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Nursing of Childbearing Family > Chapter 15: Prenatal Diagnostic Tests > Flashcards

Chapter 15: Prenatal Diagnostic Tests Flashcards

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1
Q

After the transcervical chorionic sampling, the nurse should check maternal ________________ and fetal _______________. The mother should ______ for several hours.

A

vital signs, heart rate, rest

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2
Q

A positive CST test indicates a possibility of ______________ of labor, which would indicate a _____________

A

intolerance, C section

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3
Q

Maternal assessment of fetal movement or “kick counts” should have at least ___ fetal movements within ___ hours

A

10, 12

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4
Q

Increased AFP levels are associated with this

A

neural tube defects

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5
Q

To encourage the fetus to stay awake during the NST, give the mother this

A

Food and/or drink

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6
Q

Accuracy of ultrasounds can be limited with maternal __________.

A

obesity

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7
Q

Three other markers that are often assessed with alpha-fetoprotein (AFP) screening

A

hCG
estriol
inhibin A
(This is also known as the Triple Screen)

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8
Q

The Percutaneous Umbilical Blood Sampling (PUBS) procedure is used to detect these four things

A
  1. blood disorders
  2. acid-base imbalance
  3. infection
  4. fetal genetic disease
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9
Q

A straight line on an NST indicates this

A

no variability

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10
Q

two indications or purposes for third trimester amniocentesis

A
  1. hemolytic disease
  2. determine lung maturity
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11
Q

Maternal assessment of fetal movements begins at ___ weeks

A

28

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12
Q

If the pregnant woman has diabetes, the LS ratio (does, does not) ensure fetal lung maturity. Amniotic fluid is further tested for the presence of these two phospholipids

A

does not
phosphatidylglycerol (PG)
phosphatidylinositol (PI)

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13
Q

Before 32 weeks, a reactive NST shows ___ FHR accelerations within ____ minutes in which each acceleration is ____ beats above the baseline for ___ seconds

A

2, 20, 10, 10

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14
Q

A nipple stimulation test involves brushing the palm across one nipple for __ minutes, stopping if a contraction begins. If contractions do not start after this time period, then test is repeated after ___ minutes of rest.

A

2, 5

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15
Q

Five main uses of an ultrasound during pregnancy

A
  1. presence and location of pregnancy
  2. multifetal gestation
  3. gestational age
  4. viability confirmation
  5. aids in performance of other tests
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16
Q

This size needle is used for an amniocentesis procedure

A

3-4 inches
20 or 21 gauge

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17
Q

Each parameter on a biophysical profile can get __-__ points, making a total of ___ points maximum possible with at least __ being a good result.

A

0, 2, 10, 8

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18
Q

How much amniotic fluid is removed for analysis during an amniocentesis?

A

20 mL

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19
Q

No change or increases in HR with contractions indicates a (positive, negative) CST

A

negative

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20
Q

If hCG is increased, then estriol is (increased, decreased)

A

decreased

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21
Q

Two things that can interfere with the mother’s ability to feel fetal movements

A

anterior placenta, maternal drugs

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22
Q

Drops in HR with contractions at least ___% of the time indicate a (positive, negative) CST

A

50, positive

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23
Q

After 32 weeks, a reactive NST shows ___ FHR accelerations within ____ minutes in which each acceleration is ____ beats above the baseline for ___ seconds

A

2, 20, 15, 15

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24
Q

This type of ultrasound is used in the first trimester and why

A

transvaginal
uterus, gestational sac, ovaries, and fallopian tubes are deep in pelvis

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25
Q

Moderate (goal) variability in an NST is between __-__ bpm

A

5, 25

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26
Q

Indications for second trimester amniocentesis:
1. maternal age _______________
2. chromosomal abnormality in ________________________
3. sex determination for maternal carrier of ____________________
4. birth of previous infant with one of these three things
5. pregnancy after multiple ____________________________.
6. unexplained elevation of maternal serum ______
7. maternal Rh ___________________

A
  1. 35 years or older
  2. close family member
  3. X-linked disorder
  4. chromosomal abnormalities, neural tube defect, body wall defect
  5. spontaneous abortions
  6. AFP
  7. sensitization
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27
Q

Alpha-fetoprotein (AFP) screening is performed to identify these two things

A

open body wall defects
chromosomal anomalies

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28
Q

A doppler ultrasound is used in complicated pregnancies with placental insufficiency to assess ____________ and ___________ in the umbilical cord.

A

blood flow, pulsation

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29
Q

Advantages of amniocentesis

A

Simple, safe, painless with few reported complications

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30
Q

Four risks associated with transcervical chorionic sampling

A
  1. pregnancy loss
  2. limb defects (before 10 weeks)
  3. uterine infection
  4. Rh sensitization
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31
Q

Three reasons that prenatal diagnostic tests are done

A
  1. detect congenital anomalies
  2. high-risk pregnancy to evaluate fetal condition
  3. baseline information
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32
Q

First method used to initiate uterine contractions for a CST if no contractions are present

A

nipple stimulation test

33
Q

FHR accelerations (periodic changes) in an NST are ___ bpm above the baseline

A

15

34
Q

Marked variability in an NST is >___ bpm, and a baseline cannot be found

A

25

35
Q

The mother should count fetal movements __-__ times per day to identify whether the fetus has at least ___ movements in ___ minutes

A

2, 3, 3, 60

36
Q

In order to interpret a CST, must have __ contractions that last ___ seconds within ___ minutes.

A

3, 40, 10

37
Q

The main protein in fetal plasma that can be measured in maternal blood or amniotic fluid

A

alpha-fetoprotein (AFP)

38
Q

A transcervical chorionic sampling procedure is done early in case of this

A

chromosomal abnormalities incompatible with life (mother may choose to terminate pregnancy)

39
Q

Medication that is given for a Contraction Stress Test

A

Pitocin (oxytocin)

40
Q

This test involves a vibrating device placed on the belly that causes the fetus to move from vibration and sound and thereby increase HR

A

vibroacoustic test

41
Q

This test is used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow

A

Contraction Stress Test (CST) (or Oxytocin Challenge Test)

42
Q

Steroid that can be given to help with lung maturity of the fetus

A

betamethasone

43
Q

Alpha-fetoprotein screening (screens for, confirms) abnormalities

A

screens for (does not confirm)

44
Q

Inhibin A helps detect this chromosomal abnormality and is accurate in mothers of this age group

A

Trisomy 21, <35

45
Q

If the nipple stimulation test does not work, this method to initiate uterine contractions for a CST is used

A

IV low-dose oxytocin

46
Q

For the amniocentesis procedure, the ultrasound is used for these three things

A
  1. locate fetus/placenta
  2. identify largest pockets of amniotic fluid that can be safely sampled
  3. guide needle insertion
47
Q

Fetal viability is determined via ultrasound by observation of the fetal _____________ of at least ______ in length

A

heartbeat, 5 mm

48
Q

Three body measurements that help estimate gestational age, especially during last half of pregnancy

A

biparietal diameter (head circumference)
femur length
abdominal circumference

49
Q

Decreased AFP levels are associated with this

A

chromosomal abnormalities (Trisomy 21)

50
Q

Before amniocentesis, these two baseline levels are collected

A

maternal BP
fetal HR (FHR)

51
Q

Disadvantage of amniocentesis

A

2+ weeks for results; may hinder decision for termination of pregnancy

52
Q

Normal fetal HR

A

110-160

53
Q

Increased detection of hCG increases the possibility of these two chromosomal abnormalities

A

Trisomy 18, Trisomy 21

54
Q

After an amniocentesis, the pregnant woman should avoid strenuous activity but resume normal activities after ___________.

A

24 hours

55
Q

To be most accurate, AFP screening must be done at ___-___ weeks

A

16, 18

56
Q

Chorionic villus sampling provides information about these two things

A

chromosomal defects
metabolic abnormalities

57
Q

True gestational age must be known in these two scenarios

A
  1. screening for maternal serum AFP (levels change with fetal age)
  2. intrauterine growth restrictions
58
Q

The biophysical profile includes these five parameters

A
  1. NST
  2. fetal breathing movements
  3. gross fetal movements (large trunk movements)
  4. fetal tone (fine body movements)
  5. amniotic fluid volume
59
Q

An ultrasound can detect any fetal defects other than this

A

inborn errors of metabolism

60
Q

A non stress test cannot be performed before ___ weeks

A

28

61
Q

amniocentesis: lecithin/sphingomyelin (LS) ratio is usually ____ until 30 weeks. The goal ratio is greater than _____. This ratio is the best-known test for estimating ___________________.

A

1:1, 2:1, fetal lung maturity

62
Q

Reason why a full bladder may be necessary for better visibility of uterus/fetus in ultrasound

A

Displaces intestines and elevates uterus

63
Q

Four contraindications of a Contraction Stress Test (CST)

A
  1. placenta previa
  2. too preterm
  3. classic uterine incision
  4. breech presentation
64
Q

A nonreactive NST lacks the characteristics of a reactive NST within ___ minutes

A

40

65
Q

Non stress test (NST): FHR accelerations with movement indicate these two things

A
  1. adequate oxygenation
  2. intact neural pathway from CNS
66
Q

Most reliable indicator of gestational age in the first trimester

A

measurement of crown-rump length of embryo

67
Q

Minimal variability in an NST is between __-__ bpm and usually indicates that the fetus is _________.

A

2, 4, asleep

68
Q

This procedure involves the aspiration of fetal blood from the umbilical cord near the placenta for prenatal diagnosis or therapy

A

Percutaneous Umbilical Blood Sampling (PUBS)

69
Q

Why is the first 1-2 mL of amniotic fluid discarded during an amniocentesis?

A

Avoids contamination with maternal cells

70
Q

Percutaneous Umbilical Blood Sampling (PUBS) procedure risks (4)

A

infection, fetal loss, cord hematoma, cord laceration

71
Q

Procedure in which a sample of chorionic villi is obtained by going in through the cervix

A

transcervical chorionic sampling

72
Q

To prepare for amniocentesis procedure, pregnant woman placed in this position

A

supine with pillow/towel under one buttock

73
Q

After an amniocentesis, the fetus is monitored for (time period) to identify any presence of these two things

A

30-60 minutes, continuing uterine contractions, nonreassuring fetal heart activity

74
Q

Percutaneous Umbilical Blood Sampling (PUBS) procedure (3 steps)

A
  1. Ultrasound locates placenta, fetus, cord
  2. Needle inserted through abdomen and uterine cavity into umbilical cord where it meets placenta
  3. Umbilical vein is targeted for blood aspiration
75
Q

This type of ultrasound is performed in the second trimester when risk factors are present

A

comprehensive

76
Q

After an amniocentesis procedure, the pregnant woman should report any of these four things if they occur

A
  1. persistent uterine contractions
  2. vaginal bleeding
  3. leakage of amniotic fluid
  4. fever
77
Q

Chorionic villus sampling can be performed as early as ____ weeks gestation

A

10

78
Q

Amniocentesis increases the risk for these two things

A

Rh sensitization, fetal loss

79
Q

Four nurse roles during an amniocentesis procedure

A
  1. Acquire supplies
  2. Prepare room
  3. Administer terbutaline to quiet contractions; RhoGAM if necessary
  4. Monitor for complications

Nursing of Childbearing Family (15 decks)

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