Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance?

Choice A Reason: This is correct because this response provides realistic and supportive advice for a woman who wants to have a baby with lupus. Lupus is an autoimmune disease that causes inflammation and damage to various organs and tissues. Lupus can affect fertility and pregnancy outcomes, such as increasing the risk of miscarriage, preterm delivery, preeclampsia, or neonatal lupus. Therefore, it is important for the woman to have her lupus under control before conceiving and to consult with her doctor about her treatment plan and prenatal care.

Choice B Reason: This is incorrect because this response is discouraging and insensitive for the woman who wants to have a baby with lupus. Lupus does not necessarily prevent a woman from having a healthy pregnancy and a healthy baby, as long as she follows her doctor's recommendations and monitors her condition closely. The nurse should respect the woman's reproductive choices and provide information and support.

Choice C Reason: This is incorrect because this response is inaccurate and misleading for the woman who wants to have a baby with lupus. Lupus can have various effects on pregnancy, such as causing flares or complications that can affect both the mother and the baby. The nurse should educate the woman about the possible risks and benefits of pregnancy with lupus and help her prepare for any challenges.

Choice D Reason: This is incorrect because this response is vague and alarming for the woman who wants to have a baby with lupus. Lupus treatment may or may not change during pregnancy, depending on the type and severity of lupus, the medications used, and the stage of pregnancy. The nurse should explain the rationale and safety of any medication changes and address any concerns or questions that the woman may have.

Choice A Reason: This is incorrect because sickle-cell anemia is a genetic disorder that affects the shape and function of red blood cells. It does not affect the AFP level, which is a protein produced by the fetus and placenta. Sickle-cell anemia can be detected by other prenatal tests, such as hemoglobin electrophoresis or DNA analysis.

Choice B Reason: This is incorrect because cardiac defects are structural abnormalities of the heart or blood vessels that affect the blood flow and oxygen delivery to the fetus. They may cause an increased AFP level, not a decreased one, as they can lead to fetal distress or edema. Cardiac defects can be detected by other prenatal tests, such as fetal echocardiography or ultrasound.

Choice C Reason: This is correct because Down syndrome is a chromosomal disorder that results from an extra copy of chromosome 21. It causes various physical and mental developmental delays and defects in the fetus. It is associated with a decreased AFP level, as well as decreased levels of human chorionic gonadotropin (hCG) and unconjugated estriol (uE3). Down syndrome can be confirmed by other prenatal tests, such as amniocentesis or chorionic villus sampling (CVS).

Choice D Reason: This is incorrect because respiratory disorders are problems that affect the breathing and gas exchange of the fetus. They may cause an increased AFP level, not a decreased one, as they can lead to fetal distress or edema. Respiratory disorders can be detected by other prenatal tests, such as fetal biophysical profile (BPP) or nonstress test (NST).