Prenatal Diagnostic Tests And Procedures > Maternal & Newborn
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Showing 42 questions, Sign in for moreA nurse is caring for a client who is scheduled for chorionic villus sampling (CVS).
Which of the following statements should indicate to the nurse that the client understands the procedure?
Explanation
Choice A is wrong because it describes a transabdominal CVS procedure, which involves a needle instead of a catheter.
Choice C is wrong because it describes a procedure that is not used for CVS.A needle inserted through the cervix could damage the fetal membranes or cause bleeding.
Choice D is wrong because it describes a procedure that is not possible.A catheter cannot be inserted through the abdomen and uterus into the placenta.
Normal ranges for CVS are not applicable as it is a diagnostic test, not a screening test.
It provides a definitive result of whether the fetus has a chromosomal abnormality or a genetic disorder.CVS is usually done between 10 and 13+6 weeks of pregnancy.
A nurse is caring for a client who had chorionic villus sampling (CVS) performed at 12 weeks’ gestation and asks when she can expect results from this test.
The nurse should inform her that results are typically available within which timeframe?
Explanation
The correct answer is choice B. The nurse should inform her that results are typically available within 7 days.
This is known as the rapid CVS result.
A more detailed set of CVS results will be available within 2 weeks.
Choice A is wrong because 24 hours is too short for the laboratory to test the sample of cells from the placenta.
Choice C is wrong because 10-14 days is the timeframe for the more detailed set of CVS results, not the rapid CVS result.
Choice D is wrong because 30 days is too long for the results to be available.
The woman would need to know the results sooner to make informed decisions about her pregnancy.
A nurse is providing education to a client who is scheduled to undergo chorionic villus sampling (CVS).
Which statement by the client indicates an understanding of this test?
Explanation
This test can detect genetic disorders.
Chorionic villus sampling (CVS) is a prenatal test that involves taking a sample of tissue from the placenta to test for chromosomal abnormalities and certain other genetic problems.
The placenta is a structure in the uterus that provides blood and nutrients from the mother to the fetus.
Choice A is wrong because CVS does not provide information on neural tube defects, such as spina bifida.
For this reason, women who undergo CVS also need a follow-up blood test between 16 to 18 weeks of their pregnancy to screen for neural tube defects.
Choice C is wrong because CVS can detect chromosomal abnormalities, but not all chromosomal abnormalities are genetic disorders.
For example, Down syndrome is a chromosomal abnormality caused by an extra copy of chromosome 21, but it is not inherited from the parents.
Choice D is wrong because CVS cannot detect Rh sensitization, which is a condition where the mother’s immune system produces antibodies against the fetus’s blood type.
Rh sensitization can be detected by a blood test that measures the level of antibodies in the mother’s blood.
A nurse is providing education to a client who is scheduled to undergo chorionic villus sampling (CVS).
Which statement by the client indicates an understanding of this test?
Explanation
This test can detect genetic disorders.
Chorionic villus sampling (CVS) is a prenatal test that involves taking a sample of tissue from the placenta to test for chromosomal abnormalities and certain other genetic problems.
The placenta is a structure in the uterus that provides blood and nutrients from the mother to the fetus.
Choice A is wrong because CVS does not provide information on neural tube defects, such as spina bifida.
For this reason, women who undergo CVS also need a follow-up blood test between 16 to 18 weeks of their pregnancy to screen for neural tube defects.
Choice C is wrong because CVS can detect chromosomal abnormalities, but not all chromosomal abnormalities are genetic disorders.
For example, Down syndrome is a chromosomal abnormality that occurs randomly and is not inherited from the parents.
Choice D is wrong because CVS cannot detect Rh sensitization, which is a condition where the mother’s immune system produces antibodies against the fetus’s blood cells.
Rh sensitization can be detected by a blood test that measures the level of antibodies in the mother’s blood.
A nurse is caring for a client who is scheduled for an amniocentesis.
Which of the following should the nurse report to the provider?
Explanation
The correct answer is choice D. The client has a history of placenta previa.
Placenta previa is a condition where the placenta covers all or part of the cervix, blocking the baby’s exit from the uterus.
This can cause severe bleeding during pregnancy and delivery and increase the risk of complications for both the mother and the baby.
Therefore, the nurse should report this condition to the provider before performing an amniocentesis.
Choice A is wrong because having Rh-negative blood type is not a contraindication for amniocentesis.
However, the client may need an injection of Rh immunoglobulin after the procedure to prevent Rh sensitization.
Choice B is wrong because having a history of preterm labor is not a contraindication for amniocentesis.
However, the client may need to be monitored closely for signs of preterm labor after the procedure.
Choice C is wrong because having a history of gestational diabetes is not a contraindication for amniocentesis.
However, the client may need to have their blood glucose levels checked before and after the procedure.
Amniocentesis is a diagnostic procedure that involves removing and testing a small sample of amniotic fluid from the uterus for genetic or chromosomal conditions, such as Down syndrome, Edwards syndrome or Patau syndrome.
It can also be used to diagnose fetal infections, treat excess amniotic fluid, or test fetal lung maturity
A nurse is caring for a client scheduled for a CST.
Which statement indicates the client understands the test procedure?
Explanation
“I will have sensors placed on my abdomen to monitor the FHR and uterine contractions.” This statement indicates the client understands the test procedure of a CST, which is a test that triggers contractions and registers how the baby’s heart reacts.
The test is done by placing two sensor belts around the abdomen, one to measure the baby’s heartbeat and the other to measure contractions.
The client may receive oxytocin through an IV to induce contractions.
Choice B is wrong because the client does not need to fast for 24 hours before the test.
There is no evidence that fasting is required for a CST.
Choice C is wrong because the client will not be sedated during the test.
Sedation is not necessary for a CST and may interfere with the results.
Choice D is wrong because the client does not need to drink plenty of fluids before the test.
There is no evidence that drinking fluids is required for a CST.
During a Non-Stress Test (NST), the client needs to press a button whenever they feel the fetus move.
What is the purpose of this action?
Explanation
To measure the fetal heart rate (FHR) in response to fetal movements.
This is because the FHR should increase by at least 15 beats per minute for at least 15 seconds when the fetus moves, which indicates a healthy and reactive fetus.
This is called an acceleration.
Choice B is wrong because the uterine contractions are not related to the fetal movements or the button pressing.
The uterine contractions are measured by a tocodynamometer or an intrauterine pressure catheter.
Choice C is wrong because the fetal oxygenation and neurological function are not directly measured by the button pressing.
The fetal oxygenation can be assessed by the FHR variability and decelerations, while the neurological function can be evaluated by other tests such as biophysical profile or fetal acoustic stimulation.
Choice D is wrong because the fetal well-being and hypoxia or distress are not indicated by the button pressing alone.
The fetal well-being and hypoxia or distress are determined by the FHR patterns, such as baseline, variability, accelerations and decelerations.
A nurse is caring for a client who is scheduled for an amniocentesis at 16 weeks gestation.
Which of the following should the nurse report to the provider?
Explanation
. The client’s cervix is dilated.
This indicates that the client may be in preterm labor, which is a contraindication for amniocentesis.
Amniocentesis is a procedure that involves inserting a needle into the amniotic sac to obtain a sample of amniotic fluid for genetic testing or other purposes.
It is usually performed between 15 and 20 weeks of gestation.
Choice A is wrong because the client’s bladder should be full for amniocentesis.
This helps to push the uterus upward and away from the bladder, reducing the risk of injury and making it easier to visualize the fetus and the needle.
Choice B is wrong because the client’s uterus should be above the symphysis pubis at 16 weeks of gestation.
This is a normal finding and does not affect the procedure.
Choice D is wrong because the client’s fundal height should measure around 16 cm at 16 weeks of gestation.
A fundal height of 20 cm may indicate a large for gestational age fetus, multiple gestation, or polyhydramnios (excess amniotic fluid), but these are not absolute contraindications for amniocentesis.
However, they may require further evaluation and adjustment of the technique.
A nurse is preparing a client for a Contraction Stress Test (CST).
Which method can be used to induce uterine contractions during the test?
Explanation
This method can be used to induce uterine contractions during the test by stimulating the uterus with a hormone that causes contractions.
Oxytocin is also the hormone that naturally triggers labor contractions.
Choice A is wrong because nipple stimulation can also induce contractions, but it is not as reliable or controllable as oxytocin infusion.
Choice C is wrong because oral medications are not used to induce contractions during a CST.
Some medications may interfere with the test results or cause side effects.
Choice D is wrong because applying warm compresses to the abdomen does not induce contractions.
It may help with pain relief or relaxation, but it does not affect the uterus.
Normal ranges for uterine contractions during a CST are three contractions in 10 minutes, each lasting 40 to 60 seconds.
Normal ranges for fetal heart rate during a CST are 110 to 160 beats per minute, with no decelerations after contractions.
A nurse is caring for a client who had an amniocentesis at 16 weeks gestation and reports cramping and vaginal bleeding 24 hours later.
Which of the following actions should the nurse take first?
Explanation
The correct answer is choice B. Monitor fetal heart rate.
This is because cramping and vaginal bleeding after amniocentesis are signs of possible complications such as miscarriage, preterm labor, or injury to the fetus.
Monitoring fetal heart rate can help assess the well-being of the fetus and detect any signs of distress.
Choice A is wrong because administering Rho(D) immunoglobulin is only necessary if the mother has Rh-negative blood and the baby has Rh-positive blood, which can cause Rh sensitization.
This is not given routinely to all women who have amniocentesis.
Choice C is wrong because assessing maternal vital signs is not the first priority when there is a risk of fetal compromise.
Maternal vital signs can be affected by many factors and are not specific indicators of fetal health.
Choice D is wrong because obtaining an order for an ultrasound exam is not the first action to take.
An ultrasound exam can help confirm the diagnosis of complications such as placental abruption or fetal demise, but it requires time and equipment that might delay immediate intervention.
Monitoring fetal heart rate can be done quickly and easily at the bedside.
A nurse is preparing a client for a biophysical profile (BPP).
The nurse should instruct the client that the test involves which of the following procedures?
Explanation
The test involves an ultrasound and a nonstress test.
A biophysical profile (BPP) is a way to check on the overall fetal health by observing the fetus’s heart rate, breathing, movement, muscle tone, and the amount of amniotic fluid surrounding the fetus in the uterus.
It is typically performed after 28 weeks of pregnancy, especially for high-risk pregnancies or if there is a chance of complications.
Choice B is wrong because a contraction stress test is not part of a BPP.
A contraction stress test measures how the fetus’s heart rate changes during contractions induced by oxytocin or nipple stimulation.
It is a different test from a nonstress test, which measures the fetus’s heart rate while moving and at rest without any stimulation.
Choice C is wrong because a Doppler ultrasound is not part of a BPP.
A Doppler ultrasound uses sound waves to measure the blood flow in the umbilical cord and other blood vessels.
It is a different type of ultrasound from the one used in a BPP, which uses sound waves to create images of the fetus and the amniotic fluid.
Choice D is wrong because it combines two incorrect components from choices B and C. A BPP does not involve a Doppler ultrasound or a contraction stress test.
A nurse is explaining the purpose of a Contraction Stress Test (CST) to a pregnant client.
What does the CST aim to assess?
Explanation
A contraction stress test (CST) is performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth.
The aim is to induce contractions and monitor the fetus to check for heart rate abnormalities using a cardiotocograph.
A normal heartbeat is a good sign that the fetus will be healthy during labor.
Choice B is wrong because a CST does not measure maternal blood pressure.
Choice C is wrong because a CST does not assess placental function directly.
Choice D is wrong because a CST does not measure amniotic fluid volume.
Normal ranges for fetal heart rate are between 110 and 160 beats per minute.
Normal ranges for uterine contractions are between 2 and 5 contractions in 10 minutes, lasting less than 90 seconds each.
A nurse is caring for a patient who had an amniocentesis performed at 16 weeks gestation and reports cramping and vaginal bleeding 24 hours later which action should be taken first?
Explanation
This is because cramping and vaginal bleeding after an amniocentesis may indicate a possible miscarriage or placental abruption, which can compromise fetal oxygenation and perfusion.
Monitoring fetal heart rate can help detect signs of fetal distress and guide further interventions.
Choice A is wrong because administering Rho(D) immune globulin is indicated for Rh-negative mothers who undergo amniocentesis to prevent isoimmunization, but it is not a priority action in this scenario.
Choice C is wrong because assessing maternal vital signs is important to monitor for signs of infection, hemorrhage, or shock, but it is not as urgent as monitoring fetal well-being.
Choice D is wrong because obtaining an order for an ultrasound exam can help confirm the diagnosis and evaluate the placenta and amniotic fluid, but it is not the first action to take in this situation.
A nurse is caring for a patient who had an amniocentesis performed at 16 weeks gestation and reports cramping and vaginal bleeding 24 hours later.
Which action should be taken first?
Explanation
The correct answer is choice A. Notify the health care provider immediately.
This is because cramping and vaginal bleeding 24 hours after amniocentesis are signs of possible complications, such as injury to the baby or mother, leaking of amniotic fluid, infection, Rh sensitization, preterm labor, or miscarriage.
These complications are rare, but they can be serious and require immediate medical attention.
Choice B is wrong because administering pain medication to the patient does not address the underlying cause of the cramping and bleeding, and may delay seeking help.
Choice C is wrong because encouraging the patient to rest and elevate her legs may not prevent further complications, and may also delay seeking help.
Choice D is wrong because offering emotional support and reassurance to the patient is not enough to ensure the safety of the baby and the mother, and may give a false sense of security.
Normal ranges for amniocentesis are:
No chromosomal defects detected in the fetus and no abnormal proteins present in amniotic fluid
No signs of infection or other illness in the baby
Fetal lungs mature enough for birth if delivery is planned sooner than 39 weeks
A nurse is interpreting the results of a biophysical profile (BPP) for a client who is at 34 weeks of gestation.
The nurse should understand that each of the five variables is assigned a score of how many points?
Explanation
Each of the five variables in a biophysical profile (BPP) is assigned a score of either 0 or 2 points, depending on whether it meets the criteria or not.
The five variables are:
Fetal breathing: 2 points if there is at least one episode of rhythmic breathing lasting at least 30 seconds within 30 minutes, 0 points otherwise.
Fetal movement: 2 points if there are at least three discrete body or limb movements within 30 minutes, 0 points otherwise.
Fetal tone: 2 points if there is at least one episode of extremity extension and subsequent return to flexion, 0 points otherwise.
Amniotic fluid volume: 2 points if there is a pocket of amniotic fluid measuring at least 2 cm in two perpendicular planes, 0 points otherwise.
Nonstress test: 2 points if there are at least two accelerations of fetal heart rate with or without fetal movement within 20 minutes, 0 points otherwise.
Choice A is wrong because each variable can have a score of either 0 or 2, not 0 or.
Choice C is wrong because there is no score of 1 for any variable.
Choice D is wrong because it is incomplete and does not provide the full range of possible scores.
A nurse is reviewing the contraindications for a Contraction Stress Test (CST) with a pregnant client.
Which condition would be a contraindication for the test?
Explanation
This is a contraindication for the Contraction Stress Test (CST) because it increases the risk of infection and umbilical cord prolapse.
A CST is a test that measures the baby’s heart rate during uterine contractions induced by oxytocin or nipple stimulation.
Choice A is wrong because gestational diabetes is not a contraindication for the CST.
It is a condition that affects how the body processes glucose during pregnancy and may cause complications such as macrosomia (large baby), hypoglycemia (low blood sugar) or preeclampsia (high blood pressure and protein in urine).
Choice B is wrong because mild preeclampsia is not a contraindication for the CST.
It is a condition that causes high blood pressure and protein in urine after 20 weeks of pregnancy and may affect the placenta, kidneys, liver or brain.
Choice C is wrong because preterm labor is a relative contraindication for the CST, not an absolute one.
It means that the test may be performed if the benefits outweigh the risks, but it should be avoided if possible because it may trigger early labor or delivery.
Preterm labor is defined as regular uterine contractions with cervical changes before 37 weeks of pregnancy.
Normal ranges for blood pressure are below 120/80 mmHg, for glucose are 70-100 mg/dL (fasting) or below 140 mg/dL (2 hours after eating), and for protein in urine are less than 300 mg/24 hours.
A nurse is educating a pregnant client about the Non-Stress Test (NST).
Which statement by the client indicates understanding of the test?
Explanation
"NST is performed after 28 weeks of gestation or earlier if there are risk factors."12 This statement indicates that the client understands when and why an NST is done.
Choice B is wrong because it describes a reactive NST, not a nonreactive one.
A reactive NST means that the fetal heart rate increases by at least 15 beats per minute for at least 15 seconds twice or more in a 20-minute period.2
Choice C is wrong because it confuses NST with contraction stress test (CST), which requires monitoring uterine contractions.
NST does not involve contractions.2
Choice D is wrong because it describes possible causes of a nonreactive NST, not a reactive one.
A nonreactive NST may indicate fetal hypoxia, distress, sleep, medication effect, or neurological abnormality.2
A client's CST result is interpreted as equivocal.
What additional diagnostic test may be recommended to further evaluate fetal well-being?
Explanation
An NST is a test that measures the fetal heart rate in response to fetal movement.
It is a non-invasive and simple way to assess fetal well-being.
An NST may be recommended to further evaluate fetal well-being if the CST result is equivocal, meaning that occasional but not persistent late decelerations are present.
Choice B. Amniocentesis is wrong because it is an invasive procedure that involves inserting a needle into the uterus to collect amniotic fluid for genetic testing or fetal lung maturity.
It is not used to evaluate fetal well-being in response to contractions.
Choice C. Magnetic resonance imaging (MRI) is wrong because it is an imaging technique that uses magnetic fields to create detailed pictures of the fetus and the placenta.
It is not used to evaluate fetal well-being in response to contractions.
Choice D. Chorionic villus sampling (CVS) is wrong because it is an invasive procedure that involves inserting a catheter or a needle into the placenta to collect chorionic villi for genetic testing.
It is not used to evaluate fetal well-being in response to contractions.
Normal ranges for CST are negative (normal) or positive (abnormal).
Equivocal and unsatisfactory are special categories of test outcomes that require further testing.
Normal ranges for NST are reactive (reassuring) ornon-reactive (non-reassuring).
A nurse is performing an abdominal ultrasound for a client who is at 28 weeks of gestation.
The nurse should instruct the client to do which of the following before the procedure?
Explanation
The woman should drink several glasses of water before the abdominal ultrasound procedure.
This is because a full bladder helps to push the intestines away and improve the visibility of the uterus and the fetus.
Drinking water also helps to avoid gas buildup in the abdomen, which could interfere with the sound waves.
Choice B is wrong because emptying the bladder would make it harder to see the uterus and the fetus.
Choice C is wrong because lying on the right side would not affect the quality of the ultrasound image.
Choice D is wrong because fasting is not necessary for an abdominal ultrasound, unless instructed by the doctor for a specific reason.
A nurse is explaining the purpose of an Alpha-fetoprotein Test (AFP) to a pregnant client.
What is the test primarily used for ?
Explanation
An alpha-fetoprotein test (AFP) is a blood test that measures the amount of AFP present in blood.
It’s usually part of what’s called a triple screen or quad screen in the second trimester of pregnancy.
The yolk sac, GI tract, and liver of an unborn baby produce AFP.
It then circulates through the fetal and maternal blood.
High levels of AFP in pregnant people can indicate that the baby has a neural tube defect, such as spina bifida or anencephaly.
Choice B is wrong because assessing placental function is not the primary purpose of an AFP test.
However, low levels of AFP can indicate problems with the placenta or the baby’s growth.
Choice C is wrong because determining fetal gender is not the primary purpose of an AFP test.
However, some genetic tests that use a sample of the baby’s DNA from the pregnant person’s blood can reveal the baby’s sex as early as 10 weeks of pregnancy.
Choice D is wrong because diagnosing chromosomal abnormalities is not the primary purpose of an AFP test.
However, an AFP test is usually part of a quad screen that also tests for other markers that can indicate the risk of chromosomal abnormalities, such as Down syndrome.
A nurse is caring for a client who has oligohydramnios and is undergoing a biophysical profile (BPP).
The nurse should expect to see which of the following findings on the ultrasound?
Explanation
An amniotic fluid index (AFI) of 4 cm indicates oligohydramnios, which is a low amount of amniotic fluid.
Oligohydramnios can be caused by various factors, such as uteroplacental insufficiency, rupture of membranes, postterm pregnancy, fetal anomalies, or certain medications.
Oligohydramnios can lead to complications such as fetal death, intrauterine growth restriction, limb contractures, or delayed lung maturation.
Choice A is wrong because an AFI of 8 cm is within the normal range for amniotic fluid volume.
Choice C is wrong because a single vertical pocket of amniotic fluid measuring 3 cm is also within the normal range for amniotic fluid volume.
Choice D is wrong because a single vertical pocket of amniotic fluid measuring 5 cm is also within the normal range for amniotic fluid volume.
Normal ranges for AFI and single vertical pocket are > 5 to < 24 cm and ≥ 2 to < 8 cm, respectively.
During a CST, the nurse observes variable decelerations of the FHR with or without contractions.
What does this finding indicate?
Explanation
This finding indicates that the umbilical cord is being compressed, which can reduce the blood flow and oxygen supply to the fetus.
Variable decelerations are abrupt decreases in the fetal heart rate (FHR) that vary in shape, duration, and degree of fall below the baseline.
They are seen as W- or U-shaped waves on the monitor.
Choice B is wrong because fetal hypoxia is not indicated by variable decelerations, but by late decelerations, which are gradual decreases in the FHR that begin after the peak of the contraction and return to baseline after the contraction ends.
Late decelerations are associated with uteroplacental insufficiency, which means that the placenta is not delivering enough oxygen to the fetus.
Choice C is wrong because normal placental function is not indicated by variable decelerations, but by reassuring FHR patterns, such as moderate variability (6 to 25 beats per minute) and accelerations (increases in the FHR above the baseline).
Normal placental function ensures adequate fetal oxygenation and well-being.
Choice D is wrong because adequate fetal oxygenation is not indicated by variable decelerations, but by reassuring FHR patterns, such as moderate variability and accelerations.
Adequate fetal oxygenation means that the fetus is not experiencing hypoxia or distress.
Normal ranges for FHR are 110 to 160 beats per minute at term and 120 to 160 beats per minute before term.
Normal ranges for uterine contractions are 2 to 5 contractions in 10 minutes, lasting less than 90 seconds each.
A client's Alpha-fetoprotein Test (AFP) result is reported as 1.2 MoM.
How should the nurse interpret this result?
Explanation
Normal level of AFP for the given gestational age.
AFP is a protein that the liver makes when its cells are growing and dividing to make new cells.
It is normally high in unborn babies and drops very low after birth.
The AFP test measures the amount of AFP present in blood and can help diagnose certain types of cancer and check how well treatment is working.
It can also help detect some birth defects in pregnant women.
Choice B is wrong because high level of AFP indicating a neural tube defect.
Neural tube defects are abnormalities that affect the brain and spinal cord of the fetus.
They can cause spina bifida, which is a condition where the spine does not close properly.
High levels of AFP can be a sign of neural tube defects, but they can also be caused by other factors, such as multiple pregnancies, inaccurate dating of pregnancy, or fetal death.
Choice C is wrong because low level of AFP indicating a chromosomal abnormality.
Chromosomal abnormalities are genetic disorders that affect the number or structure of chromosomes in the fetus.
They can cause Down syndrome, which is a condition where the fetus has an extra copy of chromosome 212.
Low levels of AFP can be a sign of chromosomal abnormalities, but they can also be caused by other factors, such as inaccurate dating of pregnancy, fetal death, or maternal obesity.
Choice D is wrong because inconclusive result, requiring further evaluation.
An inconclusive result means that the AFP level is neither too high nor too low to indicate a problem with the fetus.
It does not necessarily mean that there is something wrong with the fetus, but it may require further testing to confirm or rule out any abnormalities.
Normal ranges for AFP levels vary depending on the gestational age and the laboratory that performs the test.
Generally, the normal range for AFP levels in pregnant
A nurse is observing fetal breathing movements on an ultrasound for a client who is undergoing a biophysical profile (BPP).
The nurse should document how many points for this variable if the fetus has at least one episode of breathing lasting for 20 seconds within a 30-minute period?
Explanation
According to the ACOG guidelines on antepartum fetal surveillance, one of the components of the biophysical profile is fetal breathing movements, which are scored as 2 points if there is one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes.
Choice A is wrong because 0 points are given for absent or no breathing episode for ≥30 seconds within a 30 minute observation period.
Choice B is wrong because there is no 1 point score for this variable.
Choice D is wrong because there is no 3 point score for this variable.
The maximum score for each variable is 2 points.
A nurse is educating a pregnant client about the Alpha-fetoprotein Test (AFP).
What should the nurse include as a reason why AFP results are reported as multiples of the median (MoM)?
Explanation
This is because AFP levels vary according to the gestational age of the fetus, and reporting them as multiples of the median (MoM) allows for a standardized comparison.
Choice B is wrong because AFP results do not differentiate between neural tube defects and chromosomal abnormalities.
They only indicate an increased risk for these conditions, which need further testing to confirm.
Choice C is wrong because AFP results do not assess the risk of fetal demise or multiple gestation.
They only measure the amount of AFP in the maternal blood, which can be affected by various factors such as maternal weight, race, diabetes, and fetal anomalies.
Choice D is wrong because AFP results are reported as MoM regardless of factors such as maternal weight and race.
These factors are taken into account when calculating the MoM value, which adjusts for the expected variation in AFP levels among different populations.
Normal ranges for AFP MoM vary depending on the laboratory and the method used, but generally they are between 0.5 and 2.52.
Values above or below this range may indicate an increased risk for certain fetal conditions or complications.
A nurse is educating a pregnant client about the Contraction Stress Test (CST).
Which statement accurately describes a negative CST?
Explanation
This means that the baby’s heart rate did not slow down after the contractions induced by oxytocin, which is a sign of normal fetal well-being.
A negative CST is normal and desirable.
Choice A is wrong because no contractions were induced during the test.
This means that the test was inconclusive and could not assess the baby’s response to stress.
Choice B is wrong because late decelerations of the FHR were observed with at least 50% of contractions.
This means that the baby’s heart rate slowed down and stayed slow after the contractions, which is a sign of fetal distress and hypoxia.
A positive CST is abnormal and concerning.
Choice D is wrong because the client experienced mild uterine cramping during the test.
This is not a relevant factor for interpreting the CST results, which depend on the FHR patterns.
Uterine cramping can be a side effect of oxytocin administration or nipple stimulation.
A client's Alpha-fetoprotein Test (AFP) result is reported as 0.8 MoM.
What does this result suggest?
Explanation
This result suggests that the baby has a low risk of having a genetic disorder or a neural tube defect.
Choice B is wrong because a high level of AFP indicating a neural tube defect would be greater than 2 MoM.
Choice C is wrong because a low level of AFP indicating a potential chromosomal abnormality would be less than 0.5 MoM.
Choice D is wrong because an inconclusive result, requiring further evaluation, would depend on other factors such as ultrasound findings and maternal age.
MoM stands for multiples of the median, which is a way of comparing the AFP level of a pregnant person to the average level for their gestational age.
Values between 0.5 and 2.49 MoM are considered normal.
A nurse is reviewing the results of an Alpha-fetoprotein Test (AFP) with a pregnant client.
What does a low level of AFP (<0.5 MoM) potentially indicate?
Explanation
A low level of AFP (<0.5 MoM) in a pregnant woman can indicate that the fetus has a chromosomal abnormality, such as Down syndrome or Edwards syndrome.
This is because these conditions affect the development of the fetal liver, which produces AFP.
Choice A is wrong because neural tube defects, such as spina bifida, are associated with high levels of AFP (>2.5 MoM) in the maternal blood.
This is because AFP can leak from the open spinal canal of the fetus into the amniotic fluid and then into the maternal blood.
Choice C is wrong because maternal weight-related factors do not affect the level of AFP in the maternal blood.
However, they can affect the interpretation of the AFP test results, as the test needs to be adjusted for maternal weight, age, ethnicity, and gestational age.
Choice D is wrong because fetal demise (death) can also cause high levels of AFP in the maternal blood, as the AFP from the dead fetus can leak into the amniotic fluid and then into the maternal blood.
Normal ranges of AFP in pregnant women vary depending on the gestational age and the method of measurement.
Generally, normal levels of AFP are below 10 ng/ml in nonpregnant adults and below 2.5 MoM in pregnant women.
A client asks the nurse about the risks and complications associated with prenatal ultrasound.
Which of the following responses by the nurse is accurate?
Explanation
There are no known risks or complications for the pregnant person or the fetus.
Prenatal ultrasound is a safe and noninvasive procedure that uses sound waves to create images of the fetus and the placenta.
It does not use radiation or harm the fetal tissues.
Choice A is wrong because ultrasound does not cause harm to the fetus.
There is no evidence that ultrasound has any adverse effects on fetal development, growth, or health.
Choice C is wrong because pregnant individuals do not need to avoid ultrasound due to potential radiation exposure.
Ultrasound does not involve radiation, unlike x-rays or CT scans.
Choice D is wrong because ultrasound does not lead to miscarriage or preterm labor.
Ultrasound is not associated with any increased risk of pregnancy complications, such as miscarriage, preterm labor, or birth defects.
A nurse is explaining the purpose of a nuchal translucency (NT) ultrasound to a pregnant client.
What does this ultrasound measure?
Explanation
This is because a nuchal translucency ultrasound measures the amount of fluid behind the baby’s neck in the first trimester of pregnancy, which can indicate the risk of having a chromosomal condition like Down syndrome.
Some possible explanations for the other choices are:
Choice A is wrong because fetal growth and development are not directly related to the nuchal translucency measurement.
Fetal growth and development are assessed by other parameters such as crown-rump length, biparietal diameter, abdominal circumference, etc.
Choice B is wrong because blood flow in the umbilical cord is not measured by the nuchal translucency ultrasound.
Blood flow in the umbilical cord is assessed by Doppler ultrasound, which evaluates the resistance and velocity of blood flow in the umbilical artery and vein.
Choice D is wrong because structural abnormalities in the baby’s organs are not detected by the nuchal translucency ultrasound.
Structural abnormalities in the baby’s organs are diagnosed by a detailed anatomy scan, which is usually performed in the second trimester of pregnancy.
The normal range for nuchal translucency is between 1 mm and 3 mm.
A measurement above 3 mm is considered increased and may indicate a higher risk of chromosomal or genetic conditions.
However, a nuchal translucency ultrasound is a screening test and not a diagnostic test, so it does not confirm or rule out any condition.
It only provides a probability based on statistical calculations.
Therefore, further testing may be recommended if the nuchal translucency measurement is increased or if other risk factors are present.
A nurse is discussing the factors that can affect Alpha-fetoprotein Test (AFP) results with a pregnant client.
Which factor should the nurse mention?
Explanation
The level of AFP in a pregnant woman’s blood depends on how far along she is in her pregnancy.
AFP levels are normally high in the early weeks of pregnancy and then decline as the pregnancy progresses.
If the AFP level is too high or too low for the gestational age, it may indicate a problem with the baby’s development.
Choice A is wrong because maternal weight does not affect AFP levels.
Choice B is wrong because fetal heart rate does not affect AFP levels.
Choice D is wrong because the placental function does not affect AFP levels directly, but it may affect the levels of other hormones that are measured along with AFP in a quad screen.
A nurse is explaining the purpose of a Doppler ultrasound blood flow analysis to a client who has intrauterine growth restriction (IUGR).
The nurse should inform the client that this test measures which of the following?
Explanation
A Doppler ultrasound blood flow analysis measures the velocity of blood flow in the uterine and fetal vessels.
This test can help assess the fetal well-being and oxygenation in cases of intrauterine growth restriction (IUGR).
Choice B is wrong because the amount of amniotic fluid in the uterine cavity is measured by ultrasound, not Doppler.
Choice C is wrong because the pressure of blood flow in the umbilical cord is not directly measured by Doppler, but rather inferred from the resistance index or pulsatility index.
Choice D is wrong because the oxygen saturation level of fetal blood is not measured by Doppler, but rather by fetal scalp sampling or pulse oximetry.
A client is scheduled for an abdominal ultrasound in two weeks.
The client asks the nurse what they should do to prepare for the test.
What is the best response by the nurse?
Explanation
The patient should wear loose-fitting clothing and lie supine on an examination table.
This is because loose-fitting clothing allows easy access to the abdomen and lying supine helps relax the abdominal muscles.
The patient should also avoid food and drinks for 8 to 12 hours before the test, as undigested food can interfere with the sound waves and affect the image quality.
Choice A is wrong because a full bladder is not necessary for an abdominal ultrasound, unless the patient is pregnant or has a pelvic condition.
A transvaginal ultrasound is a different type of ultrasound that uses a probe inserted into the vagina to examine the reproductive organs.
Choice B is wrong because tight-fitting clothing can restrict the movement of the ultrasound probe and make it harder to get a clear image.
Lying prone (on the stomach) can also tense up the abdominal muscles and obscure the organs.
Choice D is wrong because lying prone can have the same disadvantages as choice B. Additionally, wearing loose-fitting clothing does not mean that the patient can eat or drink anything before the test, as this can affect the results.
A client asks the nurse about the significance of Alpha-fetoprotein Test (AFP) results.
How should the nurse respond?
Explanation
AFP is a screening tool that can indicate the possibility of certain fetal anomalies, such as neural tube defects, abdominal wall defects, or chromosomal abnormalities.
However, AFP results are not diagnostic and cannot confirm the presence or absence of these conditions.
Therefore, further tests, such as ultrasound or amniocentesis, are needed to verify the results.
Choice A is wrong because AFP results are not diagnostic for fetal anomalies.
They only indicate a risk level that needs to be confirmed by other tests.
Choice C is wrong because AFP results can detect not only neural tube defects, but also other fetal anomalies, such as abdominal wall defects or chromosomal abnormalities.
Choice D is wrong because AFP results are not affected by maternal race and ethnicity.
They are affected by maternal age, weight, diabetes, multiple gestation, and gestational age.
A nurse is reviewing the results of a Contraction Stress Test (CST) with a pregnant client.
What does an equivocal CST indicate?
Explanation
An equivocal CST indicates late decelerations of the FHR with less than 50% of contractions.
This means that the fetus may have some degree of hypoxia or distress, but not enough to warrant immediate delivery.
An equivocal CST may also result from hyperstimulation of the uterus, which can cause excessive contractions and reduce blood flow to the placenta.
Choice B is wrong because late decelerations of the FHR with at least 50% of contractions is a positive CST, which indicates a high risk of fetal death due to hypoxia and is a contraindication to labor.
Choice C is wrong because no late decelerations of the FHR during contractions is a negative CST, which indicates a good fetal wellbeing and tolerance of labor.
Choice D is wrong because variable decelerations of the FHR with or without contractions are not related to uterine activity and may indicate cord compression or other fetal problems.
Variable decelerations are not used to interpret CST results.
A nurse is reviewing contraception options for four clients.
The nurse should identify that which of the following clients has a contraindication for receiving oral contraceptives?
Explanation
This is because migraine headaches with aura are a contraindication for receiving oral contraceptives, as they increase the risk of stroke and other cardiovascular complications.
Some possible explanations for the other choices are:
Choice B: A 32-year-old client who has endometriosis.
This is not a contraindication for receiving oral contraceptives, as they can actually help reduce the symptoms of endometriosis by suppressing ovulation and reducing menstrual bleeding.
Choice C: A 28-year-old client who has polycystic ovary syndrome (PCOS).
This is not a contraindication for receiving oral contraceptives, as they can help regulate the menstrual cycle and lower the levels of androgens (male hormones) that cause acne, hirsutism (excess hair growth), and other problems in women with PCOS.
Choice D: A 22-year-old client who has irregular menstrual cycles.
This is not a contraindication for receiving oral contraceptives, as they can help normalize the menstrual cycle and prevent unintended pregnancy.
Normal ranges for oral contraceptive doses are:
Estrogen: 10 to 35 mcg of ethinyl estradiol or estradiol valerate
Progestin: varies depending on the type and brand of oral contraceptive
A client is scheduled for a transvaginal ultrasound in two weeks.
The client asks the nurse what they should do to prepare for the test.
What is the best response by the nurse?
Explanation
“The patient should have a full bladder for a transabdominal US and an empty bladder for a transvaginal US.”1 This is because a full bladder helps to lift the uterus and improve the visibility of the pelvic organs in a transabdominal US, while an empty bladder prevents distortion of the image in a transvaginal US.
Choice B is wrong because tight-fitting clothing is not necessary and lying prone on an examination table is uncomfortable and may interfere with the insertion of the vaginal probe.
Choice C is wrong because loose-fitting clothing is not necessary and lying supine on an examination table may cause supine hypotension syndrome in pregnant women.
Choice D is wrong because loose-fitting clothing is not necessary and lying prone on an examination table is uncomfortable and may interfere with the insertion of the vaginal probe.
A nurse is caring for a client who is scheduled for a maternal serum alpha-fetoprotein test at 15 weeks of gestation.
The nurse provides which of the following explanations about this test to the client?
Explanation
A maternal serum alpha-fetoprotein test is a type of prenatal blood test that measures the levels of MSAFP in the blood of a pregnant person.The test helps the healthcare provider assess the baby’s risk of certain medical conditions, such as neural tube defects and chromosomal abnormalities.The test is usually done between 15 and 20 weeks of pregnancy.
A screening test means that it does not diagnose any health conditions, but only indicates the probability of having them.
A positive test means that the baby has a higher risk of having a birth defect, but it does not confirm it.
A negative test means that the baby has a lower risk of having a birth defect, but it does not rule it out.Further tests are needed to confirm or exclude the diagnosis.
A diagnostic test means that it can provide a definite diagnosis of a health condition.A maternal serum alpha-fetoprotein test is not a diagnostic test for spinal defects or chromosomal abnormalities in the fetus.
Statement A is wrong because it says that the test is a diagnostic test for spinal defects in the fetus, which is not true.
Statement C is wrong because it says that the test is a diagnostic test for chromosomal abnormalities in the fetus, which is not true.
Statement D is wrong because it says that the test is a screening test for chromosomal abnormalities in the fetus, which is only partially true.The test can screen for some chromosomal abnormalities, such as Down syndrome, but not all of them.
The test also screens for neural tube defects, which are not chromosomal abnormalities.
Normal ranges for MSAFP vary depending on the gestational age and the laboratory methods used.Generally, MSAFP levels increase until about 32 weeks of pregnancy and then decrease until delivery.
High levels of MSAFP may indicate neural tube defects, multiple pregnancies, incorrect dating of pregnancy, or other conditions.Low levels of MSAFP may indicate Down syndrome, other chromosomal abnormalities, or other conditions.
A nurse is discussing the risks associated with a Contraction Stress Test (CST) with a pregnant client.
Which complication should the nurse mention?
Explanation
A contraction stress test (CST) is a test that simulates labor contractions to see how the baby’s heart rate responds to the stress of uterine contractions.
The biggest risk of the test is that it may cause the pregnant person to go into labor before their due date.
Some possible explanations for the other choices are:
Choice B. Premature rupture of membranes.
This is a condition where the amniotic sac breaks before labor begins.
It can increase the risk of infection and cord prolapse, but it is not a direct complication of CST.
Choice C. Infection.
This is a possible risk of any invasive procedure, but CST is usually done with external fetal monitoring and oxytocin infusion, which do not require breaking the skin or entering the uterus.
Choice D. Bleeding.
This is a potential risk of CST for people who have placenta previa, a condition where the placenta covers the cervix and can detach during contractions.
However, CST is not recommended for people who have placenta previa or other conditions that increase the risk of uterine rupture or bleeding.
A client is scheduled for an abdominal ultrasound in two weeks to assess fetal growth and development during pregnancy.
Which of these statements made by the client indicates that further teaching is needed?
Explanation
The client should not eat a light meal before an abdominal ultrasound because it can interfere with the quality of the images.
The client should fast for 8 to 12 hours before the procedure.
Some additional information about the other choices are:
Choice A is correct.
The client should drink plenty of fluids before an appointment for an abdominal ultrasound because it helps to fill the bladder and push the uterus up for better visualization.
Choice C is correct.
The client should wear comfortable clothing that can be easily removed or lifted up to expose the abdomen.
Choice D is correct.
The client should arrive at the appointment with a full bladder because it acts as an acoustic window and improves the quality of the ultrasound images.
Normal ranges for fetal growth and development during pregnancy vary depending on the gestational age, but some general parameters are:
Fetal heart rate: 110 to 160 beats per minute
Biparietal diameter: 2.4 to 9.5 cm
Crown-rump length: 0.8 to 8.4 cm
Femur length: 1.0 to 7.8 cm
Abdominal circumference: 9.4 to 35.6 cm
A nurse is teaching about fetal development to a group of clients in the antenatal clinic.
Which of the following statements should the nurse include in the teaching?
Explanation
The baby’s heart beat is audible by a Doppler stethoscope at 12 weeks of pregnancy.
This is a device that uses sound waves to create an image of the baby’s heart and measure its rate and rhythm.
Some possible explanations for the other choices are:
Choice B is wrong because the baby’s sex can not be determined by ultrasound at 8 weeks of pregnancy.
The external genitalia are not fully developed until around 14 to 16 weeks of pregnancy.
Even then, the accuracy of ultrasound depends on factors such as the position of the baby, the quality of the equipment, and the skill of the sonographer.
Choice C is wrong because the baby’s lungs are not fully mature by 24 weeks of pregnancy.
The lungs are one of the last organs to develop in the fetus and they continue to grow and mature until near term.
The production of surfactant, a substance that helps the lungs expand and prevent collapse, begins around 24 weeks but is not sufficient until around 34 to 36 weeks.
Choice D is wrong because the baby’s eyes do not open and close by 16 weeks of pregnancy.
The eyelids are fused together until around 26 to 28 weeks of pregnancy, when they start to open and close periodically.
The baby can also respond to light and dark stimuli around this time.
A nurse is caring for a client who is scheduled for a maternal serum alpha-fetoprotein test at 15 weeks of gestation.
The nurse provides which of the following explanations about this test to the client?
Explanation
"It is a screening test for spinal defects in the fetus."
The MSAFP test is a blood test that measures the amount of alpha-fetoprotein (AFP) in the mother’s blood.
AFP is a protein produced by the baby during pregnancy.The test helps to assess the baby’s risk of certain birth defects, such as neural tube defects, which are abnormalities in the development of the brain and spine.
A. “It is a diagnostic test for spinal defects in the fetus.” This statement is wrong because the MSAFP test is not a diagnostic test.
It only indicates the probability of having a spinal defect, but it does not confirm or rule out the condition.A diagnostic test, such as an ultrasound or amniocentesis, is needed to make a definitive diagnosis.
C. “It is a diagnostic test for chromosomal abnormalities in the fetus.” This statement is wrong because the MSAFP test is not a diagnostic test for chromosomal abnormalities either.
It only indicates the probability of having a chromosomal abnormality, such as Down syndrome, but it does not confirm or rule out the condition.A diagnostic test, such as a chorionic villus sampling (CVS) or amniocentesis, is needed to make a definitive diagnosis.
D. “It is a screening test for chromosomal abnormalities in the fetus.” This statement is partially correct, but not the best answer.
The MSAFP test alone is not very accurate for screening chromosomal abnormalities.It is usually combined with other blood tests and an ultrasound to form a more reliable screening test called a quad screen or an integrated screen.
The normal range of MSAFP levels varies depending on the gestational age of the baby and the laboratory methods used.Generally, the MSAFP levels increase until about 15 weeks of pregnancy and then decrease until delivery.The average MSAFP level at 15 weeks of pregnancy is about 38 ng/mL.However, different laboratories may have different reference ranges, so it is important to consult your healthcare provider for your specific results and interpretation.
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