A nurse is observing fetal breathing movements on an ultrasound for a client who is undergoing a biophysical profile (BPP).
The nurse should document how many points for this variable if the fetus has at least one episode of breathing lasting for 20 seconds within a 30-minute period?
0 points.
1 point.
2 points.
3 points.
The Correct Answer is C
According to the ACOG guidelines on antepartum fetal surveillance, one of the components of the biophysical profile is fetal breathing movements, which are scored as 2 points if there is one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes.
Choice A is wrong because 0 points are given for absent or no breathing episode for ≥30 seconds within a 30 minute observation period.
Choice B is wrong because there is no 1 point score for this variable.
Choice D is wrong because there is no 3 point score for this variable.
The maximum score for each variable is 2 points.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
An NST is a test that measures the fetal heart rate in response to fetal movement.
It is a non-invasive and simple way to assess fetal well-being.
An NST may be recommended to further evaluate fetal well-being if the CST result is equivocal, meaning that occasional but not persistent late decelerations are present.
Choice B. Amniocentesis is wrong because it is an invasive procedure that involves inserting a needle into the uterus to collect amniotic fluid for genetic testing or fetal lung maturity.
It is not used to evaluate fetal well-being in response to contractions.
Choice C. Magnetic resonance imaging (MRI) is wrong because it is an imaging technique that uses magnetic fields to create detailed pictures of the fetus and the placenta.
It is not used to evaluate fetal well-being in response to contractions.
Choice D. Chorionic villus sampling (CVS) is wrong because it is an invasive procedure that involves inserting a catheter or a needle into the placenta to collect chorionic villi for genetic testing.
It is not used to evaluate fetal well-being in response to contractions.
Normal ranges for CST are negative (normal) or positive (abnormal).
Equivocal and unsatisfactory are special categories of test outcomes that require further testing.
Normal ranges for NST are reactive (reassuring) ornon-reactive (non-reassuring).
Correct Answer is C
Explanation
. The client’s cervix is dilated.
This indicates that the client may be in preterm labor, which is a contraindication for amniocentesis.
Amniocentesis is a procedure that involves inserting a needle into the amniotic sac to obtain a sample of amniotic fluid for genetic testing or other purposes.
It is usually performed between 15 and 20 weeks of gestation.
Choice A is wrong because the client’s bladder should be full for amniocentesis.
This helps to push the uterus upward and away from the bladder, reducing the risk of injury and making it easier to visualize the fetus and the needle.
Choice B is wrong because the client’s uterus should be above the symphysis pubis at 16 weeks of gestation.
This is a normal finding and does not affect the procedure.
Choice D is wrong because the client’s fundal height should measure around 16 cm at 16 weeks of gestation.
A fundal height of 20 cm may indicate a large for gestational age fetus, multiple gestation, or polyhydramnios (excess amniotic fluid), but these are not absolute contraindications for amniocentesis.
However, they may require further evaluation and adjustment of the technique.
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