Nonreactive:
See Nonstress Test section; a. test measures response of FHR to fetal activity to determine adequacy of placental perfusion and fetal oxygenation b. tell her that she can eat before and during the test; schedule test at time of day that fetus is usually active; assist woman into semi recumbent or seated position c. attach tocotransducer to funds and Doppler transducer at site of point of maximum intensity (PMI); instruct woman to indicate when fetus moves; assess change, if any, in FHR following movement d. see figs. 10.11 and 10.12 and box 10.7 for the criteria to determine the test results
Discuss the role of the nurse when caring for high risk pregnant women who are required to undergo antepartal assessment testing to determine fetal well-being.
See Nurses' Role in Assessment and Management of High Risk Pregnancy section;
Annie is a primigravida who is at 10 weeks of gestation. Her prenatal history reveals that she was treated for pelvic inflammatory disease 2 years ago. She describes irregular menstrual cycles and is therefore unsure about the first day of her last menstrual period. Annie is scheduled for a transvaginal ultrasound. a. Cite the likely reasons for the performance of this test. b. Describe how the nurse should prepare Annie for this test.
See Ultrasonography section: a. this woman was tested to determine location of gestational sac because PID could have resulted in narrowing of Fallopian tube, thereby increasing risk for ectopic pregnancy; in addition, a determination of gestational age and estimation of date of birth would be done related to irregular cycles and unknown date of last menstrual period (LMP). b. explain purpose of test, how will be performed, and how it will feel; assist her into a lithotomy position or supine position with hips elevated on a pillow; point out structures on monitor as test is performed.
Latisha, a pregnant woman at 20 weeks of gestation, is scheduled for a series of trans abdominal ultrasounds to monitor the growth of her fetus. Describe the nursing role as it applies to Latisha and transabdominal ultrasound examinations.
See Ultrasonography section; Instruct woman to come for test with full bladder if appropriate; explain purpose of test and method of examination; assister her into a supine position with head and shoulders elevated on pillow and hip slightly tipped to right or left side; observe fore supine hypotension during test and orthostatic hypotension when rising to upright position after test; indicate how the fetus is being measured and point out fetus and its movements.
Jan, age 42, is 18 weeks pregnant. Because of her age, Jan's fetus is at risk for genetic anomalies. Jan's blood type is A negative and her partner's, the father of her baby, is B positive. Her primary health care provider has suggested an amniocentesis. Describe the nurse's role in terms of each of the following: a. preparing Jan for the amniocentesis b. supporting gran during the procedure c. providing Jan with post procedure care and instruction
See amniocentesis including Safety Alert section and Nurse's Rold in Assessment and Management of High Risk Pregnancy section; a. explain procedure, witness informed consent, assess maternal vital signs and health status and FHR before the test; ensure that ultrasound is performed to locate placenta and fetus before the test. b. explain what is happening and what she will be feelingg; help her relax; encourage her to ask questions and voice concerns and feelings; assess her reactions c. monitor maternal vital signs, status, and FHR; tell her when test results should be available and whom to call; administer RhoGAM because she is Rh negative; teach her to assess herself for signs of infection, bleeding, rupture of membranes, and uterine contractions; make a follow-up phone call to check her status;
Beth is scheduled for a contraction stress test following a nonreactive result on a stress test. Nipple stimulation will be used to stimulate the required contractions. a. Discuss what you would tell Beth about the purpose of this test and what will be learned about the well-being of her fetus b. Describe how you would prepare Beth for the test. c. Indicate how you would conduct the test. d. State how you would conduct the test differently if exogenous oxytocin (Pitocin) is used instead of nipple stimulation e. Indicate the criteria you would use to determine whether the result of the test was: - Negative - Positive - Suspicious or equivocal - Equivocal-hyperstimulatory - Unsatisfactory
See contraction Stress Test section a. the test is a way of determining how her fetus will react to the stress of uterine contractions as they would occur during labor; uterine contractions decrease perfusion through the placenta leading to fetal hypoxia; late decelerations during this test could be interpreted as an early warning of fetal compromise. b. assess woman's vital signs. general health status, and contraindications for the test; attach external electronic fetal monitor and assess FHR and uterine activity; assist woman into lateral, semi recumbent, or seated position; determine whether an informed consent is required because contractions will be stimulated. c. see nipple-stimulated contraction stress test section d. see oxytocin-stimulated contraction stress test section e. see table 10.5 for criteria used to interpret the rest results: negative: no late decelerations are noted; positive: late decelerations with more than half of the contractions, limited variability; Suspicious/ equivocal: late decelerations with less than half of the contractions Equivocal-hyperstimulatory: late decelerations with excessive uterine contractions or tone Unsatisfactory: recording is inadequate.
Test used to screen for Down syndrome. It is performed between 16v and 18 weeks of gestation. The levels of three markers, namely ______, ______, and ______. _______ Test used to screen for Down syndrome that adds an additional marker, namely ______; it increases accuracy of the test, especially in women less than 35 years of age.
Triple-marker; MSAFP, unconjugaed estriol, hCG, age; quad screen, inhibit A
Diagnostic test that involves the use of sound having a frequency higher than that detectable by humans to examine structures inside the body. During pregnancy, it can be done by using either the ______ or the ______ approach
Ultrasound (sonography); transvaginalabdominal
Test that determines fetal response to the stimulation of vibration and sound; the expected response is acceleration of the fetal heart rate.
Vibroacoustic stimulation test (fetal acoustic stimulation test)
A pregnant woman is scheduled for a transvaginal ultrasound test to establish gestational age. In preparing this woman for the test, the nurse would: a. place the woman in a supine position wit her hips elevated on a folded pillow b. instruct her to come for the test with a full bladder c. administer an analgesic 30 minutes before the test d. lubricate the vaginal probe with transmission gel.
a; a supine position with hips elevated enhances the view of the uterus; a lithotomy position may also be used; a full bladder is not required for the vaginal ultrasound but would be needed for most abdominal ultrasounds; during the test the woman may experience some pressure but medication for pain relief before the test is not required; contact gel is used with the abdominal ultrasound; water-soluble lubricant may be used to ease insertion of the vaginal probe.
A nurse in a health care clinic is instructing a client on how to perform "kick rounds." Which statement by the client indicates a need for further instruction? a. I will record the number of movement or kicks. b. I need to lie flat on my back to perform the procedure. c. If I count fewer than 10 kicks in a 12 hour period, I need to contact the physician. d. I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks.
b. I need to lie flat on my back to perform the procedure. A pregnant woman should never be instructed to lie flat on her back.
A 40-year-old woman at 18 weeks of gestation is having a triple marker test performed. She is obese, and her health history reveals that she is Rh negative. The primary purpose of this test is to screen for: a. spina bifida b. Down syndrome c. gestational diabetes d. Rh antibodies
b; the triple marker test is used to screen the older pregnant woman for the possibility that her fetus has Down syndrome; serum levels of alpha fetoprotein (AFP), unconjugated estriol, and hCG are measured; maternal serum alpha-fetoprotein alone is the screening test for open neural tube defects such as spina bifida; a 1-hour, 50g glucose test is used to screen for gestational diabetes; amniocentesis and Coombs tasting would be used to check for Rh antibodies and sensitization
During a contraction stress test, four contractions lasting 45-55 seconds were recorded in a 10-minute period. A late deceleration was noted during the third contraction. The nurse conducting the test would document that the result is: a. negative b. positive c. suspicious d. unsatisfactory
c; A suspicious result is recorded when late decelerations occur Sith less than 50% of the contractions; a negative test result is recorded when no late decelerations occur during at least three uterine contractions lasting 40-60 seconds each, within a 10-minute period; a positive test is recorded when there are persistent late decelerations with more than 50% of the contractions; unsatisfactory is the result recorded when there is a failure to achieve adequate uterine contractions.
As part of preparing a 24 year old women at 42 weeks gestation for a non stress test, the nurse would: a. tell the woman to fast for 8 hours before the test. b. explain that the test will evaluate how well her baby is moving inside her uterus. c. show her how to indicate when her baby moves. d. attach a spiral electrode to the presenting part to determine FHR patterns.
c; food/fluid is not restricted before the test; the test will evaluate the response of the fetal heart rate (FHR) to fetal movement - acceleration is expected; external not internal monitoring is used.
A 34-year-old woman at 36 weeks of gestation has been scheduled for a biophysical profile. She asked the nurse why the test needs to be performed. The nurse would tell her the test: a. determines how well her baby will breathe after it is born. b. evaluates the response of her baby 's heart to uterine contractions. c. measures her baby's head size and length. d. observe her baby's activities in utero to predict fetal well-being.
d; an amniocentesis with analysis of amniotic fluid for the L/S ratio and presence of phosphatidylglycerol (Pg) is used to determine pulmonary maturity; choice b refers to a contraction stress test; choice c refers to serial measurements of fetal growth using ultrasound
