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Flashcards in Chapter 9 Assessment for Risk Factors Test 1 Deck (36):
1

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 of 17.5. She admits to having used cocaine several times during the past year and drinks alcohol occasionally. Her BP is 108/70 mm Hg, her pulse rate is 72 beats/min, and her RR 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. Which characteristics place the woman in a high risk category?
a. Blood pressure, age, BMI
b. Drug/alcohol use, age, family history
c. Family history, blood pressure, BMI
d. Family history, BMI, drug/alcohol abuse

D. Her family history of NTD, low BMI, and substance abuse are all high risk factors of pregnancy. The woman’s BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman’s drug/alcohol use and family history put her in a high risk category, but her age does not. The woman’s family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal.

2

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein screening (MSAFP)
c. Amniocentesis
d. Nonstress test (NST)

A. An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform the MSAFP, an amniocentesis, or an NST. The MSAFP is performed at 16 to 18 weeks of gestation, followed by amniocentesis if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected. An NST is performed to assess fetal well-being in the third trimester.

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?
A. Doppler blood flow analysis
B. Amniocentesis
C. Contraction stress test (CST)
D. Daily fetal movement counts

A. Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the 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.

4

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein screening (MSAFP)
d. Percutaneous umbilical blood sampling (PUBS)

B. Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

5

At 35 weeks of pregnancy a woman experiences preterm labor. Although tocolytics are administered and she is placed on bed rest, she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. Nonstress test

C. Amniocentesis would be performed to assess fetal lung maturity in the event of a preterm birth. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Typically fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario. A nonstress test measures the fetal response to fetal movement in a noncontracting mother.

6

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?
a. Biophysical profile
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP)
d. Transvaginal ultrasound

D. An ultrasound is the method of biophysical assessment of the infant that would be performed at this gestational age. A biophysical profile would be a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. An MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

7

A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal anomalies
c. Biophysical profile (BPP) for fetal well-being
d. Amniocentesis for genetic anomalies

B. If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated AFP, ultrasound examination, and possibly amniocentesis. Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A BPP is a method of assessing fetal well-being in the third trimester. Before an amniocentesis is considered, the client first would have an ultrasound for direct visualization of the fetus.

8

A client asks her nurse, “My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?” The best response by the nurse is:
a. “Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.”
b. “Your placenta isn’t working properly, and your baby is in danger.”
c. “This means that we will need to perform an amniocentesis to detect if you have any placental damage.”
d. “Don’t worry about it. Everything is fine.”

A. An accurate and appropriate statement is, “Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.” Although “Your placenta isn’t working properly, and your baby is in danger” may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. “Don’t worry about it. Everything is fine” is not appropriate and discredits the client’s concerns.

9

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:
a. Negative.
b. Satisfactory.
c. Positive.
d. Unsatisfactory.

A. Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.

10

In the United States today:
a. More than 20% of pregnancies meet the definition of high risk to either the mother or the infant.
b. Other than biophysical criteria, the chief factor in high risk pregnancies is the number of women who have no access to prenatal care.
c. High risk pregnancy status extends from first confirmation of pregnancy to birth.
d. High risk pregnancy is less critical a medical concern because of the reduction in family size and the decrease in unwanted pregnancies.

B. In addition to women without access to prenatal care, lifestyles that pose health risks also are a concern. Approximately 500,000 of the four million births (12.5%) in the United States will be categorized as high risk. The high risk status for the mother extends through 30 days after childbirth. High risk pregnancy is less critical a medical concern because of the reduction in family size and the decrease in unwanted pregnancies., along with technologic advances that both facilitate pregnancies in previously infertile couples and advance the potential of care, have enhanced emphasis on delivering babies safely.

11

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that:
a. Alcohol or cigarette smoke can irritate the fetus into greater activity.
b. “Kick counts” should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off.
c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
d. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women.

C. No movement in a 12 hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time. Obese women have a harder time assessing fetal movement.

12

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their clients that:
a. Both require the woman to have a full bladder.
b. The abdominal examination is more useful in the first trimester.
c. Initially the transvaginal examination can be painful.
d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

D. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and also allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman will feel pressure as the probe is moved.

13

In the first trimester, ultrasonography can be used to gain information on:
a. Amniotic fluid volume.
b. The presence and location of an intrauterine contraceptive device.
c. Placental location and maturity.
d. Cervical length.

B. In the first trimester, ultrasonography can be used to gain information on the presence and location of an intrauterine contraceptive device and can also detect certain uterine abnormalities. Information about amniotic fluid volume, placental location and maturity, and cervical length would not be available via ultrasonography until the second or third trimester

14

Nurses should be aware that the biophysical profile (BPP):
a. Is an accurate indicator of impending fetal death.
b. Is a compilation of health risk factors of the mother during the later stages of pregnancy.
c. Consists of a Doppler blood flow analysis and an amniotic fluid index.
d. Involves an invasive form of ultrasonic examination.

A. An abnoral BPP score is one indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

15

With regard to amniocentesis, nurses should be aware that:
a. Because of new imaging techniques, it is now possible in the first trimester.
b. Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases.
c. The shake test, or bubble stability test, is a quick means of determining fetal maturity.
d. The presence of meconium in the amniotic fluid is always cause for concern.

C. Diluted fluid is mixed with ethanol and shaken. After 15 minutes the bubbles tell the story. Amniocentesis is possible after the fourteenth week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasonography. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.

16

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 triple-marker tests for Down syndrome.
d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

D. MSAFP is a screening tool, not a diagnostic tool. 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 triple-marker tests for Down syndrome.

17

In comparison to contraction stress tests (CSTs), the nonstress test (NST) for antepartum fetal assessment:
a. Has no known contraindications.
b. Has fewer false-positive results.
c. Is more sensitive in detecting fetal compromise.
d. Is slightly more expensive.

A. The CST has several contraindications. The NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive.

18

The nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
a. Sometimes uses vibroacoustic stimulation.
b. Is an invasive test; however, contractions are stimulated.
c. Is considered negative if no late decelerations are observed with the contractions.
d. Is more effective than the nonstress test (NST) if the membranes have already been ruptured.

C. No late decelerations is good news. Vibroacoustic stimulation is sometimes used with the NST. The CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured.

19

A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion, showing declining interest. The nurse can best help the couple by:
a. Telling her that the physician will isolate the problem with more tests.
b. Encouraging her and urging her to continue with childbirth classes.
c. Becoming assertive and laying out the decisions the couple needs to make.
d. Downplaying her risks by citing success rate studies.

B. The nurse can best help the woman and her family regain a sense of control in their lives by providing support and encouragement (including active involvement in preparations and classes). The nurse can try to present opportunities for the couple to make as many choices as possible in prenatal care.

20

In the past factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:
a. Biophysical.
b. Geographic.
c. Psychosocial.
d. Environmental.

B. This category is correctly referred to as sociodemographic 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. 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. Environmental risks are those that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants

21

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus, the nurse is aware that he or she is at a greater risk for:
a. Oligohydramnios.
b. Postterm pregnancy.
c. Polyhydramnios.
d. Chromosomal abnormalities.


C. Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in diabetic rather than nondiabetic pregnancies. This will put the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age greater than 35 and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.

22

Intrauterine growth restriction is associated with what pregnancy-related risk factors? Choose all that apply.
a. Poor nutrition
b. Maternal collagen disease
c. Gestational hypertension
d. Premature rupture of membranes
e. Smoking

A, B, C, E
Poor nutrition, maternal collagen disease, gestational hypertension, and smoking are all risk factors associated with the occurrence of intrauterine growth restriction (IUGR). Premature rupture of membranes is associated with preterm labor, not IUGR.

23

MSAFP levels have been used as a screening tool for ________________ in pregnancy.

neural tube defects

24

A woman who is 26 weeks pregnant asks the nurse educator during a childbirth class about herb use during pregnancy. The nurse should base the answer on the knowledge that:
A. herbs are natural and therefore safe with pregnancy.
B. herbs have not been proved to be safe with pregnancy and should not be used.
C. some herbs are safe for pregnancy; some are not. The patient needs to discuss which one she desires to use with her health care provider.
D. herbs can be used with pregnancy, but the patient needs to inform the nursery staff to assess the newborn for complications after birth.

C. Some complementary and alternative therapies are very safe and helpful during pregnancy. However, some can be harmful. Before ingesting any herb or using any therapy the patient needs to discuss them with her health care provider.

25

During prenatal teaching it is important for the nurse to inform the patient about danger signs in pregnancy. Which sign need to be reported immediately to the health care provider?
A. Clear mucous vaginal discharge
B. Frequent urination
C. Vaginal bleeding
D. Backache that occurs after standing for a long period


C. Vaginal bleeding during pregnancy needs to be reported immediately. It may be an indication of several complications of pregnancy, such as placenta previa or abruptio placenta

26

A woman who is 10 weeks pregnant is complaining of nausea and vomiting every morning. Which action can the nurse suggest to the woman to alleviate the nausea?
A. Eat dry crackers before arising in the morning.
B. Eat only three meals a day.
C. Drink plenty of fluids with meals.
D. Eat mostly protein foods and very little carbohydrates.

A. Eating dry crackers or toast before arising in the morning has been found to decrease nausea. The woman should get out of bed slowly.

27

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test?

A. “I will need to have a full bladder for the test to be done accurately.”
B. “I should have my husband drive me home after the test because I may be nauseous.”
C. “This test will help to determine if the baby has Down syndrome or a neural tube defect.”
D. “This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”

D. An ultrasound is the test that requires a full bladder. An amniocentesis would be 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 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.

28

What is an indicator for performing a contraction stress test?

A. Increased fetal movement and small for gestational age
B. Maternal diabetes mellitus and postmaturity
C. Adolescent pregnancy and poor prenatal care
D. History of preterm labor and intrauterine growth restriction

B. Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Although adolescent pregnancy and poor prenatal care are risk factors of 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.

29

A 40-year-old woman with a high body mass index (BMI) 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. 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. Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

30

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

A. sometimes uses vibroacoustic stimulation.
B. is an invasive test; however, contractions are stimulated.
C. is considered negative if no late decelerations are observed with the contractions.
D. is more effective than nonstress test (NST) if the membranes have already been ruptured.


C. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. No late decelerations indicate a positive CST. CST is contraindicated if the membranes have ruptured.

31

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?

A. Doppler blood flow analysis
B. Contraction stress test (CST)
C. Amniocentesis
D. Daily fetal movement counts


A. Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the 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.

32

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. 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. This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

33

Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to:

A. administer RhoD immunoglobulin.
B. administer anticoagulant.
C. send the patient for a computed tomography (CT) scan before the procedure.
D. assure the mother that short-term radiation exposure is not harmful to the fetus.

A. Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered before amniocentesis as this would increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required before amniocentesis, because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.

34

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result?

A. Indirect Coombs test
B. Hemoglobin level
C. hCG level
D. Maternal serum alpha-fetoprotein (MSAFP)

A. 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.

35


The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant patient to evaluate fetal structure and growth. The nurse should include which instructions when preparing the patient for this test? (Select all that apply.)

A. A lead apron must be worn during the test.
B. A full bladder is required prior to the test.
C. An intravenous line must be inserted before the test.
D. Jewelry must be removed before the test.
E. Remain still throughout the test.



D. E.
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.

36

A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient? (Select all that apply)

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


B. C. E.
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. During this time vibroacoustic stimulation (see later discussion) may be used to stimulate fetal activity. 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). 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.