NCM 109 2ND YEAR MIDTERMS > QUIZ 1: HIGH-RISK PREGNANCY ASSESSMENT AND SCREENING > Flashcards
QUIZ 1: HIGH-RISK PREGNANCY ASSESSMENT AND SCREENING Flashcards
All _____ and deliveries are potentially at risk.
Pregnancies
A ______ is one in which a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, the fetus, or both.
high-risk pregnancy
A _____ is defined as any ascertainable characteristic or circumstance of a person (or group of such persons) known to be associated with an abnormal risk of developing or being adversely affected by a morbid process
risk factor
is a process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations
Assessment
is a process of identifying apparently healthy people who may be at increased risk of a disease or condition.
Screening
is a test to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test.)
Diagnostic Test
is a test done during pregnancy that uses reflected sound waves to produce a picture of a fetus, the organ that nourishes the fetus (placenta), and the liquid that surrounds the fetus (amniotic fluid).
Fetal ultrasound
It is a technical means of recording (-graphy), the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester.
Cartocography
common prenatal test used to check on a baby’s health. During a nonstress test. Also known as fetal heart rate monitoring
Non-stress test
It is performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth.
Contraction Stress Test
small structures in the placenta that act like blood vessels.
Chrionic Villi
These structures contain cells from the developing fetus. A test that removes a sample of these cells through a needle is called
Chorionic Villus Sampling
test that can be done during pregnancy to look for birth defects and genetic problems in the developing baby
Amniocentesis
is most often offered to women who are at increased risk for bearing a child with birth defects.
Amniocentesis
It is the examination of the embryo at 9-10 weeks’ gestation through the intact membranes by introducing an endoscope into the exocoelomic space/cavity transcervically or transabdominally
embryoscopy
is the examination of the fetus after 11 weeks’ gestation. This is performed transabdominally in the amniotic fluid
Fetoscopy
also called percutaneous umbilical cord blood sampling (PUBS), is a diagnostic test that examines blood from the fetus to detect fetal abnormalities
Cordocentesis
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?
A. Biophysical profile
B. Amniocentesis
C. Maternal serum alpha-fetoprotein (MSAFP)
D. Transvaginal ultrasound
D. Transvaginal ultrasound
(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.)
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?
A. Negative CST results
B. Positive CST results
C. Suspicious CST results
D. Unsatisfactory CST results
B. Positive CST results
(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.)
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.
A. Low level of inhibin-A in the maternal serum
B. Low level of unconjugated estriol in serum
C. Elevated nuchal translucency (NT) in the fetus
D. Low level of maternal human chorionic gonadotrophin (hCG)
E. Low level of maternal serum alpha-fetoprotein (MSAFP)
B,D,E
(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.)
A patient in the first trimester of pregnancy undergoes a triple marker screening test. 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.
A. High levels of beta-human chorionic gonadotropin (β-hCG)
B. Low levels of pregnancy-associated placental protein (PAPP-A)
C. Low levels of inhibin-A in the fetal blood
D. Low levels of maternal serum alpha-fetoprotein (MSAFP)
E. Low levels of unconjugated estriol in the fetal blood
A,B
(Triple marker 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.)
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?
A. The fetal lungs are well developed.
B. The gestational age is 36 weeks.
C. The fetus has a neural tube defect.
D. The fetus has an open neural tube defect.
A. The fetal lungs are well developed.
(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’ gestation indicates that the fetus has an open neural tube defect.)
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?
A. No qualifying accelerations in a 20-minute period
B. Two qualifying accelerations in a 20-minute period
C. Less than two qualifying accelerations in a 20-minute period
D. More than two qualifying accelerations in a 20-minute period
C. Less than two qualifying accelerations in a 20-minute period
(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.)
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:
A. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis.
B. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects.
C. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome.
D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
(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.)
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?
A. Nuchal translucency (NT) test
B. Chorionic villus sampling (CVS)
C. Doppler blood flow analysis
D. Percutaneous umbilical blood sampling (PUBS)
C. Doppler blood flow analysis
(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.)
Which physiologic parameters does the nurse check in the ultrasound report to assess fetal well-being? Select all that apply.
A. Amniotic fluid volume (AFV)
B. Fetal breathing movements (FBMs)
C. Fetal limb and head movements
D. Daily count of fetal movements
E. Fluid volume in the nape of the fetal neck
A,B,C
(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.)
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?
A. Down syndrome
B. Hemolytic anemia
C. Potter syndrome
D. Fetal hydrops
B. Hemolytic anemia
(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.)
The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. Which specific lab result should the nurse assess?
A. Indirect Coombs test
B. Hemoglobin level
C. hCG level
D. Maternal serum alpha-fetoprotein (MSAFP)
A. Indirect Coombs test
(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.)
Which test does the nurse recommend for the patient to help assess fetal genetic abnormalities?
A. Amniotic fluid volume (AFV)
B. Fetal body movements
C. Nuchal translucency (NT)
D. Fetal heart activity
C. Nuchal translucency (NT)
(The NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 and 14 weeks’ 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.)
While reviewing the ultrasound reports of a patient, the nurse notices a floating fetus in the scanned image. What potential fetal risks should the nurse interpret from this finding? Select all that apply:
A. Renal agenesis
B. Growth restriction
C. Neural tube defects
D. Gastrointestinal obstruction
E. Cardiac disease.
C,D
(A floating fetus is seen in cases of elevated amniotic fluid volume, or polyhydramnios.
Polyhydramnios is associated with neural tube defects and gastrointestinal obstruction. Renal agenesis and severe intrauterine growth restriction are associated with oligohydramnios, or low amniotic fluid volume. A low amount of fluid may not result in a floating fetus in the scanned image. The amniotic fluid level is unrelated to cardiac disease in the fetus.)
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?
A. Normal finding
B. Congenital abnormality
C. Impaired growth
D. Cardiac disorder
A. Normal finding
(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.)
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?
A. High amniotic fluid volume (AFV)
B. High systolic-to-diastolic (S/D) ratio
C. Low amniotic fluid volume (AFV)
D. Low systolic-to-diastolic (S/D) ratio
B. High systolic-to-diastolic (S/D) ratio
(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.)
After reviewing the reports of a pregnant patient, the nurse infers that there might be a high risk for intrauterine growth restriction (IUGR). What could be the reason for this? The amniotic fluid index (AFI) is:
A. Less than 5 cm.
B. Equal to or more than 10 cm.
C. Between 5 and 10 cm.
D. More than 25 cm
A. Less than 5 cm.
(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 amniotic fluid index (AFI) of a pregnant patient is 3 cm. What clinical information related to the fetus does the nurse infer from this?
A. Neural tube defect
B. Fetal hydrops
C. Renal defects
D. Low activity level
C. Renal defects
(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.)
While performing the fetal acoustic stimulation test (FAST) in a patient, the nurse observes that there is no fetal response even after 3 minutes of testing. Which test does the nurse suggest?
A. Amniocentesis
B. Biophysical profile (BPP)
C. Cordocentesis
D. Coombs’ test
B. Biophysical profile (BPP)
(Lack of response after 3 minutes of FAST indicates that the fetus has low activity levels. In this situation, to accurately assess fetal activity, the nurse should recommend a BPP of the fetus. Amniocentesis helps detect genetic abnormalities in the fetus. Fetal activity cannot be determined using this technique. In cordocentesis, the umbilical blood is tested for Rh incompatibility and hemolytic anemia in the fetus. Coombs’ test is used to determine the presence of antibody incompatibilities in the fetus and the mother.)
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? To check:
A. For fetal anomalies
B. Gestational age
C. Fetal position
D. For fetal well-being
D. For fetal well-being
(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.)
