MATERNAL CHILD NURSING CARE
CHAPTER 10 ASSESSMENT OF HIGH
RISK PREGNANCY QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
4
Transvaginal ultrasound is useful for obese women whose thick abdominal layers cannot be penetrated
adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of
fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of
pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are
ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this
gestational age. - ANSWER A 40-year-old woman with a high body mass index is 10 weeks pregnant.
Which diagnostic tool is appropriate to suggest to her at this time?
1
Biophysical profile
2
Amniocentesis
3
Maternal serum alpha-fetoprotein (MSAFP)
4
Transvaginal ultrasound
2
Meconium is normally stored in the infant's intestines until after birth, but sometimes (in cases of fetal
distress and hypoxia) it is expelled into the amniotic fluid before birth. The amniotic fluid is then said to
be meconium stained. Fewer than three contractions in 10 minutes or late decelerations occurring with
50% or more of contractions constitute positive CST results. Positive CST results are associated with
meconium-stained amniotic fluid. Negative CST results indicate that the fetus is normal. Suspicious or
unsatisfactory CST results are not associated with any other fetal conditions. - ANSWER The nurse is
reviewing the contraction stress test (CST) reports of a pregnant patient. The nurse expects the fetus to
have meconium-stained amniotic fluid. What would be the reason for that conclusion?
,1
Negative CST results
2
Positive CST results
3
Suspicious CST results
4
Unsatisfactory CST results
2, 4, 5
The triple marker screen measures the levels of three maternal serum markers: unconjugated estriol,
hCG, and MSAFP. Low values of unconjugated estriol, hCG, and MSAFP indicate that the fetus has trisomy
18. The quad screen has an additional serum marker: inhibin-A. A low inhibin-A level indicates the
possibility of Down syndrome. NT is not a serum marker protein. Moreover, elevated NT indicates that
the fetus has a chromosomal abnormality but does not specifically indicate that the fetus has trisomy 18.
- ANSWER After reviewing the triple marker screen reports of a patient who is in the second trimester of
pregnancy, the nurse concludes that the fetus has trisomy 18. What factors in the report led to the
nurse's conclusion? Select all that apply.
1
Low level of inhibin-A in the maternal serum
2
Low level of unconjugated estriol in serum
3
Elevated nuchal translucency (NT) in the fetus
4
Low level of maternal human chorionic gonadotrophin (hCG)
5
Low level of maternal serum alpha-fetoprotein (MSAFP)
1, 2
, Triple marker screening, which is performed in the first trimester of pregnancy, includes the
measurement of two maternal biomarkers: PAPP-A and free β-hCG. High levels of free β-hCG and low
levels of PAPP-A in the first trimester indicate that the fetus has Down syndrome, or trisomy 21.Inhibin-A
is a placental hormone. Low levels of inhibin-A also indicate the possibility of Down syndrome, but
inhibin-A levels are not measured in the triple marker screen; these levels are measured in quad
screening. A low level of MSAFP and unconjugated estriol also indicate Down syndrome, but these can
be measured only in the second and third trimesters. - ANSWER A patient in the first trimester of
pregnancy undergoes a triple marker screening test. On reviewing the report, the nurse infers that the
fetus may have Down syndrome. What clinical findings are noted by the nurse in the test reports? Select
all that apply.
1
High levels of beta-human chorionic gonadotropin (β-hCG)
2
Low levels of pregnancy-associated placental protein (PAPP-A)
3
Low levels of inhibin-A in the fetal blood
4
Low levels of maternal serum alpha-fetoprotein (MSAFP)
5
Low levels of unconjugated estriol in the fetal blood
1
Biochemical findings such as an L/S ratio of 2:1, an S/A ratio of 60 mg/g, and the presence of PG in
amniotic fluid indicate that the fetal lungs are well developed. The gestational age can be predicted only
with the help of creatinine and lipid levels in the amniotic fluid. Creatinine levels greater than 2 mg/dL in
amniotic fluid indicate that the gestational age is more than 36 weeks. The presence of alpha-fetoprotein
(AFP) in the amniotic fluid indicates a neural tube defect in the fetus. The nurse needs to assess AFP
levels in the amniotic fluid to determine whether the fetus has an open neural tube defect. A high AFP
level in amniotic fluid after 15 weeks' gestation indicates that the fetus has an open neural tube defect. -
ANSWER Biochemical examination of the amniotic fluid of a pregnant patient yields the following results:
lecithin-to-sphingomyelin (L/S) ratio, 2:1; surfactant-to-albumin (S/A) ratio, 60 mg/g; and
phosphatidylglycerol (PG) present. What conclusions will the nurse draw from this report?
1
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Performance. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.99. You're not tied to anything after your purchase.
