Review terms and
definitions Focus your studying with a path Get faster at matching terms A woman arrives at the clinic
seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect
(NTD). Which characteristics place the woman in a high risk category? Sets with similar termsC Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. This category is correctly referred to as sociodemographic risk, not geographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Environmental risks are those that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants. ANS: A, B, C, E A bicornuate uterus, multifetal gestation, presence of ovarian cysts, and presence and location of pregnancy can be determined by transvaginal ultrasound in the first trimester of pregnancy. This procedure is also used for estimating gestational age, confirming fetal viability, identifying fetal abnormalities or chromosomal defects, and identifying the maternal abnormalities mentioned, as well as fibroids. Amniotic fluid volume is assessed during the second and third trimesters. Conventional ultrasound would be used. PTS: 1 DIF: Cognitive Level: Analysis REF: 167 OBJ: Nursing Process Step: Planning MSC: Client Needs: Physiologic Integrity ANS: A, B, C Elevated levels of AFP may indicate open neural tube defects (e.g., anencephaly, spina bifida), abdominal wall defects (e.g., omphalocele, gastroschisis), or fetal demise. Low levels of AFP may indicate chromosomal trisomies (e.g., Down syndrome, trisomy 21) or gestational trophoblastic disease. PTS: 1 DIF: Cognitive Level: Analysis REF: 169 Review terms and
definitions Focus your studying with a path Get faster at matching terms The nurse is working in an
outpatient clinic. Which patient's indications most warrant fetal monitoring in the third trimester? Sets with similar termsThe nurse is performing a nonstress test (NST) on a patient who is at 37 weeks of gestation. The nurse notes the fetal heart rate is increased at 12 bpm above the baseline and stays elevated for 20 seconds with fetal movement. How should the nurse document this assessment? 1 Accelerations When an NST shows fetal heart is increased at 12 bpm above the baseline and stays elevated for 20 seconds with fetal movement, it is documented as an acceleration. Deceleration is a decrease in fetal heart rate. An acceleration in heart rate does not indicate poor fetal reaction. Bradycardia is indicated by a fetal heart rate below the normal range for gestational age. A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? 4 "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." 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 requires a full bladder. An amniocentesis is a test after which a pregnant woman should be driven home. A maternal serum alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps determine Down syndrome. Which screening test monitors fetal activity? 1 Nonstress Test (NST) An NST measures fetal activity and fetal heart rate. An amniocentesis evaluates the amniotic fluid. PUBS examines the blood of the fetus. CVS examines the chorionic villus of the fetus. The nurse is reviewing a 17-week gestational patient's multiple-marker screen and notes it is elevated. Which diagnostic test does the nurse anticipate the health care provider will request ? 2 Amniocentesis An amniocentesis is used to identify chromosomal, metabolic, or genetic abnormalities. Amniocentesis for prenatal diagnosis is usually performed midtrimester, between 15 and 20 weeks of gestation. An ultrasound is not used as a diagnostic tool to evaluate an elevated multiple marker. CVS is normally performed between 10 and 13 weeks of gestation to diagnose fetal chromosomal, metabolic, or deoxyribonucleic acid (DNA) abnormalities. PUBS can be used to obtain fetal chromosomes after 18 weeks of gestation but is not as safe as an amniocentesis and is only performed for high-risk patients on a case-by-case basis. The nurse is caring for a patient recovering from a transcervical chorionic villi sampling (CVS) procedure. Which information will the nurse include in the patient's discharge instructions? 3 Avoid exercise for 24 hours Discharge instructions after a CVS should include avoiding exercise for 24 hours. The patient should rest for 24 hours, not 72. Sexual intercourse should be avoided for 24 hours, not 2 weeks. Passage of clots from the vagina is an abnormal finding that should be reported Which is a complication related to percutaneous umbilical blood sampling (PUBS)? 4 Thrombosis PUBS increases the risk of thrombosis formation. Fetal bradycardia, not tachycardia, is a complication of PUBS. Decreased fetal lung maturity is not a complication of PUBS. Preterm, not postterm, labor is a complication of PUBS. The nurse notes a patient had a reactive nonstress test (NST). How should the nurse interpret this test result? 4 There were two or more fetal heart rate accelerations within a 20-minute period. A reactive NST is defined as having two or more fetal heart rate accelerations within a 20-minute period. This is a normal finding. A deceleration, whether over 15 minutes or 1 minute, is when the fetal heart rate decreases; this is not a reactive NST. A 4-minute fetal heart rate acceleration is not a reactive NST; it is too long. The nurse is preparing to draw a blood sample for a multiple-marker screening on a pregnant patient. The nurse understands that which factor predisposes the fetus to the highest
risk of a neural tube defect (NTD), but may have a lower alpha-fetoprotein (AFP) level? 4 Type 1 Diabetes Women with type 1 diabetes have a greater risk for a fetus with an NTD but have a lower AFP level. Black women have a lower risk for a baby with an NTD but a higher AFP level than other ethnic groups. Asthma and systemic lupus are not associated with NTDs or abnormal AFP levels. The nurse is teaching a patient in the second trimester about fetal kick count. Which statement by the patient needs correction?
4 "I should consult an obstetrician if the fetal movements are less than 10 in 1 hour." The fetal movement count helps monitor the condition of the fetus. If the fetal movements are less than three in 1 hour, it indicates a risk of abnormality. Therefore, less than 10 fetal movements in an hour may not be abnormal and the patient may not need to consult the obstetrician. The patient should count fetal kicks at least once a day for a period of 60 minutes because it helps assess fetal activity. Fetal movements are usually not present during the fetal sleep cycle. The patient can count the fetal kicks either after meals or before bedtime when fetal movements are typically highest. The nurse is performing a contraction stress test (CST) and notes no late decelerations. How should the nurse interpret this test result? 1 Negative CST A negative CST describes a fetal heart rate response to contractions with no decelerations. A positive CST describes a fetal heart rate deceleration with a minimum of 50% of the contractions. A suspicious or equivocal response describes intermittent late decelerations or a sudden decrease in fetal heart rate that quickly returns to the baseline. The levels of which hormones and proteins are measured in a triple screen maternal
serum test? Select all that apply. 1,2,3 The hormones and proteins that are measured in a triple screen are hCG, AFP, and uE3. Hemoglobin and bilirubin are not measured in a triple screen. How is percutaneous umbilical blood sampling (PUBS) performed? 1 A long needle is inserted through the abdomen into the umbilical vein. PUBS is performed by inserting a long needle through the abdomen into the umbilical vein. Transvaginal ultrasound is performed by inserting a transducer probe into the vagina. A transabdominal ultrasound transducer is performed by placing a Doppler ultrasound on the abdomen. An amniocentesis is performed by inserting a long needle through the abdomen into the amniotic sac. What does a nurse providing care for the antepartum woman need to understand about the contraction stress test (CST)? 3 It is considered negative if no late decelerations are observed with the contractions. 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. The nurse is caring for four patients, all at 38 weeks of gestation. Which patient's nonstress test (NST) is most likely to show altered fetal movement? 2 The patient who is taking methadone daily Ingestion of methadone can alter fetal movement. Intake of eggs and grits, ingestion of ferrous sulfate, and the presence of twins should not cause altered fetal movement. While caring for a patient receiving a nonstress test, the nurse does not observe accelerations in the fetal heart rate after 30 minutes of FHR monitoring.
What intervention might the nurse perform in order to elicit FHR accelerations? 4 Provide vibroacoustic stimulation If fetal heart rate accelerations do not occur after 20 to 30 minutes of continuous FHR monitoring, the nurse can use vibroacoustic stimulation. The patient in labor is usually placed in a lateral or semi-Fowler's position to prevent umbilical cord prolapse. Often, the patient is assisted to turn to the left side. The nurse administers oxygen via a nonrebreather face mask in case of fetal hypoxemia. A nurse is caring for a patient who is scheduled for a biophysical profile. Which criteria are included in the scoring of a biophysical profile? Select all that apply. 1,2,4,5,6 The biophysical profile includes the fetal tone, NST, gross body movement, amniotic fluid volume, and fetal breathing movements. A CST is not included in the scoring for a biophysical profile. What is the preferred gestational age to have chorionic villi
sampling (CVS) performed? 2 11 weeks The preferred time to have CVS performed is between 10 and 13 weeks of gestation; 11 weeks falls into this range. Six weeks of gestation is too early for CVS to be performed; 20 and 30 weeks of gestation are too late for CVS to be performed. What is a disadvantage of an amniocentesis? 2 Test results can take at least 10 days to obtain A disadvantage of an amniocentesis is the length of time it takes to get test results. It takes at least 10 to 14 days to get test results. An amniocentesis is often performed between 15 and 20 weeks of gestation. An amniocentesis is performed to determine fetal lung maturity and genetic abnormalities. The nurse is caring for a patient who has undergone a contraction stress test. The test results were found to be equivocal. What intervention should the nurse perform based on the test results? 2 Repeat the contraction stress test the next day If the results of contraction stress test are equivocal, it indicates that decelerations that occur in the presence of contractions are more frequent than every 2 minutes. Therefore, the primary health care provider would ask the nurse to repeat the test the next day. The contraction stress test is prescribed after a nonstress test if the test results are nonreactive. If the contraction stress test is negative, then the primary health care provider would ask the patient to resume the weekly testing schedule. If the contraction stress test is positive, then the primary health care provider would instruct the nurse to admit the patient to the hospital. Which are prenatal tests used for diagnosing fetal defects in pregnancy? Select all that apply. 1,4,6 Amniocentesis, PUBS, and CVS are prenatal tests used for diagnosing fetal defects in pregnancy. Polyhydramnios is increased amniotic fluid. AFI is a method in which the vertical depths (in centimeters) of the largest pocket of amniotic fluid in all four quadrants surrounding the maternal umbilicus are totaled. DFMC, the kick count, is frequently used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Which test will be included in a pregnant patient's appointment at 17 weeks of gestation? 1 Multiple-marker triple screen A multiple-marker triple screen is a blood test that measures maternal serum markers; it is done in the second trimester. A combined test is a first trimester screening test. A nuchal translucency ultrasound is a prenatal screening test that measures the small space behind the fetal neck to check for chromosomal abnormalities, cardiac anomalies, and genetic disorders. An amniocentesis is a screening of the amniotic fluid to test to check for chromosomal abnormalities. The nurse is
reviewing the laboratory results of a woman who is at 8 weeks of gestation. The nurse notes the human chorionic gonadotropin (hCG) levels more than doubled since the patient's 6-week checkup. What is the most appropriate nursing action? 2 Nothing, this is a normal finding The hCG levels in the mother's blood should increase up until 8 to 10 weeks of gestation. It is normal for the hCG level to double between 6 and 8 weeks of gestation. Because this is a normal finding, it is unnecessary to prepare the woman for a miscarriage, check for fetal heart rate, or schedule a transvaginal ultrasound. A nurse working in a prenatal clinic understands that which maternal risk factors require antepartum fetal
assessment? 1 Obesity The maternal risk factors that require antepartum fetal assessment include obesity, cholestasis, thrombophilia, and chronic hypertension. Asthma does not require antepartum fetal assessment. What is the recommended time period for cell-free fetal DNA (cfDNA) screening? 1 First Trimester cfDNA screening is done in the first trimester of pregnancy. It is not done in the second or third trimesters, or after delivery. Which hormones and proteins produced by an embryo are detected in maternal circulation? Select all that apply. 1,2,3,4 The hormones and proteins produced by the embryo that are detected in maternal circulation are hCG, AFP, uE3, and inhibin A. Serum glucose is not detected in maternal circulation. While performing a contraction stress test in a pregnant patient, the nurse finds that the patient has three uterine contractions in a
10-minute period with no significant variable decelerations. The nurse communicates the test findings to the primary health care provider. Which instruction would the nurse expect to receive from the primary health care provider? 4 "Resume a routine weekly testing schedule for the patient." A contraction stress test helps determine fetal heart rate during uterine contraction. If the patient has three uterine contractions within 10 minutes, with no significant deceleration, it indicates normal or negative results and the fetus is doing well. Therefore, the primary health care provider would resume a routine weekly testing schedule for the patient. If three contractions are not produced within 10 minutes and no fetal heart rate is heard, then the test will be repeated the next day. Presence of uterine contractions is a normal finding, and it does not indicate risk of dehydration. Therefore, the primary health care provider will not instruct the nurse to administer intravenous fluids to the patient. If the patient has late decelerations with 50% or more of contractions, then the primary health care provider would instruct the nurse to admit the patient for further evaluation.
Which patient would best qualify for a specialized obstetric ultrasound? 3 A woman who is at 10 weeks of gestations and has a child with a cleft palate A specialized obstetric ultrasound is performed to give more detailed imaging, such as to assess for cleft palate. A standard ultrasound is used to determine fetal presentation, multiple gestations, and the presence of fetal cardiac activity. The primary health care provider recommends genetic screening to a pregnant patient to identify the risk of Down syndrome in the fetus. The
patient requests a noninvasive test. Which test does the nurse expect that the provider will order for the patient? 4 Chronic villus sampling Maternal serum testing is a blood test that is used to identify whether the fetus of a pregnant patient is at risk for Down syndrome. It is a noninvasive technique that requires only the maternal serum sample. Amniocentesis is an invasive technique that is used for testing fetal aneuploidy. Urine analysis is involved in the detection of pregnancy but is not used to detect chromosomal abnormalities. Chronic villus sampling is also an invasive technique that is used for determining fetal aneuploidy. The amniotic fluid index (AFI) in a patient is 15 cm. What should the nurse interpret form this finding? 1 The patient has normal AFI. AFI values between 10 and 25 cm are considered normal. Therefore, a 15-cm amniotic fluid index is normal and does not indicate any fetal abnormality. An AFI of less than 5 cm indicates that the patient has oligohydramnios, which is characterized by intrauterine growth restriction and congenital abnormalities. If the patient has an AFI above 25 cm, it indicates that the patient has polyhydramnios, which would put the fetus at risk of neural tube defect The nurse is helping a pregnant patient monitor the daily fetal movement. Which finding should be reported to the primary health care provider? 1 Fetal movement was not detected for 12 hours. The presence of fetal movements is a reassuring sign of fetal health. If fetal movements are not felt by the mother for 12 hours, then it is reported as the fetal alarm signal. Limb straightening, breathing movement, and amniotic fluid index do not indicate the fetal alarm signal. One episode of limb straightening is also a normal finding. One episode of fetal breathing movement seen in 30 minutes is a normal finding. An amniotic fluid index greater than 5 cm is a normal finding. After fetal ultrasonography, the nurse observes that a patient has elevated levels of alpha-fetoprotein in the amniotic fluid. For which conditions is the fetus at risk? Select all that apply. 1,2,3 Neural tube defects (NTDs) are diagnosed by elevated levels of alpha-fetoprotein in the amniotic fluid using fetal ultrasonography. Therefore, the fetus is at risk for meningocele, anencephaly, and encephalocele. Tetralogy of Fallot and ventricular septal defects are congenital heart defects that are diagnosed using echocardiography and cardiac catheterization. How
is a four-dimensional (4D) ultrasound different from a three-dimensional (3D) ultrasound? 2 It provides live streaming video images A 4D ultrasound provides live streaming video images. Greater detail of features is seen on both 3D and 4D ultrasound images. The width, height, and depth of structures can been seen on both 3D and 4D ultrasound images. A two-dimensional ultrasound provides a flat picture of structures. After a woman with blood type Rh negative undergoes amniocentesis, which is the most appropriate nursing intervention? 1 The nurse is caring for a patient recovering from a transcervical chorionic villi sampling (CVS) procedure. What can the patient expect? 2 The nurse is caring for a pregnant patient who is scheduled for cordocentesis. What could be the consequences of the test on the fetus? 3 The nurse is providing discharge instructions for a patient following an amniocentesis. What information should be included? 1 The nurse is precepting a new nurse on the antepartum unit. Together they are reviewing the reactive nonstress test (NST) of a patient who is at 34 weeks of gestation. Which statement made by the new nurse indicates an understanding of a reactive NST? 4 The nurse is performing a contraction stress test (CST) and notes a positive CST. Based on these findings, what
is the most appropriate nursing action? 2 What is the primary test performed to determine fetal lung maturity? 4 The nurse is caring for several patients, all at 40 weeks of gestation. Which
patient's nonstress test (NST) is most likely to show altered fetal movement? 1 Why is an amniocentesis performed? 1 During a prenatal checkup a 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? 4 The nurse is caring for a patient in the second month of pregnancy. Which condition can be diagnosed through ultrasonography? 4 Which prenatal screening test measures the small space behind the fetal neck? 3 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 would be another tool useful in confirming the diagnosis? 1 Which statement made by a patient indicates an understanding of the transvaginal ultrasound? 4 A 40-year-old woman with a high body mass index is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? 4 The
nurse understands that an ultrasound that is scheduled in the second trimester may be primarily done for which purpose? 1 The nurse is performing a nonstress test (NST) on a patient at 38 weeks of gestation. The nurse notes an increased fetal heart rate with fetal movement. What is the most appropriate nursing intervention? 3 The nurse is preparing a patient for a fetal
ultrasound. What instructions will the nurse give the patient? 4 The nurse is caring for a patient scheduled for an amniocentesis. Which statement made by the patient indicates an understanding of how an amniocentesis is performed? 1 The nurse is preparing a patient who is at 10 weeks of gestation for a transvaginal ultrasound. In what position
should this woman be placed? 1 What is the difference between the following fetal heart rate monitoring tests nonstress test and contraction stress test?A biophysical profile combines a nonstress test with a fetal ultrasound that evaluates your baby's breathing, body movements, muscle tone and amniotic fluid level. Contraction stress test. This test looks at how your baby's heart rate reacts when your uterus contracts.
What is the difference between non stress test and contraction stress test?What is the difference between a nonstress test and a contraction stress test? During a nonstress test, your healthcare provider monitors your baby's heart rate without putting any external stress on the baby. A contraction stress test measures your baby's heart rate during the stress of uterine contractions.
What is the difference between Cardiotocography and non stress test?A nonstress test (NST) is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its responsiveness. A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine contractions.
What is a fetal contraction stress test?A contraction stress test checks to see if your baby will stay healthy during contractions when you are in labour. This test includes external fetal heart monitoring. The test is done when you are 34 or more weeks pregnant. During a contraction, the blood and oxygen supply to your baby drops for a short time.
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What is the difference between the following fetal heart rate monitoring tests Nonstress test and contraction stress test quizlet?
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