CCRN-NICU Exam with Answers

A patient who is G3P2 at 32 weeks' ges￾tation arrives at the triage unit complain￾ing of regular uterine contractions. Her pregnancy history includes a preterm delivery at 34 weeks. Before examining her, the nurse performs electronic fetal monitoring and obtains a complete his￾tory.The patient reports no bleeding and no rupture of membranes. She has no vaginal examinations or sexual activity for more than 24 hours.The biochemical marker useful in this situation for predict￾ing preterm birth is: When electronic fetal monitoring is used, the best indicator of fetal oxygenation status during labor is The biophysical profile (BPP) is current￾ly the primary method for evaluating fe￾tal well-being through the assessment of various activities that are controlled by the central nervous system and are sen- sitive to oxygenation. The five variables included in the BPP are: An appropriate gestational age for glu- cose screening in women who are at low risk for developing gestational diabetes is Fetal Fibronectin- Fibronectins are a family of proteins found in extracellular matrix. Fetal fibronectins are found in fe￾tal membranes and decidua throughout the pregnancy. As the gestational sac implants and attaches to the interior of the uterus in the first half of pregnancy, fFns are normally found in cervicovagi- nal fluid. After 22 wks, the presence of fFns normally is no longer detected in vaginal secretions until approximately 2 weeks before the onset of delivery, term or preterm. Moderate fetal heart rate variability- vari- ability is the most important fetal HR characteristic. It is the most important indicator of normal fetal pH or acido- sis. Moderate FHR variability reliably predicts the absence of fetal metabolic academia Feral tone, fetal breathing, fetal move- ment, nonstress test, and amniotic fluid 24-28 weeks' gestation.Patients with risk factors (>35 years, body mass index >30, history of gestational diabetes, delivery of a LGA infant, polycystic ovarian syn- drome, strong family hx) should receive a plasma glucose screening at their first prenatal visit followed by one at 24-28 weeks PCO2 CCRN-NICU Study online at 2 / 20 When women give birth sitting upright, which of the following indicators show lower values in cord blood? What is the physiologic cause of late de- celerations? An intrauterine pressure catheter, placed for the monitoring of uterine pressure, amnioinfusion, and fluid sampling, is useful in the treatment of A patient who is at 42+5 has been pushing for 90 minutes and is near deliv- ery. Her membranes spontaneously ruptured 3 hours ago and meconium was observed. The electronic fetal monitor demonstrates minimal fetal heart rate baseline variability. The most likely potential cause is: When performing a BPP, which of these fetal variables should the nurse recog- nize as placing the fetus at high risk and in need of either delivery or repeat BPPs no fewer than two times/week? Elevated maternal serum a-fetoprotein is associated with: What is triple marker screening? Transient interruption in fetal oxygenation Variable decelerations- amnioinfusion is used to attempt to resolve variable fetal heart rate decelerations by correcting umbilical cord compression as a result of oligohydramnios. Must be careful to not cause polyhydramnios Fetal metabolic acidosis- moderate vari- ability reliably predicts the abscence of fetal metabolic acidemia at the time it is observed. Absent variability --> severe hypoxia. Marked variability--> metham- phetamine use and scalp stimulation An amniotic fluid pocket measuring 1.5cm in two planes perpendicular to each other. Oligohydramnios is defined as a single deepest pocket of <2cm, or an amniotic fluid index of <5cm neural tube defects- MSAFP is a protein made by the fetal liver. High levels may indicate neural tube defects or ventral abdominal wall defects, esophageal and duodenal atresia, and some renal or uri- nary tract anomalies. Low levels occur in some case of down syndrome Combines the chemical markers of MSAFP, hCG, and unconjugated estriol with the mother's age. A low value is associated with trisomy 18