A couple has been diagnosed with infertility after trying to conceive for a year.

 Which test would likely be performed first? 

Choice A rationale:

Trisomy 21, also known as Down syndrome, is a genetic condition caused by the presence of an extra copy of chromosome 21.

The nuchal translucency test (NT) is a non-invasive ultrasound screening test that measures the thickness of the fluid-filled space at the back of a developing baby's neck.

Evidence suggests that fetuses with Down syndrome tend to have increased fluid accumulation in this area, resulting in a larger-than-average nuchal translucency measurement.

Therefore, an increased NT measurement can be a marker for an increased risk of Down syndrome.

It's important to emphasize that the NT test is a screening tool, not a diagnostic test.

This means it can only indicate an increased risk of Down syndrome; it cannot definitively diagnose the condition.

To confirm a diagnosis, further testing, such as chorionic villus sampling (CVS) or amniocentesis, is required.

Choice B rationale:

Neural tube defects (NTDs) are birth defects that affect the brain, spine, or spinal cord.

The most common NTDs are spina bifida and anencephaly.

The NT test is not a diagnostic test for NTDs, although it might detect some cases of open spina bifida.

However, it's not specifically designed for this purpose, and other tests, such as alpha-fetoprotein (AFP) screening or detailed ultrasound, are more reliable for diagnosing NTDs.

Choice C rationale:

The NT test is typically performed in the first trimester of pregnancy, between 11 and 14 weeks gestation.

It's not available in the second trimester because the nuchal translucency measurement becomes less reliable after this point in pregnancy.

Choice D rationale:

A nuchal translucency measurement of 3mm or less is generally considered normal.

Measurements greater than 3mm are associated with an increased risk of Down syndrome and other chromosomal abnormalities.

The higher the measurement, the greater the risk.

Choice A rationale:

It is true that a laboring client may not be able to eat, but this is not the primary reason for starting an IV. The client can receive fluids and electrolytes through the IV to maintain hydration and energy levels.

However, this response does not directly address the client's question about why the IV is necessary for the epidural.

It's important to provide a clear and accurate explanation to help the client understand the purpose of the intervention.

Choice B rationale:

This response is dismissive of the client's concerns and does not provide any information about why the IV is necessary.

It's important to acknowledge the client's concerns and provide them with the information they need to make informed decisions about their care.

Choice C rationale:

This is the correct response. The IV is necessary to administer medication for relaxation before the epidural is placed.

The epidural is a regional anesthetic that blocks pain signals from the lower body.

The medication for relaxation helps to reduce anxiety and discomfort, which can make it easier to place the epidural.

It also helps to prevent the client from moving during the procedure, which could lead to complications.

Choice D rationale:

This response is not accurate. An IV bolus is not typically given to minimize the side effects of the epidural.

Side effects of the epidural, such as hypotension and nausea, are usually managed with other medications.