Ch 6 OB
The nurse is teaching a group of students about the different types of tests performed at different stages of pregnancy. Which statement would the nurse include in the teaching? Select all that apply. "Amniocentesis is an ultrasound assessment of the fetal status with an NST. It utilizes ultrasound with EFM to assess five variables." "Biophysical Profile (BPP) is a diagnostic procedure where a needle is inserted through the abdominal wall into the uterine cavity to obtain amniotic fluid and commonly performed for genetic testing." "Amniocentesis is necessary to elevate the uterus out of the pelvis for better visualization of the fetus body. It is done during the first half of the pregnancy." "A nonstress test is a screening tool that uses fetal heart rate patterns and accelerations as an indicator of fetal well-being." "Maternal Serum Alfa-Fetoprotein is a screening test that assesses for levels of AFP in the maternal blood to detect certain developmental defects in the fetus, such as neural tube defects."
"A nonstress test is a screening tool that uses fetal heart rate patterns and accelerations as an indicator of fetal well-being." "Maternal Serum Alfa-Fetoprotein is a screening test that assesses for levels of AFP in the maternal blood to detect certain developmental defects in the fetus, such as neural tube defects."
A client who is 21 weeks pregnant is scheduled for an amniocentesis today. The client informs the nurse that her bladder feels full. which is the nurse's best response? "Do not drink any more liquids for the rest of the day." "Empty your bladder before the test." "You will need to measure the urine. "Keep your bladder full for the procedure."
"Empty your bladder before the test."
During a prenatal education class, the educator discussed the types of environmental substances that can negatively impact pregnancy. Which statement from one of her clients would concern the nurse? Exposure to substance abuse drugs in not good for the pregnancy Exposure to air and environmental pollutants is harmful to the fetus Exposure to alcohol use causes harm to the fetus "It is ok to use marijuana for pain."
"It is ok to use marijuana for pain."
The client is prepared to have the amniocentesis test and asked the nurse the reason for the ultrasound. Which is the nurse's best response? "It is used for the purpose of identifying the fetal gestational age." "It is for assisting the perinatologist to visualize the intestinal wall." "It is used to take fetal measurements and locate the placenta, and the amniotic sac." "It is used for the purpose of obtaining images of the gestational uterine structures."
"It is used to take fetal measurements and locate the placenta, and the amniotic sac."
The nurse is performing an admission assessment on a client who is 14 weeks pregnant. The client told the nurse that she is having uncertainty about the pregnancy. Which is the best response by the nurse? "Do not worry because all pregnant moms experience the same feelings." "I will let the doctor know." "Tell me what you are uncertain about." "Let us talk about the discomforts of the pregnancy."
"Tell me what you are uncertain about."
The biophysical profile reports the following test results: Three episodes of limb movement; one episode of active extension with return to flexion of the fetal limb or trunk and opening and closing of the hand; absent pockets of amniotic fluid; one breathing episode that lasts a minimum of 30 secs; the NST was reactive. Which is the total score? 5 10 8 6
8
A client, 12 weeks' gestational age, is scheduled for a diagnostic test to detect ectopic pregnancy and evaluate uterine structures. The nurse anticipates that the client will need: A full bladder for the test Pain medications prior to the test To empty her bladder before the procedure To elevate her legs for the test
A full bladder for the test
The nurse understands that the diagnostic/screening test below uses high-frequency sound waves to produce an image of the fetus organs or tissues and is the most common diagnostic test in the first trimester during pregnancy. Which would the nurse include in the plan of care instructions for this client? The client should be in a lithotomy position. The client should lie on her side. A full bladder is necessary for the test. A needle is inserted into the client's abdominal wall.
A full bladder is necessary for the test.
Based on the image below, the nursing student on an Antepartum unit recognized that the client is on the electronic fetal monitoring (EFM) for which test? An ultrasound A nonstress test A vibroacoustic stimulation A magnetic resonance imaging (MRI)
A nonstress test
During an amniocentesis, the nurse instructs the client to call the nurse if she experiences: Fetal movements Hunger Abdominal cramping Fetal kicks
Abdominal cramping
The nurse reviews the client's umbilical artery Doppler test. which would be the nurse's interpretation if the result of the end-diastolic blood flow is absent or reversed? Normal Equivocal Abnormal Equal
Abnormal
The nurse is reviewing antenatal screening and diagnostic testing with a group of nursing students. The nurse explains that this test inserts a needle into the maternal abdominal area through the uterine cavity to obtain amniotic fluid. One of the student's best response is: Amniocentesis Percutaneous Biopsy Percutaneous umbilical cord sampling Chorionic villus sampling (CVS)
Amniocentesis Chorionic villus sampling (CVS)
The nurse on the antepartum unit is caring for a client post chorionic villus sampling procedure. Which would the nurse's priority intervention be? Provide 2L of fluids during the shift. Assess the fetal heart rate (FHR). Administer RhoGAM. Administer oxygen 2L via nasal cannula.
Assess the fetal heart rate (FHR
The nurse is caring for an 18 weeks gestation client who recently had an amniocentesis procedure. The client informed the nurse that she feels her underwear is wet. Which would be the nurse's first action? Call the physician Measure the client's vital signs Assess the perineal area Administer IV fluids
Assess the perineal area
The nurse admits a client who is 34 weeks pregnant on the Labor & Delivery unit. The client complains of no fetal movements since the morning. The health care provider (HCP) orders a non-stress test (NST) which is performed, but the result does not show any fetal heart rate accelerations within a 20-minute period. Which test would the nurse anticipate the HCP ordering? Select all that apply. Maternal serum alfa-fetoprotein profile (MSAFP) Biophysical profile Amniocentesis Ultrasound Vibroacoustic Stimulation (VAS)
Biophysical profile Ultrasound Vibroacoustic Stimulation (VAS)
The nurse reviews the client's amniotic fluid index (AFI) report and the AFI shows 24 cm. The nurse's best action would be to: Inform the charge nurse. Assess the maternal vital signs. Call the physician. Administer IV fluids
Call the physician
The nurse observed that there are five or more contractions in 10 minutes and a contraction greater than 10 minutes on the electronic fetal monitoring (EFM) strip. The nurse discontinued the IV oxytocin. Which is the next step the nurse should take? Continue to monitor the client. Readjust the EFM belts on the client's abdomen. Continue the IV oxytocin. Call the physician.
Call the physician.
The nurse is monitoring a client on the electronic fetal monitor (EFM). She observes one variable deceleration on the strip within a 20-minute period. Which would be the nurse's best action? Continue to assess the maternal vital signs. Keep the client in the supine position. Change the client's position to the left or right side. Call the physician.
Change the client's position to the left or right side.
The nurse is caring for a pregnant client and knows that this test is done for chromosomal analysis between 10-12 weeks' gestation to detect fetal anomalies caused by genetic disorders. It does not test for neural tube defects (NTDs). The nurse identified the following test as: Amniocentesis Tripler marker screening Percutenousum bilical cord sampling Chorionic villus sampling (CVS)
Chorionic villus sampling (CVS)
A pregnant client at 34 weeks gestation called the OB/GYN clinic, stating that she does not feel any fetal activity. How would the nurse respond to the client? "Tell me about your intake of meals and fluids." "When was the last time you ate?" "Come to the hospital so that further assessments can be done." "You will need to have a biophysical profile test."
Come to the hospital so that further assessments can be done."
A nurse is caring for a pregnant client who is to have a contraction stress test (CST). Which findings are indications for this procedure? Select all that apply. History of bleeding A reactive nonstress test (NST) Decreased fetal movement Preterm labor A non-reactive NST
Decreased fetal movement A non-reactive NST
The maternal serum alpha-fetoprotein (MSAFP) is a screening tool indicated for all high-risk pregnant clients between 15 -20 weeks gestation. A client who is 18 weeks pregnant had her blood drawn for this test. Her test results showed low levels which is associated with which disorder? Spina bifida Diabetes mellitus Down syndrome (Trisomy 21) Anencephaly
Down syndrome (Trisomy 21)
A nurse is discussing the indications for an ultrasound with pregnant women in a prenatal education class. A client, who is in her first trimester, asks the nurse which tests the ultrasound could assess for at this time. Which would be an appropriate nursing response? Select all that apply. Estimate gestational age Evaluate the uterus structures Confirm intrauterine pregnancy Detect fetal anomalies Confirm fetal cardiac activity
Estimate gestational age Evaluate the uterus structures Confirm intrauterine pregnancy Confirm fetal cardiac activity
A nurse in the antepartum unit is reviewing the indications for ultrasound by trimester of pregnancy. Put the following nursing actions in the order in which they will occur. Estimate gestational age Detect fetal anomalies Confirm the client's due date Assess biophysical profile (BPP)
Estimate gestational age Confirm the client's due date Detect fetal anomalies Assess biophysical profile (BPP)
The nurse is caring for a client on the electronic fetal monitor (EFM). Which will be the nurse's priority? Position the client in a lithotomy position Place the client on a lateral position to prevent compression of the inferior vena cava Put a folded sheet under the back of the client Have the client sit up for the test
Place the client on a lateral position to prevent compression of the inferior vena cava
The nurse knows that the client is scheduled for a transabdominal chorionic villus sampling test. Based on the diagram below, where is the sample collected from? Amniotic membrane Placenta Bladder Uterine wall
Placenta
The nurse reviews the biophysical profile (BPP) report of 8/10 and interprets the result as: Equivocal Reassuring Non-reassuring Abnormal
Reassuring
The nurse reviews a pregnant client's record and notes that the amniotic fluid index (AFI) is 30 cm. The nurse understands that this measurement can indicate: An AFI of 30 cm is average measurement of amniotic fluid in pregnancy and represents good renal perfusion. This result is indicative of oligohydramnios (decreased or no amniotic fluid) and can be associated with increased prenatal death, and close maternal and fetal monitoring is needed. The result is good measurement and shows increased urine production. The result reflects polyhydramnios and may indicate fetal malformation, such as NTDs, obstruction of fetal gastrointestinal tract.
The result reflects polyhydramnios and may indicate fetal malformation, such as NTDs, obstruction of fetal gastrointestinal tract.
A pregnant mother in her third trimester is scheduled for an amniotic fluid index (AFI) test. The nurse understands the reason for the test when she verbalizes which statement? The test is a screening tool that assesses fetal accelerations The test evaluates the uterine and cervical structures of the pregnancy The test is a screening tool that measures the volume of amniotic fluid w/ ultrasound The test uses a needle to puncture the abdomen to obtain amniotic fluid
The test is a screening tool that measures the volume of amniotic fluid w/ ultrasound
The nurse is caring for a 30 weeks gestational client on the antepartum unit. In the client's discharge plan of care, the nurse should include which instructions on daily fetal movement count? Select all that apply. The woman must lie on her side while counting movements. If fetal movement is decreased, inform the client to eat and drink some fluids, rest, and focus on fetal movement for an hour. The client must increase her caffeine intake to initiate fetal movements. Inform the client to report decreased fetal movements below the normal. The client must only begin her fetal count in the morning
The woman must lie on her side while counting movements. If fetal movement is decreased, inform the client to eat and drink some fluids, rest, and focus on fetal movement for an hour. Inform the client to report decreased fetal movements below the normal.
The nurse is reading the contraction stress test (CST) result and interprets it as a negative result. Which is the criteria for interpretation of a negative result? There are two late decelerations of fetal heart rate (FHR) with 50% of uterine contractions noted on the EFM. There are significant variable decelerations. There is no fetal activity. There are no decelerations (variable or late) in a 10-minute EFM strip with three uterine contractions greater than 40 seconds.
There are no decelerations (variable or late) in a 10-minute EFM strip with three uterine contractions greater than 40 seconds.
The nurse is caring for a 24-week gestational age client. The client states that she is worried about the scheduled antenatal tests. Which is the nurse's best response? "There is no need to worry since all the tests are non-invasive procedure." "Tell me what your concerns are." "You are not scheduled for the tests until tomorrow." "The risks for the tests are minimal."
"Tell me what your concerns are."
A nurse is a guest speaker for a maternal/newborn class and her topic is antenatal testing. One of the students demonstrates understanding of the risk factors for fetal genetic disorders when she responds: Select all that apply. "The client is more than 35 years old." "The client has a history of genetic disorders." "The client uses folic acid every day." "The client has a history of birth control use." "The client has a positive alpha-fetoprotein screening test."
"The client is more than 35 years old." "The client has a history of genetic disorders." "The client has a positive alpha-fetoprotein screening test."
A client in her first trimester is undergoing an ultrasound test in the Radiology department. A nursing student is observing and asks the nurse why the physician ordered a three-dimensional (3D) ultrasound. The nurse's best response is: The test will tell us if the mother is in pre-term labor The physician wants to know the age of the fetus "The test is needed for further evaluation of possible fetal anomalies of the face, heart, or skeletal system." The test will identify the sex of the baby
"The test is needed for further evaluation of possible fetal anomalies of the face, heart, or skeletal system."
A nurse working on the antepartum unit is caring for a 20 weeks gestation mother. As the nurse reviews the client's record, she notices that the lung maturity indicator test L/S ratio is < 2:1. The nurse knows that this result is indicative of: Fetal lung maturity Effective lung function Fetal lung immaturity Effective lung growth
Fetal lung immaturity
The nurse is reviewing the biophysical profile (BPP) results and would expect which variables to be included in this test? Select all that apply. Fetal position Fetal tone Amniotic fluid volume Fetal breathing movements Fetal movement
Fetal tone Amniotic fluid volume Fetal breathing movements Fetal movement
A nurse is caring for a client who is scheduled for a maternal serum alpha-fetoprotein test at 15 weeks of gestation. The nurse would provide which explanation about this test to the client? It is a screening test for spinal defects in the fetus. It looks for different types of diseases in the fetal cells. This test identifies a Rh incompatibility between the mother and fetus. It assesses fetal lung maturity and lecithin/sphingomyelin (L/S) ratio.
It is a screening test for spinal defects in the fetus.
A client is scheduled for an amniocentesis. Which is the most important instruction that the nurse would include in the plan of care? Tell the client to drink 2L of fluids Instruct the client not to have anything by mouth for eight hours Place the cleint a lithotomy position Provide breathing and relaxation techniques the client can use.
Provide breathing and relaxation techniques the client can use.
The nurse is caring for a client following an amniocentesis procedure. The nurse reviews the client's chart and notices that the client's blood type is O negative. Which does the nurse anticipate administering? Antibiotic IV Blood transfusion - 1 unit of packed RBCs RhoGAM Normal Saline - IV fluids bolus
RhoGAM
The physician orders a Magnetic Resonance Imaging (MRI) test to have very detailed images of the fetus anatomy. The nurse working on an antepartum unit should include which instructions in the plan of care? Select all that apply. The client must keep her silver metal bracelet on for identification. The client must lie in a supine position for the test with a left lateral tilt on the MRI table. The client must remove all metallic objects before the test. The client must remove her earrings. No iodine contrast will be used for the test.
The client must lie in a supine position for the test with a left lateral tilt on the MRI table. The client must remove all metallic objects before the test. The client must remove her earrings. No iodine contrast will be used for the test.
The nurse is caring for a client who completed the chorionic villus sampling test 2 hours ago. Which finding would be concerning for the nurse? The client complains of nausea. The client reports abdominal cramping. The client's temperature is 98.3 degrees Fahrenheit. The client's blood pressure is 102/64.
The client reports abdominal cramping.
A nurse is monitoring a 30 weeks gestation client on the antepartum unit. Which assessment findings concern the nurse? The EFM strip shows two or more accelerations that increase 10 beats above the FHR baseline for 10 seconds in 20 minutes. There are several variable decelerations that last for 30 seconds within a 20 minutes period. There are no decelerations noted on the EFM strip. The EFM strip shows a baseline fetal heart rate (FHR) of 120 bpm (beats per minute).
There are several variable decelerations that last for 30 seconds within a 20 minutes period.
The nurse knows that RhoGAM is given to O negative mothers for which reason? To increase lung maturity To promote lung function To increase folic acid production To prevent antibody formation in Rh-negative women
To prevent antibody formation in Rh-negative women
The nurse is caring for a client who is scheduled for a contraction stress test (CST). During the procedure, the nurse's best action is to: Assess the mother's vital signs every hour. Monitor the fetal heart rate (FHR) and fetal activity. Have the mother brush her nipples for 15 minutes. Hang Dextrose IV fluids.
Monitor the fetal heart rate (FHR) and fetal activity.
The nursing student asks the nurse about tests that are commonly performed for a suspected brain abnormality. How would the nurse respond? NST Magnetic resonance imaging Amniocentisis Doppler Velocimetry
Magnetic resonance imaging
The client asked the nurse what a complication of the amniocentesis procedure could be. which would be the nurse's best response? Select all that apply. Maternal or fetal hemorrhage Leakage of amniotic fluid Preterm labor Maternal or fetal infection Nausea/vomiting
Maternal or fetal hemorrhage Leakage of amniotic fluid Preterm labor Maternal or fetal infection
The nurse is caring for a 38 weeks gestational client who is scheduled for a contraction stress test (CST). Which would the nurse do to prepare the client? Inform the client to remove all her jewelry. Have the client void before the test. Position the client in the prone position. Perform a fundus measurement.
Have the client void before the test.
A woman planning on becoming pregnant is receiving perinatal education from the nurse. Which statements by the client would concern the nurse? Select all that apply. "I have to consume a large amount of alcohol to cause significant harm to my child." "Any amount of alcohol can have a negative impact on the pregnancy." "Beer is okay since it is low in alcohol." "I can have a glass of red wine since the food will absorb it." "If I consume alcohol, the fetus can be harmed before I am aware of being pregnant."
I have to consume a large amount of alcohol to cause significant harm to my child." "Beer is okay since it is low in alcohol." "I can have a glass of red wine since the food will absorb it."
The nurse is caring for a client at 32 weeks gestation who requires a non-invasive screen tool to indicate well-being of the fetus. The findings of the test performed indicate reactivity when the fetal heart rate (FHR) increases 15 beats above baseline, lasting for 15 seconds twice or more in 20 minutes. Which test did the nurse use to obtain these findings? Non-stress test (NST) Ultrasound Biophysical profile (BPP) Amniocentesis
Non-stress test (NST)
The nurse knows that the assessment of fetal status is a key component of perinatal care. In a class discussion with nursing students, which would the nurse identify as appropriate methods used for ongoing assessment of the fetal-well-being during pregnancy? Select all that apply. Non-stress test (NST) Daily fetal movement count (kick count) Biophysical profile Amniotic fluid index Vibroacoustic stimulation
Non-stress test (NST) Daily fetal movement count (kick count) Biophysical profile Amniotic fluid index Vibroacoustic stimulation
While caring for a mother during a transabdominal ultrasound procedure, which finding would the nurse be most concerned about? The radiology technician inserted a sterile sheathed probe into the vagina. The client is in lithotomy position. The client is in high-fowler position. The client has pillow under her head.
The client is in high-fowler position.
A nursing student is examining a client's chart on the Antepartum unit and asks why an umbilical artery Doppler flow test is ordered. which would be an appropriate response for the nurse? Select all that apply. "It is used for some mothers to identify the gestational age of the fetus." "It is used to detect any abnormal structures of the fetus." It is non-invasive screening technique that uses advanced ultrasound technology to assess resistance to blood flow in the placenta." "Images are obtained of blood flow in the umbilical artery." "This test assesses placental perfusion."
It is non-invasive screening technique that uses advanced ultrasound technology to assess resistance to blood flow in the placenta." "Images are obtained of blood flow in the umbilical artery." "This test assesses placental perfusion."
The biophysical profile (BPP) is an ultrasound assessment of fetal status along with a non-stress test (NST). A score of 2/10 will prompt to nurse to: Reposition the client on the left side Prepare the client for immediate delivery Continue to monitor the fetal heart rate and the mother's vital signs Repeat the biophysical profile screening test
Prepare the client for immediate delivery
The nurse explains to the nursing student that a triple marker screening (multiple marker screening) is done to accomplish which? To identify amniotic fluid index (AFI) To detect some trisomy and neural tube defects (NTDs), such as anencephaly, omphalocele To obtain blood sample for a complete blood count (CBC) analysis To identify fetal lung maturity
To detect some trisomy and neural tube defects (NTDs), such as anencephaly, omphalocele
The maternal serum alpha-fetoprotein (MSAFP) is a screening tool for certain developmental defects in the fetus. The client wants to know at what time in her gestational period the test should be performed. which is the nurse's best response? "The test should be scheduled in the first trimester of the pregnancy." "The test should be scheduled in the last trimester of the pregnancy." "The test should be scheduled between 15-20 weeks' gestation." "The test is scheduled between 30-34 weeks' gestation
"The test should be scheduled between 15-20 weeks' gestation."
The nurse is performing a vibroacoustic stimulation, a screening tool that uses auditory stimulation (an artificial larynx) to assess fetal well-being with electronic fetal monitor (EFM). The nurse has placed the artificial larynx in the indicated area on the maternal abdomen two times lasting for one second and has noted no fetal accelerations. The next step would be to: Call the physician. Repeat the test again for 1 second on the indicated area of the maternal abdomen. Provide comfort measures. Schedule the client for a week's follow up visit.
Repeat the test again for 1 second on the indicated area of the maternal abdomen.
The nonstress test (NST) uses electronic fetal monitoring (EFM) to assess fetal well-being. A nursing caring for a 32 weeks' gestational client on EFM will place the client in the following position: High fowler Prone Lithotomy Semi-fowler's or lateral
Semi-fowler's or lateral
The nurse is caring for a client who had a percutaneous umbilical blood sampling procedure (PUBS) an hour ago. The client complains of lower back pains and the electronic fetal monitor (EFM) shows some contractions. Which medication would the nurse anticipate the healthcare provider to order? Terbutaline Labetalol Percocet Oxytocin
Terbutaline (tocolytic med)
The nurse reviews the client's file upon return from Radiology. The client is 37 weeks gestational age and completed the amniotic fluid index test (AFI). The nurse is concerned with which AFI result? AFI is 22 AFI is 4 cm AFI is 12 cm AFI is 9 cm
The AFI measurement is 4 cm
