Chapter 15: Prenatal Diagnostic Tests My Nursing Test Banks

Chapter 15: Prenatal Diagnostic Tests

Test Bank

MULTIPLE CHOICE

1. A pregnant womans biophysical profile score is 8. She asks the nurse to explain the results. The nurses best response is

a.

The test results are within normal limits.

b.

Immediate delivery by cesarean birth is being considered.

c.

Further testing will be performed to determine the meaning of this score.

d.

An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.

ANS: A

Feedback

A

The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated.

B

Scores less than 4 should be investigated, and delivery could be initiated sooner than planned.

C

This score is within normal range, and no further testing is required at this time.

D

The results of the biophysical profile are usually available immediately after the procedure is performed.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 313 | Table 15-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?

a.

Multiple-marker screening

b.

Lecithin/sphingomyelin (L/S) ratio

c.

Biophysical profile

d.

Type and crossmatch of maternal and fetal serum

ANS: A

Feedback

A

Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus.

B

The L/S ratio is used to determine fetal lung maturity.

C

A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems.

D

The blood type and crossmatch will not predict chromosomal defects in the fetus.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 305

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. The nurse providing care for the pregnant woman understands that a factor indicating the need for fetal diagnostic procedures is

a.

Maternal diabetes

b.

Maternal age older than 30 years

c.

Previous infant more than 3000 g at birth

d.

Weight gain of 25 pounds

ANS: A

Feedback

A

Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion.

B

A maternal age greater than 35 years is an indication for testing.

C

Having had another infant weighing greater than 4000 g at birth is an indication for testing.

D

Excessive weight gain is an indication for testing. Normal weight gain is 15 to 35 pounds.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 302 | Box 15-1

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. When is the best time to determine gestational age based on biparietal diameter through ultrasound?

a.

4 to 6 weeks

b.

5 to 7 weeks

c.

7 to 10 weeks

d.

12 to 20 weeks

ANS: D

Feedback

A

During this time frame, the gestational age is determined by measuring the crown-rump length.

B

During this time frame, the gestational age is determined by measuring the crown-rump length.

C

During this time frame, the gestational age is determined by measuring the crown-rump length.

D

The biparietal diameter, a method of assessing gestational age during the last half of pregnancy, is most accurate from 12 to 20 weeks.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 303

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine if the fetus has

a.

Hemophilia

b.

A neural tube defect

c.

Sickle cell anemia

d.

A normal lecithin/sphingomyelin (L/S) ratio

ANS: B

Feedback

A

Hemophilia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis.

B

An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum.

C

Sickle cell is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis.

D

L/S ratios are determined with an amniocentesis and is usually done in the third trimester.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 304

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling can be performed during pregnancy as early as _____ weeks.

a.

4

b.

8

c.

10

d.

12

ANS: C

Feedback

A

It is too early to perform this test at 4 weeks.

B

It is too early to perform this test at 8 weeks.

C

Fetal villus tissue can be obtained as early as 10 weeks of gestation and analyzed directly for chromosomal or genetic abnormalities.

D

The test should be performed at 13 weeks, but it can be done as early as 10 weeks.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 305

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

7. The nurses role in diagnostic testing is to provide

a.

Advice to the couple

b.

Assistance with decision-making

c.

Information about the tests

d.

Reassurance about fetal safety

ANS: C

Feedback

A

The nurses role is to inform, not to advise.

B

Decision making should always lie with the couple involved. The nurse should provide information so that the couple can make an informed decision.

C

The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision.

D

Ensuring fetal safety is not possible with all of the diagnostic testing. To offer this is to give false reassurance to the parents. The nurse can inform the couple about potential problems so they can make an informed decision.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 314

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

8. Which diagnostic test evaluates the effect of fetal movement on fetal heart activity?

a.

Contraction stress test (CST)

b.

Sonography

c.

Biophysical profile

d.

Nonstress test (NST)

ANS: D

Feedback

A

CST evaluates the fetal reaction to contractions.

B

Sonographic examinations visualize the fetus and are done for various reasons.

C

The biophysical profile evaluates fetal status using many variables.

D

An NST evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 309

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. Which nursing intervention is necessary before a second-trimester transabdominal ultrasound?

a.

Place the woman NPO for 12 hours.

b.

Instruct the woman to drink 1 to 2 quarts of water.

c.

Administer a soapsuds enema.

d.

Perform an abdominal prep.

ANS: B

Feedback

A

The woman needs a full bladder in order to elevate the uterus; therefore being NPO is not appropriate.

B

When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a window through which the uterus and its contents can be viewed.

C

A soapsuds enema is not necessary for this procedure.

D

An abdominal prep is not necessary for this procedure.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 303

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

10. The major advantage of chorionic villus sampling (CVS) over amniocentesis is that it

a.

Is not an invasive procedure

b.

Does not require hospitalization

c.

Has less risk of spontaneous abortion

d.

Is performed earlier in pregnancy

ANS: D

Feedback

A

It is an invasive procedure.

B

The woman does have to be in a hospital setting for the fetus and her to be properly assessed during and after the procedure.

C

The risk of an abortion is at the same level for both procedures.

D

CVS is performed between 10 and 13 weeks of gestation, providing earlier results than amniocentesis.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 305

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. What is the purpose of amniocentesis for the patient hospitalized at 34 weeks with pregnancy-induced hypertension?

a.

Identification of abnormal fetal cells

b.

Detection of metabolic disorders

c.

Determination of fetal lung maturity

d.

Identification of sex of the fetus

ANS: C

Feedback

A

Identification of abnormal cells is done during the early portion of the pregnancy.

B

The test is done in the early portion of the pregnancy if the metabolic disorder is genetic.

C

During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In pregnancy-induced hypertension, preterm delivery may be necessary because of changes in placental perfusion.

D

Amniocentesis is done early in the pregnancy to do genetic studies and determine the sex.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 307

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed

a.

Nonreactive

b.

Positive

c.

Negative

d.

Reactive

ANS: D

Feedback

A

A nonreactive result means that the heart rate did not accelerate during fetal movement.

B

A positive result is not used with an NST. The CST uses positive as a result term.

C

A negative result is not used with an NST. The CST uses negative as a result term.

D

The NST is reactive (normal) when two or more FHR accelerations of at least 15 bpm (each with a duration of at least 15 seconds) occur in a 20-minute period.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 309

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. The purpose of initiating contractions in a CST is to

a.

Determine the degree of fetal activity.

b.

Apply a stressful stimulus to the fetus.

c.

Identifying fetal acceleration patterns.

d.

Increase placental blood flow.

ANS: B

Feedback

A

The NST and biophysical profiles look at fetal movements.

B

The CST involves recording the response of the FHR to stress induced by uterine contractions.

C

The NST looks at fetal heart accelerations with fetal movements.

D

The CST records the fetal response to stress. It does not increase placental blood flow.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 310

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

14. Which response by the nurse is most appropriate to this statement: This test isnt my idea, but my husband insists?

a.

Dont worry. Everything will be fine.

b.

Why dont you want to have this test?

c.

Youre concerned about having this test?

d.

Its your decision.

ANS: C

Feedback

A

This is false reassurance and does not deal with the concerns expressed by the woman.

B

The woman may not be able to answer why questions. It may also make her defensive.

C

The nurse should clarify the statement and assist the patient in exploring her feelings about the test.

D

This is a closed statement and does not encourage the woman to express her feelings.

PTS: 1 DIF: Cognitive Level: Application REF: p. 314

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

15. In many settings, nurses may perform nonstress tests (NST), conduct an initial assessment of the woman and begin necessary interventions for nonreassuring results. These nursing procedures are accomplished after additional education and training under established protocols. Which nursing action is necessary when preparing the patient for the NST?

a.

Position the woman on her left side.

b.

Be certain that the woman is seated comfortably in a reclining chair.

c.

Encourage the woman to drink one liter of water prior to the test.

d.

Place conduction gel on the womans abdomen with one belt.

ANS: B

Feedback

A

The woman should be seating in a reclining chair or in semi-Fowler position if on a bed or stretcher.

B

To correctly position the pregnant patient for an NST, the nurse should place the woman in a reclining chair or in semi-Fowler position with a lateral tilt. will optimize uterine perfusion and prevent supine hypotension.

C

This is the appropriate preparation for abdominal ultrasonography. Caregivers sometimes suggest that the women drink juice in order to increase her glucose level and stimulate fetal movement. Although this practice is common, research has not proven it effective.

D

Conduction gel should be applied along with two belts. One belt has a Doppler transducer to detect the fetal heart rate. The other belt has a tocodynamometer to detect fetal movement or uterine contractions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 309

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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 between 10 and 12 weeks of gestation in order to give parents time to consider options.

c.

Percutaneous umbilical blood sampling (PUBS) is one of the multiple marker screen tests for Down syndrome.

d.

MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

ANS: D

Feedback

A

CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques.

B

MSAFP screening is recommended for all pregnant women.

C

Screening is recommended between 15 and 20 weeks of gestation. Abnormal findings give parents time to have additional tests done.

D

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

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 305

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

17. Ultrasonography is an important and safe technique used in antepartum surveillance. It provides critical information related to fetal activity, gestational age and fetal well-being. Which statement regarding ultrasonography during pregnancy is most accurate?

a.

Ultrasonography uses infrared technology to create an image.

b.

Ultrasonography is only utilized as an adjunct to more invasive tests.

c.

Ultrasonography is not harmful to the fetus.

d.

Ultrasonography is not a component of biophysical profile testing.

ANS: C

Feedback

A

Ultrasonography uses sound waves to create an image.

B

As an adjunct to more invasive tests, ultrasonography can provide visual guidance for increased safety. It can be done as a standalone test.

C

Most women look forward to the results of this test, which causes no harm to the fetus.

D

Ultrasonography is a component of biophysical profile testing.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 304

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week-gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be necessary to determine which of the following? Select all that apply.

a.

Multifetal gestation

b.

Bicornate uterus

c.

Presence and location of pregnancy (intrauterine or elsewhere)

d.

Amniotic fluid volume

e.

Presence of ovarian cysts

ANS: A, B, C, E

Feedback

Correct

All of these conditions 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.

Incorrect

Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.

PTS: 1 DIF: Cognitive Level: Application REF: p. 303

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

2. Percutaneous umbilical cord sampling (PUBS), also called cordocentesis, involves the aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy. Major indications include (select all that apply)

a.

Rh disease

b.

Fetal well-being

c.

Infection

d.

Lung maturity

e.

Karyotyping

ANS: A, C, E

Feedback

Correct

These are all indications for PUBS. Another indication is for diagnosis or disorders that require fetal blood for testing. Although used to develop a karyotype (chromosome evaluation) other DNA analysis techniques might also be utilized.

Incorrect

NST or BPP are used to determination fetal well-being. An amniocentesis is done in order to determine lung maturity.

PTS: 1 DIF: Cognitive Level: Application REF: p. 308

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

COMPLETION

1. A woman who is 36 weeks pregnant reports to the labor and delivery triage area expressing concerns that her baby is not moving. Along with a nonstress test (NST) the nurse might also use ______________ to determine fetal well-being.

ANS:

vibroacoustic stimulation

Also referred to as VAS or acoustic stimulation, the vibroacoustic stimulator (similar to an electronic larynx) is applied to the maternal abdomen over the area of the fetal head. Vibration and sound are emitted for up to 3 seconds and may be repeated. A fetus near term responds by increasing the number of gross body movements, which can be easily seen and felt. The procedure can confirm reassuring NST findings and shorten the length of time necessary to obtain NST data.

PTS: 1 DIF: Cognitive Level: Application REF: p. 310

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

TRUE/FALSE

1. The nurse has instructed the pregnant patient to self-assess movement of her fetus by doing kick counts. The nurse knows that the woman has had effective learning when she states Two or three times a day I will be sure that my baby moves at least three times in an hour. Is this statement true or false?

ANS: T

The other method of self-assessment for fetal well-being is referred to as the count to 10. The woman is taught to perceive at least 10 fetal movements within a 12 hour period of time. However, maternal reporting of atypical changes in fetal activity has shown to be as valid as counting and documentation.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 313

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

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