Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/186

Click to flip

186 Cards in this Set

  • Front
  • Back
Conditions that indicate a pregnancy at risk include all of the following EXCEPT:

a) Maternal age less than 15 or more than 30 yrs of age
b) Chronic maternal hypertension, preeclampsi, diabetes mellitus, heart disease
c) presence of RH alloimmunization
d) maternal history of unexplained stillbirth
e) suspected intrauterine growth restriction
f) pregnancy prolonged past 42 week gestation
g) multiple gestation
h) maternal history of preterm labor
i) previous cervical incompetence
a) Maternal age less than 15 or more than 30 yrs of age

The first risk listed in the book is:

Maternal age less than 16 or more than 35 yrs
Antenatal testing is:

a) fetal well being
b) infant well being
a) fetal well being
Fetal movement is directly related to:

a) gestational age
b) fetal health
c) maternal health
d) sleep-wake cycle
sleep-wake cycle

Fetal movement are directly related to the infants sleep-wake cycle & vary from the maternal sleep-wake cycle.
Maternal assessment of fetal activity is typically used from week:

a) 12 to week 42
b) 22 to week 42
c) 28 to week 38
d) 30 to week 40
c) 28 to week 38
Assessment of fetal lung maturity is conducted by:

a) ultrasound
b) Amniocentesis
c) Chorionic villus sampling
d) Fetoscopy
b) Amniocentesis
To determine how advanced a pregnany is:

a) ultrasound
b) amniocentesis
c) biophysical profile
d) Percutaneous blood sampling
a) ultrasound
To identify normal growth of the fetus:

a) ultrasound
b) amniocentesis
c) biophysical profile
d) Percutaneous blood sampling
a) ultrasound
All of the following are used to detect congenital anomolies & problems EXCEPT:

a) ultrasound
b) amniocentesis
c) biophysical profile
d) Percutaneous blood sampling
e) fetoscopy
f) chorionic villus sampling
g) Triple test or quadruple test
c) biophysical profile
To localize the placenta:

a) ultrasound
b) amniocentesis
c) biophysical profile
d) fetoscopy
a) ultrasound
All of the following are used to assess fetal status EXCEPT:

a) biophysical profile
b) maternal assessment of activity
c) amniocentesis
d) Nonstress test
e) contraction stress test
c) amniocentesis
When ultrasound is used to validate the pregnancy it is generally done as endovaginal ultrasound between:

a) 1-2 weeks after last menstrual period
b) 2-3 weeks after last menstrual period
c) 3-4 weeks after last menstrual period
d) 5-6 weeks after last menstrual period
a) 5-6 weeks after last menstrual period
Localizing the placenta using ultrasound is usually done:

a) 1st trimester
b) 2nd trimester
c) 3rd trimester
d) labor
c) 3rd trimester

before amniocentesis
Using the biophysical profile, maternal assessment of fetal activity, the nonstress test or contraction stress test to assess the fetal status is generally performed:

a) 28 weeks to birth
b) 32 weeks to birth
c) 38 weeks to birth
d) 42 weeks to labor
a) 28 weeks to birth
Diagnosing cardiac problems using a fetal echocardiography is most generally performed:

a) 1st trimester
b) 2nd trimester
c) 1st & 2nd trimester
d) 2nd & 3rd trimester
d) 2nd & 3rd trimester
Four dimensional ultrasound combines the components of 3-dimensional ultrasound with a 4th dimension. That 4th dimension is:

a) differentiate soft tissue masses such as tumors)
b) monitor fetal growth
c) monitor live action
d) detect impending cervical incompentence
c) live action
Name the 2 most common methods of ultrasound scanning.

1._____
2._____
transabdominal
transvaginal
In the transabdominal approach, the transducer is moved across the womans abdomen with:

a) an empty bladder
b) a full bladder
b) a full bladder

full bladder alows assessment of other structures such as the vagina, cervix, & lower portion of the uterus.
Preparation for a transabdominal ultrasound include advising the woman to drink 1-1.5 quarts of water 2hrs before the examination & refrain from emptying her bladder. If the bladder is not suffiecently filled she will be asked to:

a) reschedule new appointment
b) drink barium
c) drink alcohol
d) drink 3-4 8oz of water & rescanned 30 to 45 minutes later
d) drink 3-4 8oz of water & rescanned 30 to 45 minutes later
A woman may feel discomfort during a transabdominal ultrasound due to having a full bladder & lying on her back during the test can cause shortness of breath. If this occurs:

a) elevate her leggs using a pillow
b) advise her to partially empty her bladder
c) remove all pillows & ask her to turn on her side
c) elevate upper body
c) elevate upper body

she can turn on her side as well but a towel should be placed under the hip to prevent vena caval compression !!!
The transvaginal ultrasound involves:

a) an empty bladder while scanning the surface of the lower abdomen

a) a full bladder while scanning the surface of the lower abdomen

c) using a probe inserted into the vagina with a full bladder

d) using a probe inserted into the vagina with an empty bladder
d) using a probe inserted into the vagina with an empty bladder
Considering the differences & advantages of using transabdominal or transvaginal ultrasound, transvaginal provides:

a) structures & fetal characteristics earlier in pregnancy; predictor for preterm birth in high risk cases; detect shortened cervical length or funneling to predict preterm labor

b) differentiate soft tissue masses such as tumors; visualize the fetus; follow fetal growth; detect cervical length & impending cervical competence; avert a number of potential problems; photolike quality; better visualization of fetal structures; provides guidance during invasive intauterine procedures such as amniocentesis & chorionic villus sampling
a) structures & fetal characteristics earlier in pregnancy; predictor for preterm birth in high risk cases; detect shortened cervical length or funneling to predict preterm labor
Using ultrasound, pregnancy may be detected as early as:

a) 2-3 weeks after the last menstrual period
b) 3-4 weeks after the last menstrual period
c) 4-5 weeks after the last menstrual period
d) 5-6 weeks after last menstrual period
d) 5-6 weeks after last menstrual period
Using ultrasound, fetal breathing movements have been observed as early as week:

a) 7 weeks of gestation
a) 9 weeks of gestation
a) 11 weeks of gestation
a) 21 weeks of gestation
a) 11 weeks of gestation
Ultrasound can be used to estimate birth weight which helps to identify macrosomia; a term used for infants weighing more than:

a) 2000 g at birth
b) 3000 g at birth
c) 4000 g at birth
d) 5000 g at birth
c) 4000 g at birth
Macrosomia is a predictor of birth related trauma & is a risk factor for:

a) maternal morbidity
b) fetal morbidity
BOTH !!!
Ultrasound cna detect fetal anomolies such as anencephaly & hydrocephalus.

True?

False?
True
Nuchal translucency describes an area in the back of the fetal neck that is measured via ultrasound during the 1st trimester of pregnancy. Fetuses are at risk for certain birth defects including trisomies when measurements are greater than:

a) 2mm during 1st trimester
b) 3mm during 1st trimester
c) 5mm during 1st trimester
d) 7mm during 1st trimester
b) 3mm during 1st trimester
Fetuses with a measurement of greater than 3mm (by ultrasound) in the 1st trimester are all of the following except:

a) normal measurements
b) risk for downs syndrome
c) risk for certain birth defects
d) risk for trisomies 13, 18, & 21
a) normal measurements
The maternal abdomen is divided into quadrants. The umbilicus is used to divide the upper & lower sections & the linea nigra is:

a) the upper section
b) the lower section
c) divides the right & left sections
c) divides the right & left sections
Ultasound is used in the identification of the amniotic fluid index. The vertical diameter of the largest amniotic fluid pocket in ea. quadrant is measured & all measurements are taken to obtain amniotic fluid index in centimeters. A woman is considered to have hydramnios with an AFI of more than:

a) 20cm
b) 30cm
c) 40cm
d) 50cm
hydramnios is over 20cm
Ultasound is used in the identification of the amniotic fluid index. The vertical diameter of the largest amniotic fluid pocket in ea. quadrant is measured & all measurements are taken to obtain amniotic fluid index in centimeters. A woman is considered to have oligohydramnios with an AFI of less than:

a) 30cm
b) 20cm
c) 10cm
d) 5cm
oligohydramnios of less than 5cm
Ultasound is used in the identification of the amniotic fluid index. The vertical diameter of the largest amniotic fluid pocket in ea. quadrant is measured & all measurements are taken to obtain amniotic fluid index in centimeters. A normal AFI is:

a) 20 cm
b) 5cm
c) between 5 & 10cm
d) between 5 & 20cm
Normal AFI is between 5 & 20cm
AMniotic fluid begins to:

a) increase at 29 weeks
b) decline at 29 weeks
c) increase at 39 weeks
d) decline at 39 weeks
d) decline at 39 weeks
As the fetus matures the placenta:

a) thickens
b) thins
c) calcifies
d) calcifies

As the fetus matures the placenta calcifies & these changes can be detected by ultrasound & graded according to the degree of calcification.
The inability to visualize the fetal heartbeating & the separation of the bones in the fetal head are signs of?
fetal death
The patient asks the nurse that she is concerned about the risks of ultrasound to her fetus. The nurse responds by telling her:

a) ultrasound has been used for over 40 years & no clinical studies verify harmful effects to the mothers, fetus, or newborns

b) The use of ultrasound in the last 40 years has been followed with very few reports of damage to the fetus & no reports of damage to the mothers have yet been made
a) ultrasound has been used for over 40 years & no clinical studies verify harmful effects to the mothers, fetus, or newborns
Until 8 weeks the Corpus Luteum secretes:

a) estogen
b) progesterone
b) progesterone
The placenta begins to manufacture its own progesterone in:

a) in 1 week
b) in 4 weeks
c) in 8 weeks
d) in 12 weeks
c) in 8 weeks

Progesterone is secreted by the corpus luteum until 8 weeks at which time the placenta begins to manufacture its own progesterone
In pregnancy levels greater than 25 are:

a) associated with spontaneous abortion & ectopic pregnancies

b) a normal pregnancy
b) a normal pregnancy
In pregnancy low levels of progesterone (below 25)are:

a) associated with spontaneous abortion & ectopic pregnancies

b) a normal pregnancy
a) associated with spontaneous abortion & ectopic pregnancies
An early transvaginal or abdominal ultrasound is indicated when there is a need to establish?
an accurate gestational age

more accuracy concerning gestational age when bHCG levels are taken
It is important to establish gestational age early in pregnancy because?
It provides a baseline so any future growth descrepancies can be identified during pregnancy
Beta Human Chorionic Gonadotropin (bHCG) is produced by the placenta & is indicative of:

a) placental health
b) prognosis of the viability & continuation of the pregnancy
Both !!!
Testing for Beta Human Chorionic Gonadotropin (bHCG) involves 2 tests drawn 48 hours apart beginning:

a) 7-10 days after conception
b) 8-11 days after conception
c) 4-6 weeks after conception
d) 8-12 weeks after conception
b) 8-11 days after conception
Low levels of beta human chorionic gonadotropin would indicate:

a) a viable pregnancy
b) Downs syndrome
c) hydamnios
d) impending loss of the pregnancy
d) impending loss of the pregnancy

this test is helpful in women who have a HX of spontaneous abortion, ectopic pregnancy, or present bleeding
The large anmount of amniotic fluid during the 2nd trimester is:

a) allows excellent images of fetal anatomy, detail, & confirmation of normalcy

b) provides an excellent opportunity to view fetal presentation

c) provides opportunity to check multiples

d) allows viewing of uterine anatonmy

e) Provides measurements for AFI & placental location
All of the above
The non-stress test is based on the knowledge that when the fetus has adequate oxygenation & an intact central nervous system there are:

a) no accelerations of the fetal heart rate with movement

b) accelerations of the fetal heart rate with movement
b) accelerations of the fetal heart rate with movement
A non-reactive nonstress test is fairly consistent in identifying:

a) normal conditions

b) at risk fetuses
b) at risk fetuses
A non stress test requires a fetal monitor to observe fetal heart rate accelerations & is done with the woman:

a) lying flat with feet elevated slightly

b) in a reclining chair or in a semi fowler position

c) lying on her right side

d) lying on her left side
b) in a reclining chair or in a semi fowler position
A reactive nonstress test shows at least 2 accelerations of the fetal heart rate w/fetal movements of:

a) 20 beats per minute lasting 20 seconds or more for 30 minutes (desired result)

b) 15 beats per minute lasting 15 seconds or more for 20 minutes (desired result)

c) 20 beats per minute lasting 20 seconds or more for 30 minutes (un-desired result)

d) 15 beats per minute lasting 15 seconds or more for 20 minutes (un-desired result)
b) 15 beats per minute lasting 15 seconds or more for 20 minutes (desired result)
In a non-reactive nonstress test:

a) criteria of at least 2 accelerations of the fetal heart rate w/fetal movements are met

b) the reactive criteria are not met such as the accelerations are not as much as 15 beats per minute or do not last as long as 15 seconds
b) the reactive criteria are not met such as the accelerations are not as much as 15 beats per minute or do not last as long as 15 seconds
If decelerations of the fetal heart rate during a nonstress test occur the nurse:

a) understands this is a normal phenomena

b) notifies the midwife or physician for further evaluation

c) shedules the test to be performed prior to bedtime
b) notifies the midwife or physician for further evaluation
The diagnostic value of a nonstress test is:

a) to determine maternal health
b) determine the viability of the placenta
c) determine fetus ability to respond to its environment by acceleration of the fetal HR w/movement
c) determine fetus ability to respond to its environment by acceleration of the fetal HR w/movement
The average number of fetal movements a day is:

a) 220 movements daily
b) 520 movements daily
c) 720 movements daily
d) 1020 movements daily
c) 720 movements daily

30/hour
kick counts >10 fetal movements in 3 hrs
The fetus has rest-sleep states that usually last:

a) 10 minutes
b) 30 minutes
c) 1 hour
d) 2-4 hours
b) 30 minutes
A biophysical Profile consists of 5 fetal biophysical variables examined during ultrasound.

Name these 5 variables

1) Bre_ _ _ _ _ _

2) Bo_ _ Mov_ _ e_ _ _

3) T_ _ e

4) Am_ _ _ _ _ _ fluid V _ _ _ _ _

5) fetal h_ _ _ _ r_t_ r_ _ct_v_ _
breathing
body movement
tone
amniotic fluid volume
fetal heart rate reactivity
Maternal assessment of fetal movement begins at:

a) 12 weeks
b) 16 weeks
c) 10 weeks
d) 28 weeks
d) 28 weeks
When assessing the fetal biophysical profile, breathing movement should be:

a) 1 episode of rhythmic breathing lasting more than 30 sec in 30 min

b) 2 episodes of rhythmic breathing lasting more than 30 sec in 30 min
a) 1 episode of rhythmic breathing lasting more than 30 sec in 30 min
When assessing the fetal biophysical profile, body movement should be:

a) more than 3 discrete body or limb movements in 1 hour

b) more than 3 discrete body or limb movements in 30 minutes
b) more than 3 discrete body or limb movements in 30 minutes
When assessing the fetal biophysical profile, tone should be:

a) 1 episode of a fetal extremity w.return to flexion or opening or closing of hand

b) 2 episode of a fetal extremity w.return to flexion or opening or closing of hand
a) 1 episode of a fetal extremity w.return to flexion or opening or closing of hand
When assessing the fetal biophysical profile, amniotic fluid volume should be:

a) single verticle pocket greater than 5 cm

b) single verticle pocket greater than 2 cm
b) single verticle pocket greater than 2 cm

evaluates uteropacental function

decrease is hypoxia
When assessing the fetal biophysical profile, fetal heart rate activity should be:

a) 2 accelerations of greater than 15 beats/min lasting 30 sec in 20-40 minutes

b) 2 accelerations of more than 15 beats/min lasting over 15 sec in 20-40 min
b) 2 accelerations of more than 15 beats/min lasting over 15 sec in 20-40 min
The oxytocin test is:

a) invasive

b) invasive
b) invasive

requires IV access & pitocin to simulate contractions
When a nonstress test is nonreactive which of the following is ordered:

a) amniocentesis
b) ultrasound
c) oxytocin challenge test
d) chorionic villus sampling
c) oxytocin challenge test
When a nonstress test is non reactive & an oxytocin challenge test s problematic (+decelerations) & the patient is over 32 weeks gestation it is possible:

a) a vaginal delivery will be induced
b) interventions such as a cesarean section will be advised
b) interventions such as a cesarean section will be advised
The patient asks why a nonstress test has been ordered by her doctor & the nurse understands this test is:

a) invasive
b) demonstrates the fetus ability to respond to its environment by acceleration of fetal heart rate w/movement
b) demonstrates the fetus ability to respond to its environment by acceleration of fetal heart rate w/movement
If a contraction stress test is negative & a nonstress test is reactive the nurse will anticipate:

a) a cesarean will be ordered
b) everything is normal
c) retesting in 7 days
c) retesting in 7 days

A CST (oxytocin challenge test) is neg & nonstress test is reactive uteroplacental perfusion is sufficient at present to allow the fetus to withstand the stress of uterine contractions perfusion i
A positive contraction stress test (oxytocin challenge) & a nonreactive nonstress test indicates:

a) impending spontaneous abortion

b) fetus would not withstand the stress of labor
b) fetus would not withstand the stress of labor

if mother is 32 weeks, delivery will be c-section
A contraction stress test (oxytocin challenge) evaluates:

a) fetal heart rate
b) fetal movement
c) respiratory exchange of placenta
c) respiratory exchange of placenta
A contraction stress test is indicated when:

a) a nonstress test is non reactive
b) beta HCG is low
c) mother is hypertensive
a) a nonstress test is non reactive
Contraindications for a contraction stress test are all of the following except:

a) beeding
b) c-section history
c) risk for preterm labor
d) incompetent cervix
e) multiple gestation
f) breech
All of these are contraindications for a contraction stress test (oxytocin challenge)
A negative contraction stress test (oxytocin challenge) is indicative of:

a) decelerations
b) no late decelerations
b) no late decelerations
A positive contraction stress test (oxytocin challenge) is indicative of:

a) late decelerations w/at least 2 of 3 contractions
b) no late decelerations
a) late decelerations w/at least 2 of 3 contractions
Chromosomal & biochemical determinations can be made with:

a) beta human chorionic vilus sampling
b) amniocentesis
c) perctaneous blood sampling
d) fetoscopy
b) amniocentesis

if done early in pregnancy
Lung maturity, L/S ratio, presence of phosphatidglycerol/phospotidchoholine, interuterine infection can be detected later in pregnancy using:

b) amniocentesis
c) perctaneous blood sampling
d) fetoscopy
b) amniocentesis
Detects neural tube defects:

a) amniocentesis
b) beta HCG
c) alpha fetoprotein screening
d) percutaneous blood sampling
c) alpha fetoprotein screening

Advise all women to take folic acid suppliments prior to conception
Neural tube defects are more common in :

a) pregancy at less than 20 yrs of age & over 35 years of age
b) low socioeconomic status
c) nutritional deficiencies
b)
all of these to include folic acid deficiency prior to conception
The result of neural tube defects is:

a) anencephaly
b) spina bifida
c) incontinence
d) developmental delay
all of these are results of neural tube defects
Maternal Serum alpha-fetoprotein (NOT "universal")screening can be performed:

a) 8-15 weeks gestation
b) 15-22 weeks gestation
c) 22-30 weeks gestation
d) 30 weeks + gestation
b) 15-22 weeks gestation

Ideal within 15-18 weeks

Maternal Serum alpha-fetoprotein screening is associated w/Downs syndrome (trisomy 12)
The majority of women w. an elevated Maternal Serum alpha-fetoprotein:

a) do not have affected fetuses
b) have affected fetuses (Downs)
a) do not have affected fetuses
Causes for elevations in maternal serum alph-fetoprotein are:

a) incorrect gestational age
b) more than 1 fetus
c) HIV
d) fetal death
ALL of these are causes other than Downs
Determining lung maturity with amniocentesis is not accurate if:

a) specimen is contaminated with blood

b) specimen is contaminated with meconium
both of these cause inaccuracy
The L/S ratioo is the factor measured in determining:

a) lung maturity
b) placental perfusion
c) Downs syndrom
d) Neural tube defects
a) lung maturity

performed with amniocentesis
When 1st trimester diagnosis is for genitic, metabolic & DNA studies are necessary:

a) percutaneous blood sampling
b) amniocentesis
c) chorionic villus sampling
d) L/S studies
c) chorionic villus sampling

conducted with guidance from ultrasound

permits earlier diagnosis than amniocentesis
Chorionic villus sampling requires?
counceling prior to testing & informed consent especially w/increased risk for spontaneous abortion, limb reduction defects, infection, RH isoimmunization, leaking or ROM
To perform chorionic villus sampling a woman needs to:

a) have a full bladder
b) have a completely empty bladder
a) have a full bladder

helps with position of uterus
Chorionic villus sampling:

a) can detect neural tube defects
b) cannot detect neural tube defects
b) cannot detect neural tube defects
Chorionic villus sampling involves:

a) amniotic fluid sampling
b) obtaining small sample of chorionic villi from placenta
c) blood sample drawn from fetus
b) obtaining small sample of chorionic villi from placenta
Chorionic villus sampling is performed:

a) transabdominally
b) transcervically
both
The advantages of chorionic villus sampling are?
early diagnosis & short waiting time for results
Amniocentesis is not performed until:

a) 6 weeks gestation
b) 10 weeks gestation
c) 16 weeks gestation
d) 22 weeks gestation
c) 16 weeks gestation
Chorionic villus sampling is performed between:

a) 6-8 weeks
b) 10-12 weeks
c) 12-14 weeks
d) 16-18 weeks
b) 10-12 weeks
Risks associated with chorionic villus sampling are:

a) rupture of membranes
b) leakage of amniotic fluid
c) bleeding
d) maternal contamination of tissue
e) RH alloimmunization
f) fetal limb defects
g) abnormalities of the fetal face & jaw
all are risks associated with CVS
Chorionic villus sampling:

a) can detect neural tube defects
b) can not detect neural tube defects
b) can not detect neural tube defects

neural tube defects are usually detected with a universal alpha-fetoprotein screening by amniocentesis

if necessary to detect with CVS a triple to quadruple test after 15 weeks would be performed & place the fetus at an increased risk again with the invasive nature of amniocentesis
When explaining testing options, inform the mother:

a) that chorionic villus sampling shows no chromosomal abnormality

b) that chorionic villus sampling cannot screen for neural tube defects
both are correct
Women with a normal CVS & abnormal triple screen test should?
Be offered amniiocentesis
Fetal echocardiography (ultrasound of cardiac structures) is indicated when:

a) there is a history of congenital heart disease in family

b) history of maternal drug use

c) evidence of fetal abnormalities
a) history
all of the following are indications for fetal echocardiographt (ultrasound of cardiac structures)
Fetal echocardiography (ultrasound) is performed:

a) 4-6 weeks
b) 8-12 weeks
c) 12-18 weeks
d) 18-22 weeks
d) 18-22 weeks
Fetoscopy, a direct visualization of the fetus where blood or skin samples are obtained requires:

a) ultrasound
b) counceling
c) informed consent
d) Iv sedation & local anesthetic
all of these are required
Advantages of fetoscopy are:

a) fetus is viewed on video monitor

b) congenital abnormalities are diagnosed more easily
both
Ultrasound is primarily used in the 1st trimenster to determine all of the following except:

a) fetal heart beat vizualization
b) gestational age
c) fetal growth
d) cervical length & incompetence
e) lung development
e) lung development
The 2 most common methods of ultrasound scanning are:

a) transabdominal
b) transuteral
c) transcervical
d) transvaginal
a) transabdominal
d) transvaginal

TRANSABDOMINAL:
-used w/full bladder
-drink 1.5-2 quarts of water prior to examination
-may feel discomfort due to pressure in bladder
-elevate upper body or position on side w/towel under hip to prevent vena caval compression
-assessment of vagina & cervix in relation to bladder
-suspect placenta previa
-identify sex
-determine amniotic fluid level
-helps mother bond w/baby

TRANSVAGINAL:
-used w/probe
-empty bladder
-lithotomy position
-sterile sheath on probe
-improved images help identify structures & fetal charactyeristics earlier
- predictor for preterm in high risks
Using ultrasound, pregnancy may be detected:

a) 2nd or 3rd week after LMP
b) 3rd or 4th week after LMP
c) 4th or 5th week after LMP
d) 5th or 6th week after LMP
d) 5th or 6th week after LMP
Using ultrasound, observation of fetal heartbeat & fetal breathing movements have been observed as early as:

a) week 5 of gestation
b) week 7 of gestation
c) week 9 of gestation
d) week 11 of gestation
d) week 11 of gestation
With ultrasound, measurements used to determine gestational age of the fetus are:

a) cervical length
b) vertebrae & spinal cord
c) biparietal diameter of fetal head
d) length of femur
c) biparietal diameter of fetal head

d) length of femur
The disadvantages of the NST include which of the following:

a) is expensive
b) sometimes difficult to obtain a suitable tracing
c) must remain relatively still for at least 20 minutes
d) side effects
b) sometimes difficult to obtain a suitable tracing
c) must remain relatively still for at least 20 minutes
Women w/a high risk pregnacy will probably begin having NST's at:

a) 6-11 weeks gestation
b) 11-16 weeks gestation
c) 16-32 weeks gestation
d) 30-32 weeks gestation
d) 30-32 weeks gestation
If the NST is reactive in less than 30 minutes, the test is:

a) concluded & rescheduled as indicated by the high risk condition that is present

b) the test time is extended for 30 minutes
a) concluded & rescheduled as indicated by the high risk condition that is present

IF the NST is non reactive then it is extended for 30 minutes until the results are reactive
It is estimated that 80-90% of NST's are non-reactive due to:

a) prolapsed umbilical cord
b) diminished lung capacity
c) inadequate surfactant
d) sleep states
d) sleep states
When the result of an NST is non reactive, all of the following should be done except:

a) stimulate fetus via vibroacoustic stimulation
b) retake after the woman eats
c) give a foot massage
d) use of palpation to stimulate
all of these are suggested by the book to activate the fetus
When methods such as eating, a foot massage, vibroacoutical stimulation, & palpation have been used & positive reactivity is not achieved within 40 minutes for an NST all of the following may be considered except:

a) ultrasound
b) biophysical profile
c) immediate birth
d) reschedule test within 72 hours
d) reschedule test within 72 hours
When the fetus has adequate oxygenation & an intact central nervous system, there are:

a) accelerations of the fetal heart rate
b) fetal movement
c) decelerations of the fetal heart rate
B O T H accelerations & movement
Before beginning an NST all of the following are necessary except:

a) position the woman on left side, in semi-Fowller's, or reclining chair
b) lithotomy position
c) Review reasons & procedure for test
d) drink 1.5-2 quarts of water prior to testing
b) lithotomy position

d) drink 1.5-2 quarts of water prior to testing
NST results of 2 FHR accelerations of 10 beats per minute lasting 15 seconds, in a 20 minute period indicate:

a) positive reactivity
b) nonreative
c) unsatisfactory
b) nonreative
NST results of 2 FHR accelerations of 15 beats per minute lasting 15 seconds, in a 20 minute period indicate:

a) positive reactivity
b) a compromised fetus
a) positive reactivity
A handheld, battery operated device which is applied to the womans abdomen over the area of the fetal head that generates a low frequency vibration & buzzing sound & used with a non reactive NST during labor is called:

a) fetal acoustic stimulation test
b) vibroacountic stimulation test
BOTH are the same !
What does "FAT BM" stand for?
F A T B M:

(biophysical profile)

F -fetal heart rate w/reactivity

A -amniotic fluid volume

T - tone (x-tension & flexion of extremities

B - breathing movement

M - movements of body or limbs
When considering the biophysical variables (FAT BM), all of the variables are assessed by ultrasound except:

a) Fetal heart rate
b) Amniotic fluid
c) Tone
d) Breathing
e) Movement
a) Fetal heart rate

assessed by a NST (Non Stress Test)
A biophysical Profile:

a) assesses long term & short term variability
b) is admission screening used for identifying maternal risks
c) helps to identify a compromised fetus or confirm a healthy fetus
d) evaluates maternal & paternal history to identify potential risk factors
d)
c) helps to identify a compromised fetus or confirm a healthy fetus

REMEMBER: "FAT BM"
A biophysical profile assigns 2 points for each normal finding & 0 points to each abnormal finding for a maximum score of 10.
2 acceleration of 15 beats/min for 15 sec or more in 40 minutes would be assigned:

a) 2 points
b) 0 points
b) 0 points

NORMAL NST:

2 or more accelerations of 15bpm for 15 or more seconds in 20 minutes

NST 2:15 - 15:20
A biophysical profile assigns 2 points for each normal finding & 0 points to each abnormal finding for a maximum score of 10.
When the largesr single vertical pocket of amniotic fluid measures 2cm or less it would be assigned:

a) 2 points
b) 0 points
b) 0 points

Amniotic fluid volume visualized as a single verticle pocket measuring more than 2cm is normal.

A - single vertical 2cm+ pocket
A biophysical profile assigns 2 points for each normal finding & 0 points to each abnormal finding for a maximum score of 10.
1 episode of extension of a fetal extremity w/return to flexion, or the opening or closing of a hand would be assigned:

a) 2 points
b) 0 points
a) 2 points

No movements or extension/flexion would be abnormal & assigned 0 points.
A biophysical profile assigns 2 points for each normal finding & 0 points to each abnormal finding for a maximum score of 10.
1 or more episodes of rhythmic breathing that last 30 seconds in 30 minutes would be assigned:

a) 2 points
b) 0 points
b) 0 points

Normal breathing:

1 episode or more of rhythmic breathing that lasts 30 seconds or more within 20 minutes

B - 1:30-30
A biophysical profile assigns 2 points for each normal finding & 0 points to each abnormal finding for a maximum score of 10.
2 or more discrete body or limb movements on 30 minutes would be assigned:

a) 2 points
b) 0 points
b) 0 points

Normal Movements:

3 or more body or limb movements in 30 minutes

M - 3:30
FAT BM:

Fetal heart Rate w/activity 2:15 - 15:20

Amniotic fluid - single verticle pocet 2cm+

Tone - 1 extremity extension/flexion or open or close hand

Breathing - 1:30-30

Movement - 3 discrete-30
FAT BM:

Fetal heart Rate w/activity 2:15 - 15:20

Amniotic fluid - single verticle pocet 2cm+

Tone - 1 extremity extension/flexion or open or close hand

Breathing - 1:30-30

Movement - 3 discrete-30
Normal range in scoring a Biophysical Profile (FATBM)is:

a) 6-10
b) 8-10
c) 10-10
8-10 is considered normal IF AMNIOTIC fluid is normal)

a score of 10 is PERFECT (normal)
A contraction Stress Test is a means of evaluating:

a) respiratory fxn (02 & C02 exchange) of fetus
b) respiratory fxn (02 & C02 exchange) of woman
c) respiratory fxn (02 & C02 exchange) of father
d) respiratory fxn (02 & C02 exchange) of placenta
d) respiratory fxn (02 & C02 exchange) of placenta
A CST is contraindicated in 3rd trimester bleeding from placenta previa or marginal abruptio placentae or a previous "C-section" w/a verticle incision. CST is also contraindicated in which of the following:

a) PROM
b) incompetent cervix
c) anomolies of maternal reproductive organs
d) history of preterm labor
e) multiple gestation
ALL of these
A CST is indicated by:

a) maternal respiratory depression
b) Maternal hypertension
c) reactive NST
d) nonreactive NST
d) nonreactive NST
A test used to evaluate the respiratory fxn (02 & C02 exchange) of the placenta by identifying the fetus at risk for intrauterine asphyxia:

a) Non-stress test
b) Biophysical Profile
c) L/S ratio
d) Contraction Stress Test
d) Contraction Stress Test
The critical component of the CST is the presence of contractions whether they occur spontaneously or induced with oxytocin (Pitocin) administered IV (oxytocin challenge test). A CST that shows 3 cxn of good quality lasting 40 or more seconds in 10 minutes w/out evidence of late decelerations is:

a) negative
b) positive
c) equivocal/suspicious
a) negative

A DESIRED result!

3 cxn-40sec+:10min w/out late decels
A CST showing repetitive persistent late decels w/more than 50% of the cxn's is:

a) negative CST
b) positive CST
c) equivocal CST
b) positive CST

UNDESIRED result
Non persistent late decels or decels associated w/hyperstimulation (cxn frequency of every 2 min or duration loger than 90 seconds):

a) negative CST
b) positive CST
c) equivocal CST
c) equivocal CST

MORE INFORMATION is needed
A positive CST w/a nonreactive NST indicates:

a) fetus can endure stress of labor
b) fetus is not likely to with stand labor
b) fetus is not likely to withstand labor

Positive results need to be verified!
A procedure used to obtain amniotic fluid during which the physician scans the uterus using ultrasound to identify fetal & placental positions & adequate pockets of amniotic fluid:

a) NST
b) Maternal Serum alpha-fetoprotein
c) Triple Test
d) amniocentesis
d) amniocentesis

-skin cleansed w/povidone iodine (betadine)
-anesthesia at site is optional
-15-20 ml drawn out
-after needle withdrawal, site is assessed for "streaming"

STREAMING:
movement of fluid which is an indication for bleeding
Complications from amniocentesis occur:

a) 50% of the time
b) 20% of the time
c) 10% of the time
d) less than 1% of cases
d) less than 1% of cases
Amniotic fluid can provide information about genitic disorders, fetal health, & fetal lung maturity.

true or false?
true
In the early stages of pregnancy, amniocentesis is generally for:

a) testing fetal lung capacity
b) chromosomal & biochemical determinations
b) chromosomal & biochemical determinations
Concentrations of certain substances in amniotic fluid provide info about the health status of the fetus. For example, the Triple Test (triple screen) is the most widely used test to determine:

a) Neural tube defects
b) Down's syndrome (trisomy 21)
Both
In the later stages of pregnancy, amniocentesis is generally for:

a) testing fetal lung capacity
b) chromosomal & biochemical determinations
a) testing fetal lung capacity

L/S ratio !!!
When offering expectant parents the option of the triple test, clarify that the test is only used:

a) for diagnosis
b) to screen for disorders
c) to determine viability of pregnancy
d) when determinations are mandatory
b) to screen for disorders
From amniotic fluid, the Universal Alpha-Fetoprotein Screening is used specifically to detect all of the following except:

a) Down syndrome (trisomy 21)
b) Neural tube defects
c) Anencephaly
d) Spina bifida
a) Down's syndrome
From amniotic fluid, the Maternal Serum alpha-Fetoprotein Screening is used specifically to detect all of the following except:

a) Down's syndrome
b) Neural tube defects
c) Anencephaly
d) Spina bifida
b) Neural tube defects
c) Anencephaly
d) Spina bifida
Neural tube defects,may be detected by the triple test (Universal Alpha-fetoprotein screening), are found more in pregancies between the ages of:

a) 16-25 yrs
b) 25-35 yrs
c) 35-45 yrs
d) 40 yrs +
b) 25-35 yrs

More frequent in:

25-35 yrs age
primipara's
grandmultipara's
low socioeconomic status
nutritional deficiencies
From amniotic fluid studies, Maternal Serum alpha-fetoprotein to screen for Down's syndrome (trisomy 21) is most IDEAL when conducted:

a) 2-6 weeks of pregnancy
b) 6-15 weeks of pregnancy
c) 15-18 weeks of pregnancy
d) 15-22 weeks of pregnancy
c) 15-18 weeks of pregnancy

15-18 is IDEAL

but screening can be performed between 15-22 weeks
The majority of women w/elevated MSAFP have affected fetuses.

True
False
False

The majority of women w/elevated MSAFP DO NOT have affected fetuses.

90-95% elevations in Maternal Serum Alph Feto-Protein is due to incorrect gestational age, more than 1 fetus, other anomolies, HIV & fetal death.
From amniotic fluid testing, the L/S ratio assists in identifying ______ & ______ ?
gestational age

lung maturity
From amniotic fluid testing, an L/S ratio of 1:1 indicates:

a) 30-32 weeks gestation

b) 35 weeks gestation
a) 30-32 weeks gestation

L/S 1:1 = 30-32

L/S 2:1 = 35
The L/S ratio is not accurate if:

a) contaminated by blood
b) contaminated by meconium
BOTH
The greatest significance of the L/S ratio is all of the following except:

a) an infant born before synthesis of surfactant is complete results in underinflation of the lungs
b) to detect the potential of RDS (respiratory distress syndrome)
c) detecting fetal lung maturity
d) detecting HIV
d) detecting HIV
When concentrations of lecithin begin to exceed sphingomyelin at 35 weeks gestation, the L/S ratio of 2:1 indicates the unlikliness of RDS.

True or False
True
The incidence of False -Positive results from L/S screening are higher:

a) when the woman is HTN
b) when the woman is Anemic
c) when the woman is Diabetic
d) when the woman is Blonde
c) when the woman is Diabetic
Early in pregnancy, the concentration of this phospholipid in regards to the L/S ratio is greater & indicates the synthesis of surfactant is incomplete:

a) Lecithin
b) Sphingomyelin
b) Sphingomyelin

greater concentration of Sphingomyelin than Lecithin indicates probability of RDS
When the concentration of this phospholipid in regards to the L/S ratio is the greatest the probability of RDS at birth is predicted to be unlikely:

a) Lecithin
b) Sphingomyelin
a) Lecithin

indicates fetal lung maturity
2:1
A procedure used to obtain amniotic fluid during which the physician scans the uterus using ultrasound to identify fetal & placental positions & adequate pockets of amniotic fluid:

a) NST
b) Maternal Serum alpha-fetoprotein
c) Triple Test
d) amniocentesis
d) amniocentesis

-skin cleansed w/povidone iodine (betadine)
-anesthesia at site is optional
-15-20 ml drawn out
-after needle withdrawal, site is assessed for "streaming"

STREAMING:
movement of fluid which is an indication for bleeding
Complications from amniocentesis occur:

a) 50% of the time
b) 20% of the time
c) 10% of the time
d) less than 1% of cases
d) less than 1% of cases
Amniotic fluid can provide information about genetic disorders, fetal health, & fetal lung maturity.

true or false?
true

TRIPLE TEST
most widely used for Downs syndrome & neural tube defects
screen for levels of:

-alphafeto-protein
Universal: Neural Tube
Maternal: Down Syndrome
-chorionic gonadotropin
-unconjugated estriol

L/S RATIO
-gestational age (early)
-lung maturity (later)
1:1=30-32 wks
2:1=35 wks;enough surfactant

CHORIONIC SAMPLING
-will NOT detect neural tube defects
-VERY high risk
-early diagnosis for genetic, metabolic, & DNA studies
-requires counceling & informed consent
In the early stages of pregnancy, amniocentesis is generally for:

a) testing fetal lung capacity
b) chromosomal & biochemical determinations
b) chromosomal & biochemical determinations
Concentrations of certain substances in amniotic fluid provide info about the health status of the fetus. For example, the Triple Test (triple screen) is the most widely used test to determine:

a) Neural tube defects
b) Down's syndrome (trisomy 21)
Both
L/S ratio 2:1 indicates:

a) gestational age 35 wks
b) gestational age 30-32 wks
c) increased Lecithin
d) increased sphingomyelin
e) RDS likely
f) RDS unlikely
a) gestational age 35 wks
and ...
c) increased Lecithin
and ...
f) RDS unlikely

WHEN Lecithin exceeds sphingomyelin at 35 weeks RDS is unlikely
L/S ratio 1:1 indicates:

a) gestational age 35 wks
b) gestational age 30-32 wks
c) increased Lecithin
d) increased sphingomyelin
e) RDS likely
f) RDS unlikely
b) gestational age 30-32 wks
and ...
d) increased sphingomyelin
and ...
e) RDS likely
L/S Ratios, obtained from amniocentesis, are used primarily to determine:

a) gesational age & fetal lung maturity
b) synthesis of surfactant
c) risk for RDS
ALL of these
Under certain conditions of stress such as a physiologic problem of the mother, placenta, or fetus, the fetal lungs mature at a slower rate.

True or False?
False

Fetal lungs may mature more rapidly
False positives are common with L/S Tests when:

a) the mother is HTN
b) the mother is Diabetic
c) the mother is brunette
d) the mother is blonde
a) the mother is HTN
and...
b) the mother is Diabetic
An L/S Ratio is not accurate if sampling is contaminated by:

a) blood
b) chocolate
c) meconium
d) perfume
All of these :)
A PG test, sampling obtained from amniocentesis, is used primarily to test lung maturity in:

a) 1sr trimester
b) 2nd trimester
c) 3rd trimester
d) at delivery
c) 3rd trimester
PG tests for the surfactant phosphatidylglycerol which only appears when fetal lung maturity has been attained at about 35 wks gestation. The advantage of the PG test vs. the L/S test is:

a) it is useful in blood contaminated specimens
b) it determines fetal disposition to diabetes
a) it is useful in blood contaminated specimens
PG tests for the surfactant phosphatidylglycerol which only appears when fetal lung maturity has been attained at about 35 wks gestation. The disadvantage of the PG test vs. the L/S test is that it is not useful in blood contaminated specimens
The PG test is not affected by bontamination of blood in specimen.

PG is also associated w/ causing PROM, infexn in the uterus (chorioamnionitis), premature delivery, transient vaginal spotting, cramping, & pregnancy loss.
Chorionic villus Sampling is a VERY high risk testing procedure that is generally performed:

a) 4-8 wks gestation
b) 8-12 wks gestation
c) 12-24 wks gestation
d) 32-40 wks gestation
b) 8-12 wks gestation
The purpose for a chorionic villus sampling is:

a) determining fetal lung maturity
b) determining fetal heart maturity
c) genetic, metabolic, & DNA studies
d) detect Neural Tube defects
c) genetic, metabolic, & DNA studies
Chorionic villus sampling requires:

a) Counceling prior to testing
b) Counceling prior to consent
c) Guidance w/ultrasound
d) Full bladder during procedure to help w/position of uterus
ALL of these

EXTREME RISKS to FETUS
Rhogam is administered for any invasive procedure to a:

a) Rh positive mother
b) Rh negative mother
b) Rh negative mother
When your patient is about to undergo amniocentesis it is important that you recognize her apprehensions about the procedure as well as the info the test may reveal. She will need additional emotional support due to increased anxiety. It will also be necessary to do which of the following prior to the procedure:

a) obtain FHR baseline data
b) obtain maternal blood pressure
c) obtain maternal body temperature
d) obtain maternal pulse & respirations
e) monitor all vital signs every 15 minutes during the procedure
Do every one of these
4 side effects that must be reported following amniocentesis are?
1 - unusual fetal hyperactivity or lack of movement

2- vaginal drainage (clear or bleeding)

3- Uterine CX or abd pain

4- Fever or Chills
AMniotic sampling is not performed until at least:

a) 6 weeks gestation
b) 10 weeks gestation
c) 12 weeks gestation
d) 16 weeks gestation
d) 16 weeks gestation
Chorionic villus sampling is performed between:

a) 4-6 weeks gestation
b) 6-10 weeks gestation
c) 10-12 weeks gestation
d) 12-16 weeks gestation
c) 10-12 weeks gestation
Chorionic villus sampling detects neural tube defects early in pregnancy.

True or False
False
Women who have a normal Chorionic Sampling & an abnormal Triple screen test should be offered:

a) L/S ratio
b) amniocentesis
c) PG
d) Universal Alpha-fetoprotein test
b) amniocentesis
Chorionic villus sampling involves obtaining a small sample of chorionic villi from:

a) amniotic fluid
b) developing placenta
c) uterine wall
d) fetus
b) developing placenta
Risks involved with Chorionic villus sampling include all of the following excet:

a) spontaeous abortion
b) fetal limb defects
c) abnormalities of the fetal face
d) abnormalities of the fetal jaw
ALL OF THESE
The advantages of Chorionic villus sampling are?
-early detection of fetal disorders
-decreased waiting time for results
The disadvantages of Chorionic villus sampling are?
-increased risk of injjury to fetus
-inability to detect neural tube defects
- potential for repeated invasive procedures
Fetal echocardiography is an ultrasound used to visualize cardiac structures. This procedure is generally performed:

a) 4-8 weeks
b) 8-12 weeks
c) 12-18 weeks
d) 18-22 weeks
d) 18-22 weeks
A fetoscopy is a direct visualization of the fetus on a video monitor& of which blood or skin samples may also be obtained. With this procedure:

a) the woman is sedated IV
b) the woman receives local anesthesia
Both

congenital abnormalities are diagnosed easily
The presence of cervicovaginal fetal fibronectin is a strong predictor of preterm delivery due to spontaneous preterm labor or premature rupture of membranes when present between:

a) 6-10 wks gestation
b) 10-20 wks gestation
c) 20-34 wks gestation
d) 34-40 wks gestation
c) 20-34 wks gestation
Fetal fibrinectin levels can by measured with?
an enzyme immunoassay.