NUR 221 Exam 2 Correct Questions &
Answers(RATED A+)
Daily Fetal Movement Count (DFMC) - ANSWER KICK COUNT
-at home, non invasive, inexpensive
-frequently monitors fetus who has complications related to fetal oxygenation
-Decreased fetal Movement = HYPOXEMIA
DFCM how to - ANSWER count once a day for 60 minutes
or
count fetal activity two or three times daily(AFTER MEALS/ BEFORE BEDTIME) for 2
hours or until 10 movements are counted
or
all fetal movements in a 12 hour period each day until minimum of 10 counts
IF DECREASED FETAL ACTIVITY
-nonstress test is performed
DFCM safety alert - ANSWER -baby should always be moving
Decreased movement
-baby may be asleep during fetal sleep cycle
-if woman is taking medications that depress CNS
-drinking alcohol
-smoking
DO NOT DECREASE AS WOMEN NEARS TERM
Maternal and fetal indications for antepartum testing - ANSWER -Diabetes
-hypertension
-preeclampsia
-systemic lupus
-renal disease
-cyanotic heart disease
-fetal growth restriction
-Oligohydramnios
-late-term/post term gestation
-previous still birth
-decreased fetal movement
Biophysical profile - ANSWER REAL TIME ULTRASOUND/ PHYSICAL EXAM
USED IN LATE SECOND or THIRD TRIMESTER
-noninvasive assessment of fetus based on acute or chronic fetal disease
INCLUDES
-Amniotic fluid volume (reflects adequacy of placental function)
-Fetal breathing movement
,-fetal movements
-fetal tone
-nonstress test (FHR)
REFLECT CNS
Biophysical profile scoring - ANSWER FETAL BREATHING MOVEMENTS (FBM)
score 2 = one episode of breathing movement of at least 30 second duration in 30 min
observation
score 0= less than 30 second duration in 30 min
FETAL MOVEMENT
score 2= at least 3 movements in 30 mins
score 0= less than 3 movements in 30 mins
FETAL TONE
score 2= 1 episode of active extension with return flexion
score 0= absence of movement
AMNIOTIC FLUID VOLUME
score 2= deepest pocket > 2 cm
score 0= deepest pocket <2 cm
NONSTRESS TEST
Score 2= reactive
Score 0= nonreactive
BPP scoring - ANSWER 8-10 NORMAL
Modified biophysical profile (mBPP) - ANSWER shortens testing time
amniocentesis - ANSWER at or after 15 weeks gestation
-obtain amniotic fluid (contains fetal cells)
-needle is inserted into uterus fluid is drawn through syringe
AVOID 13-14 WEEKS OF GESTATION (high risk of pregnancy loss/fluid
leakage/clubfoot( fetal talipes equinovarus))
amniocentesis indications - ANSWER prenatal diagnosis of
-genetic disorders
-congenital anomalies
-neural tube defects
-assessment of pulmonary maturity
-fetal hemolytic disease
Amniocentesis maternal complications - ANSWER leakage of amniotic fluid
-hemorrhage
-fetomaternal hemorrhage
-maternal Rh isoimmunization
-infection
-labor
-placental abruption
,-damage to intestines/ bladder
-amniotic fluid embolism
Amniocentesis fetal complications - ANSWER -death
-hemorrhage
-infection (amnionitis)
-direct injury from needle
Genetic concern/indications for use of amniocentesis - ANSWER families with certain
characteristics have increase risk of child with genetic disorders
-Older maternal age (age 35 or greater
-Older paternal age (40-50 years)
-parents who have or carry sickle cell anemia, Tay-sachs disease, cystic fibrosis
-women with prior child structural birth defects
-structural defect identified by ultrasound
-women with prior child chromosomal abnormality
AFP levels - ANSWER High AFP levels in amniotic fluid help confirm diagnosis of NTD
such as Spina bifida/ anencephaly/ abdominal wall defect such as omphalocele
RESULTS FROM INCREASED LEAKAGE OF CEREBROSPINAL/ABDOMINAL FLUID
INTO AMNIOTIC FLUID
Fetal lung maturity - ANSWER Examined by Amniocentesis (amniotic fluid)
Non-stress test (NST) - ANSWER FIRST STEP= LEAST INVASIVE
-normal fetus produce heart patterns in response to
(FHR/contractions/movements/stimulation)
-Normal= reactive
-fetus who do not produce normal test results area not compromised/ they fail to exhibit
accelerations ( due to sleep state)
-performed fast and in outpatient setting/ noninvasive
Disadvantages of NST - ANSWER -twice weekly testing
-high false positive rate
-low false negative rate
NST procedure - ANSWER seated in reclining chair/ semi-fowler position
-recorded using doppler transducer
-Tocodynamometer is applied to detect contractions/movement (external contraction
monitor)
-traced for signs of fetal activity/ concurrent accelerations of FHR
-if no movement women may be asked to press button when movement is felt
Completed in 10-15 minutes
Vibroacoustic stimulation (buzzing) may be used if fetus is sleep (wakes up fetus)
reactive NST following vibroacoustic stimulation is reliable for predicting fetal well-being
, Interpretation of NST - ANSWER either reactive (normal) or nonreactive (bad)
if test does not meet criteria in 40 minutes Biophysical profile is performed
repeated twice weekly for remainder of pregnancy
Vibroacoustic stimulation (VAS) - ANSWER tests FHR
-performed with NST
-buzz/stimulate fetus
-fetus monitored for 10-20 minutes before stimulation for baseline FHR
-activated for 3 seconds or less on maternal abdomen over fetal head
Hypertension in pregnancy - ANSWER Three most common types
-gestational hypertension
-preeclampsia
-chronic essential hypertension (before pregnancy)
Gestational hypertension - ANSWER systolic 140 or more/ diastolic 90 or more
-RECORDED ON TWO SEPARATE OCCASIONS AT LEAST 4 HOURS APART
AFTER 20 WEEKS GESTATION IN WOMEN WITH PREVIOUSLY NORMAL BP
-resolves after giving birth or 6-12 months to resolve
-may go on to develop preeclampsia
Preeclampsia - ANSWER hypertension and proteinuria develop after 20 weeks
gestation
in women who never had either
-symptoms can develop after giving birth
-leading cause of mortality/morbidity
diagnosis of preeclampsia - ANSWER eliminated from criteria
-amount of proteinuria
-oliguria
-IUGR
Diagnosis: in absence of proteinuria
-hypertension
-thrombocytopenia
-impaired liver function
-persistent upper right quadrant/ epigastric pain
unresponsive to medication
-progressive renal insufficiency
-pulmonary edema
-cerebral symptoms (headache) not responding to analgesia
Eclampsia - ANSWER onset of seizure activity/ coma in woman with preeclampsia
-can occur before during or after brith
-can occur 48 hour postpartum (mother may be home by then)
Answers(RATED A+)
Daily Fetal Movement Count (DFMC) - ANSWER KICK COUNT
-at home, non invasive, inexpensive
-frequently monitors fetus who has complications related to fetal oxygenation
-Decreased fetal Movement = HYPOXEMIA
DFCM how to - ANSWER count once a day for 60 minutes
or
count fetal activity two or three times daily(AFTER MEALS/ BEFORE BEDTIME) for 2
hours or until 10 movements are counted
or
all fetal movements in a 12 hour period each day until minimum of 10 counts
IF DECREASED FETAL ACTIVITY
-nonstress test is performed
DFCM safety alert - ANSWER -baby should always be moving
Decreased movement
-baby may be asleep during fetal sleep cycle
-if woman is taking medications that depress CNS
-drinking alcohol
-smoking
DO NOT DECREASE AS WOMEN NEARS TERM
Maternal and fetal indications for antepartum testing - ANSWER -Diabetes
-hypertension
-preeclampsia
-systemic lupus
-renal disease
-cyanotic heart disease
-fetal growth restriction
-Oligohydramnios
-late-term/post term gestation
-previous still birth
-decreased fetal movement
Biophysical profile - ANSWER REAL TIME ULTRASOUND/ PHYSICAL EXAM
USED IN LATE SECOND or THIRD TRIMESTER
-noninvasive assessment of fetus based on acute or chronic fetal disease
INCLUDES
-Amniotic fluid volume (reflects adequacy of placental function)
-Fetal breathing movement
,-fetal movements
-fetal tone
-nonstress test (FHR)
REFLECT CNS
Biophysical profile scoring - ANSWER FETAL BREATHING MOVEMENTS (FBM)
score 2 = one episode of breathing movement of at least 30 second duration in 30 min
observation
score 0= less than 30 second duration in 30 min
FETAL MOVEMENT
score 2= at least 3 movements in 30 mins
score 0= less than 3 movements in 30 mins
FETAL TONE
score 2= 1 episode of active extension with return flexion
score 0= absence of movement
AMNIOTIC FLUID VOLUME
score 2= deepest pocket > 2 cm
score 0= deepest pocket <2 cm
NONSTRESS TEST
Score 2= reactive
Score 0= nonreactive
BPP scoring - ANSWER 8-10 NORMAL
Modified biophysical profile (mBPP) - ANSWER shortens testing time
amniocentesis - ANSWER at or after 15 weeks gestation
-obtain amniotic fluid (contains fetal cells)
-needle is inserted into uterus fluid is drawn through syringe
AVOID 13-14 WEEKS OF GESTATION (high risk of pregnancy loss/fluid
leakage/clubfoot( fetal talipes equinovarus))
amniocentesis indications - ANSWER prenatal diagnosis of
-genetic disorders
-congenital anomalies
-neural tube defects
-assessment of pulmonary maturity
-fetal hemolytic disease
Amniocentesis maternal complications - ANSWER leakage of amniotic fluid
-hemorrhage
-fetomaternal hemorrhage
-maternal Rh isoimmunization
-infection
-labor
-placental abruption
,-damage to intestines/ bladder
-amniotic fluid embolism
Amniocentesis fetal complications - ANSWER -death
-hemorrhage
-infection (amnionitis)
-direct injury from needle
Genetic concern/indications for use of amniocentesis - ANSWER families with certain
characteristics have increase risk of child with genetic disorders
-Older maternal age (age 35 or greater
-Older paternal age (40-50 years)
-parents who have or carry sickle cell anemia, Tay-sachs disease, cystic fibrosis
-women with prior child structural birth defects
-structural defect identified by ultrasound
-women with prior child chromosomal abnormality
AFP levels - ANSWER High AFP levels in amniotic fluid help confirm diagnosis of NTD
such as Spina bifida/ anencephaly/ abdominal wall defect such as omphalocele
RESULTS FROM INCREASED LEAKAGE OF CEREBROSPINAL/ABDOMINAL FLUID
INTO AMNIOTIC FLUID
Fetal lung maturity - ANSWER Examined by Amniocentesis (amniotic fluid)
Non-stress test (NST) - ANSWER FIRST STEP= LEAST INVASIVE
-normal fetus produce heart patterns in response to
(FHR/contractions/movements/stimulation)
-Normal= reactive
-fetus who do not produce normal test results area not compromised/ they fail to exhibit
accelerations ( due to sleep state)
-performed fast and in outpatient setting/ noninvasive
Disadvantages of NST - ANSWER -twice weekly testing
-high false positive rate
-low false negative rate
NST procedure - ANSWER seated in reclining chair/ semi-fowler position
-recorded using doppler transducer
-Tocodynamometer is applied to detect contractions/movement (external contraction
monitor)
-traced for signs of fetal activity/ concurrent accelerations of FHR
-if no movement women may be asked to press button when movement is felt
Completed in 10-15 minutes
Vibroacoustic stimulation (buzzing) may be used if fetus is sleep (wakes up fetus)
reactive NST following vibroacoustic stimulation is reliable for predicting fetal well-being
, Interpretation of NST - ANSWER either reactive (normal) or nonreactive (bad)
if test does not meet criteria in 40 minutes Biophysical profile is performed
repeated twice weekly for remainder of pregnancy
Vibroacoustic stimulation (VAS) - ANSWER tests FHR
-performed with NST
-buzz/stimulate fetus
-fetus monitored for 10-20 minutes before stimulation for baseline FHR
-activated for 3 seconds or less on maternal abdomen over fetal head
Hypertension in pregnancy - ANSWER Three most common types
-gestational hypertension
-preeclampsia
-chronic essential hypertension (before pregnancy)
Gestational hypertension - ANSWER systolic 140 or more/ diastolic 90 or more
-RECORDED ON TWO SEPARATE OCCASIONS AT LEAST 4 HOURS APART
AFTER 20 WEEKS GESTATION IN WOMEN WITH PREVIOUSLY NORMAL BP
-resolves after giving birth or 6-12 months to resolve
-may go on to develop preeclampsia
Preeclampsia - ANSWER hypertension and proteinuria develop after 20 weeks
gestation
in women who never had either
-symptoms can develop after giving birth
-leading cause of mortality/morbidity
diagnosis of preeclampsia - ANSWER eliminated from criteria
-amount of proteinuria
-oliguria
-IUGR
Diagnosis: in absence of proteinuria
-hypertension
-thrombocytopenia
-impaired liver function
-persistent upper right quadrant/ epigastric pain
unresponsive to medication
-progressive renal insufficiency
-pulmonary edema
-cerebral symptoms (headache) not responding to analgesia
Eclampsia - ANSWER onset of seizure activity/ coma in woman with preeclampsia
-can occur before during or after brith
-can occur 48 hour postpartum (mother may be home by then)
