Exhibits

A nurse is assisting in the care of a newborn. Which of the following should be included in the electronic medical record (EMR)? Select all that apply.

Choice A rationale

Elevated maternal serum alpha-fetoprotein (MSAFP) levels are more often associated with intrauterine growth restriction (IUGR) due to placental compromise, which can lead to increased leakage of AFP into the maternal circulation. AFP is a glycoprotein produced by the fetal liver and yolk sac. Normal MSAFP levels vary by gestational week, but generally, a level ≥ 2.5 Multiples of the Median (MoM) is considered elevated.

Choice B rationale

Multiple gestation, such as twins or triplets, typically results in an elevated MSAFP because there are multiple fetuses producing AFP, leading to a higher total concentration in the maternal serum. This physiological increase requires adjustment of the median value used for interpretation to prevent false-positive results for neural tube defects.

Choice C rationale

Down syndrome (Trisomy 21) is associated with low MSAFP levels, often ≤ 0.75 MoM, along with decreased unconjugated estriol and increased human chorionic gonadotropin (hCG) and inhibin A in the quad screen. This specific pattern is due to complex, poorly understood pathophysiology related to the aneuploidy's effect on fetal protein synthesis and maternal-fetal exchange.

Choice D rationale

Neural tube defects (NTDs), such as spina bifida and anencephaly, are associated with markedly elevated MSAFP levels, usually ≥ 2.5 MoM. This is caused by the exposed fetal meninges or neural tissue leaking a large amount of AFP directly into the amniotic fluid, which then diffuses into the maternal circulation.

Choice A rationale

. Instructing a pregnant client to move their car seat close to the steering wheel is unsafe. The steering wheel poses a significant trauma risk to the abdomen and uterus, especially in the event of airbag deployment or a collision. The ideal distance is at least 10 inches between the chest and the steering wheel to prevent blunt abdominal trauma and protect the fetus.

Choice B rationale

. Advising the client to wear the shoulder harness snug across their stomach is incorrect and potentially dangerous. The shoulder harness must be positioned above the pregnant abdomen, across the middle of the chest and between the breasts, to distribute crash forces across the bony structures (clavicle and sternum) and away from the fetus and the uterus.

Choice C rationale

. Directing the client to position the lap belt across their navel is incorrect and must be avoided. The lap belt should be worn snugly and low, under the pregnant abdomen, across the bony pelvis (hips and pubic bone), not the soft tissue of the abdomen. This prevents the forces of a collision from being directed toward the uterus and fetus.

Choice D rationale

. Encouraging frequent breaks and walking is crucial during long car trips to promote venous return and prevent venous stasis. The gravid uterus compresses the inferior vena cava, impairing blood flow from the lower extremities, which increases the risk of developing a deep vein thrombosis (DVT), a life-threatening complication, making this an essential safety instruction.