Chapter 19 Assessment of Fetal Well-Being My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 19 Assessment of Fetal Well-Being

1) A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Confirm fetal heart activity.

2. Evaluate the cervix.

3. Determine fetal presentation.

4. Amniotic fluid volume.

5. Fetal number.

Answer: 3, 4, 5

Explanation: 3. A standard ultrasound examination is performed during the second or third trimester and includes an evaluation to determine fetal presentation.

4. A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of amniotic fluid volume.

5. A standard ultrasound examination is performed during the second or third trimester and includes an evaluation of fetal number.

Page Ref: 414

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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2) When assisting with a transabdominal sampling, which of the following would the nurse do?

1. Obtain preliminary urinary samples.

2. Have the woman empty her bladder before the test begins.

3. Assist the woman into a supine position on the examining table.

4. Instruct the woman to eat a fat-free meal 2 hours before the scheduled test time.

Answer: 3

Explanation: 3. Clients are placed in a supine position on the table.

Page Ref: 436

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Identify indications and interpret findings for ultrasound examinations performed in the first trimester.

MNL LO: 2.8.1 Explain the nurses role and responsibilities in the administration of antenatal testing.

3) The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching has been effective?

1. If the ultrasound is normal, it means my baby has no abnormalities.

2. The nuchal translucency measurement will diagnose Down syndrome.

3. I might be able to see who the baby looks like with the ultrasound.

4. Measuring the length of my cervix will determine whether I will deliver early.

Answer: 3

Explanation: 3. Three-dimensional ultrasound uses algorithms to vary opacity, transparency, and depth to project an image. This allows curved structures such as the fetal face to be viewed.

Page Ref: 413

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all health care settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

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MNL LO: 2.8.1 Explain the nurses role and responsibilities in the administration of antenatal testing.

4) A woman at 28 weeks gestation is asked to keep a fetal activity record and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for more than 30 minutes. Which of the following would be the nurses most appropriate initial comment?

1. You need to come to the clinic right away for further evaluation.

2. Have you been smoking?

3. When did you eat last?

4. Your baby might be asleep.

Answer: 4

Explanation: 4. Lack of fetal activity for 30 minutes typically is insignificant. Movement varies considerably, but most women feel fetal movement at least 10 times in 3 hours.

Page Ref: 424

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 5 Identify pertinent information to be discussed with the woman regarding her own assessment of fetal activity and methods of recording fetal activity.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

5) Which of the following tests provides information about the fetal number?

1. Amniocentesis

2. Standard second-trimester sonogram

3. Beta hCG

4. Maternal serum alpha-fetoprotein

Answer: 2

Explanation: 2. A standard (comprehensive) second trimester sonogram provides the information about the fetus, placenta, and uterine conditions including fetal number.

Page Ref: 419

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Knowledge and Science: Systematically reflect on practice as a basis for the generation of new knowledge and innovation. | Nursing/Integrated Concepts: Nursing Process: Planning

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Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

6) The client at 24 weeks gestation is experiencing painless vaginal bleeding after intercourse. The physician has ordered a transvaginal ultrasound examination. Which statements by the client indicate an understanding of why this exam has been requested?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. This ultrasound will show the babys gender.

2. This ultrasound might cause the miscarriage of my baby.

3. This ultrasound carries a risk of creating a uterine infection.

4. This ultrasound can determine the location of my placenta.

5. This ultrasound might detect whether the placenta is detaching prematurely.

Answer: 4, 5

Explanation: 4. Painless bleeding in the second and third trimesters can be a symptom of placenta previa. Transvaginal ultrasound will determine the placental location.

5. Painless bleeding in the second and third trimesters can be a symptom of placenta previa. Transvaginal ultrasound will determine the placental location.

Page Ref: 415

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4 Delineate the use of ultrasound in the second trimester to assess fetal life, number, presentation, anatomy, age, and growth.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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7) The nurse is returning phone calls from clients. Which client does the nurse anticipate would not require a serum beta hCG?

1. A client with a risk of ectopic pregnancy

2. A client with spotting during pregnancy

3. A client with previous pelvic inflammatory disease

4. A client with a previous history of twins

Answer: 4

Explanation: 4. A previous history of twins is not a risk factor for ectopic pregnancy. Beta hCG testing is not indicated for this client.

Page Ref: 416

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the lifespan continuum, across lifespan, and in all health care settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Identify indications and interpret findings for ultrasound examinations performed in the first trimester.

MNL LO: 2.8.2 Examine indications and procedures for antenatal testing performed during the first trimester.

8) Which of the following tests has become a widely accepted method of evaluating fetal status?

1. Contraction stress test (CST)

2. MSAFP test

3. Non-stress test (NST)

4. Nuchal translucency test

Answer: 3

Explanation: 3. The non-stress test (NST) has become a widely accepted method of evaluating fetal status. This test involves using an external electronic fetal monitor to obtain a tracing of the fetal heart rate (FHR) and observation of acceleration of the FHR with fetal movement.

Page Ref: 422

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6 Identify the indications and recommendations for fetal movement awareness, the non-stress test, and vibroacoustic stimulation.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third tri

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mester.

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9) The prenatal clinic nurse is explaining test results to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test result?

1. The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby.

2. The reactive non-stress test means that my baby is not growing because of a lack of oxygen.

3. Because my contraction stress test was positive, we know that my baby will tolerate labor well.

4. My biophysical profile score of 6 points to everything being normal and healthy for my baby.

Answer: 1

Explanation: 1. A decrease in fetal cardiac output or an increase in resistance of placental vessels will reduce umbilical artery blood flow. Doppler velocimetry is best used when intrauterine growth restriction is diagnosed; therefore, the baby is getting an adequate blood supply.

Page Ref: 431

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Identify the indications and recommendations for fetal movement awareness, the non-stress test, and vibroacoustic stimulation.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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10) At 32 weeks gestation, a woman is scheduled for a second non-stress test (following one she had at 28 weeks gestation). Which statement by the client would indicate an adequate understanding of this procedure?

1. I cant get up and walk around during the test.

2. Ill have an IV started before the test.

3. I can still smoke before the test.

4. I need to have a full bladder for this test.

Answer: 1

Explanation: 1. The purpose of the non-stress test is to determine the results of movement on fetal heart rate. The NST is typically performed with the woman in the semi-Fowlers position with a small pillow or blanket under the right hip to displace the uterus to the left.

Page Ref: 422, 424

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Identify the indications and recommendations for fetal movement awareness, the non-stress test, and vibroacoustic stimulation.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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11) During a non-stress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test, and last 20 seconds each. The nurse realizes these results will be interpreted as which of the following?

1. A negative test

2. A reactive test

3. A nonreactive test

4. An equivocal test

Answer: 3

Explanation: 3. The FHR acceleration must be at least 15 beats per minute above baseline for at least 15 seconds from baseline to baseline. A nonreactive NST is one that lacks sufficient FHR accelerations over a 40-minute period.

Page Ref: 425

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 6 Identify the indications and recommendations for fetal movement awareness, the non-stress test, and vibroacoustic stimulation.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

12) The nurse is responding to phone calls. Whose call should the nurse return first?

1. A client at 37 weeks gestation reports no fetal movement for 24 hours.

2. A client at 29 weeks gestation reports increased fetal movement.

3. A client at 32 weeks gestation reports decreased fetal movement X 2 days.

4. A client at 35 weeks gestation reports decreased fetal movement X 4 hours.

Answer: 1

Explanation: 1. Lack of fetal movement can be an indication of nonreassuring fetal status or even fetal death. This client is the highest priority.

Page Ref: 422

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6 Identify the indications and recommendations for fetal movement awareness, the non-stress test, and vibroacoustic stimulation.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third tri

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mester.

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13) The nurse is working in an outpatient clinic. Which clients indications most warrant fetal monitoring in the third trimester?

1. Gravida 4, para 3, 39 weeks, with a history of one spontaneous abortion at 8 weeks

2. Gravida 1, para 0, 40 weeks, with a history of endometriosis and a prior appendectomy

3. Gravida 3, para 2, with a history of gestational diabetes controlled by diet

4. Gravida 2, para 1, 36 weeks, with a history of history of preterm labor or cervical insufficiency

Answer: 4

Explanation: 4. The preterm client with a history of preterm labor or cervical insufficiency needs close monitoring for preterm labor onset.

Page Ref: 415, 421

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6 Identify the indications and recommendations for fetal movement awareness, the non-stress test, and vibroacoustic stimulation.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

14) A client at 37 weeks gestation has a mildly elevated blood pressure. Her antenatal testing demonstrates three contractions in 10 minutes, no decelerations, and accelerations four times in 1 hour. What would this test be considered?

1. Positive non-stress test

2. Negative contraction stress test

3. Positive contraction stress test

4. Negative non-stress test

Answer: 2

Explanation: 2. A negative CST shows three contractions of good quality lasting 40 or more seconds in 10 minutes without evidence of late decelerations. This is the desired result.

Page Ref: 427

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Compare the indications and procedures for the non-stress test, contraction stress test, biophysical profile, and amniotic fluid index.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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15) A pregnant woman is having a nipple-stimulated contraction stress test. Which result indicates hyperstimulation?

1. The fetal heart rate decelerates when three contractions occur within a 10-minute period.

2. The fetal heart rate accelerates when contractions last up to 60 seconds.

3. There are more than five fetal movements in a 10-minute period.

4. There are more than three uterine contractions in a 6-minute period.

Answer: 4

Explanation: 4. Hyperstimulation is characterized by contractions that occur more frequently than every 2 minutes or last longer than 90 seconds.

Page Ref: 428

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Safety and Quality: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 7 Compare the indications and procedures for the non-stress test, contraction stress test, biophysical profile, and amniotic fluid index.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

16) Of all the clients who have been scheduled to have a biophysical profile, the nurse should check with the physician and clarify the order for which client?

1. A gravida with intrauterine growth restriction

2. A gravida with mild hypotension of pregnancy

3. A gravida who is postterm

4. A gravida who complains of decreased fetal movement for 2 days

Answer: 2

Explanation: 2. The biophysical profile is used when there is a risk of placental and/or fetal compromise. The gravida with mild hypotension will need to be monitored more closely throughout the pregnancy, but is not a candidate at present for a biophysical profile.

Page Ref: 429

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Compare the indications and procedures for the non-stress test, contraction stress test, biophysical profile, and amniotic fluid index.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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17) The client with an abnormal quadruple screen is scheduled for an ultrasound. Which statement indicates that the client understands the need for this additional antepartal fetal surveillance?

1. After the ultrasound, my partner and I will decide how to decorate the nursery.

2. During the ultrasound we will see which of us the baby looks like most.

3. The ultrasound will show whether there are abnormalities with the babys spine.

4. The blood test wasnt run correctly, and now we need to have the sonogram.

Answer: 3

Explanation: 3. Ultrasound is used to detect neural tube defects. An abnormal serum quadruple screen is not the result of a lab error, and can indicate either an open neural tube defect or trisomy 18 or 21.

Page Ref: 433

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patient or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spiritual, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8 Explain the purposes of the sequential screen, quad screen, and fetal DNA testing and the implications of abnormal values.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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18) A 27-year-old married woman is 16 weeks pregnant and has an abnormally low maternal serum alpha-fetoprotein test. Which statement indicates that the couple understands the implications of this test result?

1. We have decided to have an abortion if this baby has Down syndrome.

2. If we hadnt had this test, we wouldnt have to worry about this baby.

3. Ill eat plenty of dark green leafy vegetables until I have the ultrasound.

4. The ultrasound should be normal because Im under the age of 35.

Answer: 1

Explanation: 1. A low maternal serum alpha-fetoprotein test can indicate trisomy 18 or trisomy 21 (Down syndrome). Many couples abort a fetus that has a genetic abnormality that significantly affects quality of life or has multiple medical problems. Down syndrome is more likely to occur in the fetuses of women over the age of 35 at delivery, but is not limited to this age group.

Page Ref: 433

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that results in developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8 Explain the purposes of the sequential screen, quad screen, and fetal DNA testing and the implications of abnormal values.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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19) The nurse is preparing a client for amniocentesis. Which statement would indicate that the client clearly understands the risks of an amniocentesis?

1. I might go into labor early.

2. It could produce a congenital defect in my baby.

3. Actually, there are no real risks to this procedure.

4. The test could stunt my babys growth.

Answer: 1

Explanation: 1. Amniocentesis has the potential for causing a spontaneous abortion.

Page Ref: 435, 436

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 12. Facilitate informed patient consent for care. | AACN Essentials Competencies: Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

20) The nurse is reviewing amniocentesis results. Which of the following would indicate that client care was appropriate?

1. The client who is Rh-positive received Rh immune globulin after the amniocentesis.

2. The client was monitored for 30 minutes after completion of the test.

3. The client began vaginal spotting before leaving for home after the test.

4. The client identified that she takes insulin before each meal and at bedtime.

Answer: 2

Explanation: 2. 20 to 30 minutes of fetal monitoring is performed after the amniocentesis.

Page Ref: 435

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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21) Each of the following pregnant women is scheduled for a 14-week antepartal visit. In planning care, the nurse would give priority teaching on amniotic fluid alpha-fetoprotein (AFP) screening to which client?

1. 28-year-old with history of rheumatic heart disease

2. 18-year-old with exposure to HIV

3. 20-year-old with a history of preterm labor

4. 35-year-old with a child with spina bifida

Answer: 4

Explanation: 4. Alpha-fetoprotein (AFP) is a fetal protein that is excreted from the fetal yolk sac during the first 6 weeks of pregnancy. AFP levels can be high or low, with each having different implications for the fetus. If the fetus has a neural tube defect (NTD), the AFP levels will be elevated. NTDs can range from anencephaly to spina bifida. With a past history of a child with spina bifida, this client would be strongly encouraged to have the AFP screening.

Page Ref: 432

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 8 Explain the purposes of the sequential screen, quad screen, and fetal DNA testing and the implications of abnormal values.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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22) The pregnant client and her partner are both 40 years old. The nurse is explaining the options of chorionic villus sampling (CVS) and amniocentesis for genetic testing. The nurse should correct the client if she makes which statement?

1. Amniocentesis results are available sooner than CVS results are.

2. CVS carries a higher risk of limb abnormalities.

3. Amniocentesis cannot detect a neural tube defect.

4. CVS is performed through my belly or my cervix.

Answer: 1

Explanation: 1. Amniocentesis results take longer to process than do CVS results.

Page Ref: 436

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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23) The client and her partner are carriers of sickle-cell disease. They are considering prenatal diagnosis with either amniocentesis or chorionic villus sampling (CVS). Which statements indicate that further teaching is needed on these two diagnostic procedures?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Chorionic villus sampling carries a lower risk of miscarriage.

2. Amniocentesis can be done earlier in my pregnancy than CVS.

3. Neither test will conclusively diagnose sickle-cell disease in our baby.

4. The diagnosis comes sooner if we have CVS, not amniocentesis.

5. Amniocentesis is more accurate in diagnosis than the CVS.

Answer: 1, 2, 5

Explanation: 1. CVS has a risk of spontaneous abortion of 0.3% in cases. This rate is higher than second trimester amniocentesis.

2. CVS is performed in some medical centers for first trimester diagnosis after 9 completed weeks. Amniocentesis is performed between 15 and 20 weeks gestation.

5. Much like amniocentesis, chorionic villus sampling (CVS) is a procedure that is used to detect genetic, metabolic, and DNA abnormalities. CVS permits earlier diagnosis than can be obtained by amniocentesis.

Page Ref: 433, 435

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Contrast the use of amniocentesis and chorionic villus sampling in detecting a fetus with a chromosomal disorder.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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Copyright 2016 Pearson Education, Inc.

24) The nurse anticipates that the physician will most likely order a cervicovaginal fetal fibronectin test for which client?

1. The client at 34 weeks gestation with gestational diabetes

2. The client at 32 weeks gestation with regular uterine contractions

3. The client at 37 weeks multi-fetal gestation

4. The client at 20 weeks gestation with ruptured amniotic membranes

Answer: 2

Explanation: 2. The absence of cervicovaginal fFN between 20 and 34 weeks gestation has been shown to be a strong predictor of a woman not experiencing preterm birth due to spontaneous preterm labor or premature rupture of membranes. Positive findings indicate a 99% probability of birth within the next 2 weeks.

Page Ref: 438

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10 Discuss fetal fibronectin and transvaginal ultrasound measurement of cervical length as predictors of preterm labor.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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Copyright 2016 Pearson Education, Inc.

25) The client at 14 weeks gestation has undergone a transvaginal ultrasound to assess cervical length. The ultrasound revealed cervical funneling. How should the nurse explain these findings to the client?

1. Your cervix has become cone-shaped and more open at the end near the baby.

2. Your cervix is lengthened, and you will deliver your baby prematurely.

3. Your cervix is short, and has become wider at the end that extends into the vagina.

4. Your cervix was beginning to open but now is starting to close up again.

Answer: 1

Explanation: 1. Transvaginal ultrasound can most accurately identify shortened cervical length and cervical funneling, which is a cone-shaped indentation in the cervical os indicating cervical insufficiency or risk of preterm labor.

Page Ref: 415

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10 Discuss fetal fibronectin and transvaginal ultrasound measurement of cervical length as predictors of preterm labor.

MNL LO: 2.8.3 Examine indications and procedures for antenatal testing performed during the second trimester.

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Copyright 2016 Pearson Education, Inc.

26) The nurse knows that a lecithin/sphingomyelin (L/S) ratio finding of 2:1 on amniotic fluid means which of the following?

1. Fetal lungs are still immature.

2. The fetus has a congenital anomaly.

3. Fetal lungs are mature.

4. The fetus is small for gestational age.

Answer: 3

Explanation: 3. The concentration of lecithin begins to exceed that of sphingomyelin, and at 35 weeks the L/S ratio is 2:1. When at least two times as much lecithin as sphingomyelin is found in the amniotic fluid, RDS is very unlikely.

Page Ref: 438

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11 Discuss how the lecithin/sphingomyelin ratio of the amniotic fluid and phosphatidylglycerol (PG) can be used to assess fetal lung maturity.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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Copyright 2016 Pearson Education, Inc.

27) A 28-year-old woman has been an insulin-dependent diabetic for 10 years. At 36 weeks gestation, she has an amniocentesis. A lecithin/sphingomyelin (L/S) ratio test is performed on the sample of her amniotic fluid. Because she is a diabetic, what would an obtained 2:1 ratio indicate for the fetus?

1. The fetus may or may not have immature lungs.

2. The amniotic fluid is contaminated.

3. The fetus has a neural tube defect.

4. There is blood in the amniotic fluid.

Answer: 1

Explanation: 1. Infants of diabetic mothers (IDMs) have a high incidence of false-positive results (i.e., the L/S ratio is thought to indicate lung maturity, but after birth the baby develops RDS).

Page Ref: 438

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 13. Revise the plan of care based on an ongoing evaluation of patient outcomes. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11 Discuss how the lecithin/sphingomyelin ratio of the amniotic fluid and phosphatidylglycerol (PG) can be used to assess fetal lung maturity.

MNL LO: 2.8.4 Examine indications and procedures for antenatal testing performed during the third trimester.

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