Review Practice Exercise 1

Antepartum Diagnostic Testing > Maternal Newborn

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Practice Exercise 1

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Total Questions : 5

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Question 1:

Which of the following statements accurately describes a key difference between prenatal screening tests and prenatal diagnostic tests?

A. Screening tests are invasive and carry a significant risk of miscarriage, while diagnostic tests are non-invasive. B. Screening tests provide a definitive diagnosis, whereas diagnostic tests only assess risk. C. Screening tests assess the risk of a condition, while diagnostic tests provide a definitive diagnosis. D. Diagnostic tests are typically performed earlier in pregnancy than screening tests.

Answer and Explanation

Choice A:

Screening tests are non-invasive and carry no direct miscarriage risk. Diagnostic tests, such as amniocentesis, are invasive and increase miscarriage risk by approximately 0.1–0.3%. Therefore, the statement reverses the actual risk profile.

Choice B:

Screening tests do not provide definitive diagnosis but only probability estimates. A positive screen result must be confirmed with a diagnostic test such as CVS or amniocentesis. Diagnostic tests provide direct chromosomal or genetic information, not just risk assessment.

Choice C:

Screening tests assess the risk of fetal conditions, while diagnostic tests provide confirmation. Screening uses maternal serum and ultrasound, estimating probability. Diagnostic methods obtain fetal cells via invasive sampling, confirming chromosomal abnormalities with high sensitivity and specificity.

Choice D:

Screening tests are performed earlier, typically in the first trimester at 11–14 weeks or second trimester at 15–20 weeks. Diagnostic tests, including CVS at 10–13 weeks and amniocentesis at 15–20 weeks, occur later or selectively. Hence, screening usually precedes diagnostic evaluation.

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Question 2:

A client expresses concern about the ethical implications of prenatal testing. The nurse’s response should be guided by which of the following ethical principles?

A. Paternalism, where the healthcare provider makes decisions for the patient. B. Beneficence, always striving for the “best” outcome as defined by the provider. C. Autonomy, respecting the patient’s right to make informed decisions without coercion. D. Non-maleficence, solely focusing on avoiding physical harm to the fetus.

Answer and Explanation

Choice A:

Paternalism removes decision-making power from the patient, placing it solely with the healthcare provider. This contradicts current ethical standards, as modern practice prioritizes patient-centered care and informed decision-making.

Choice B:

Beneficence involves acting in the patient’s best interests but does not override autonomy. Defining the “best” outcome from the provider’s perspective risks imposing values that may conflict with the patient’s own beliefs or cultural views.

Choice C:

Autonomy ensures that patients retain control over healthcare decisions, including whether to undergo prenatal testing. Nurses must provide unbiased, clear, and accurate information, respecting the patient’s choices even if they differ from provider preferences.

Choice D:

Non-maleficence focuses on avoiding harm but only addresses physical outcomes. While important, it does not address ethical concerns about choice, consent, and respect for patient values, which are central in prenatal testing discussions.

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Question 3:

The following maternal conditions may necessitate antepartum diagnostic testing to assess fetal well-being except:

A. Gestational diabetes B. Iron-deficiency anemia C. Mild asthma D. Hypothyroidism

Answer and Explanation

Choice A:

Gestational diabetes increases risk for macrosomia, polyhydramnios, and stillbirth due to altered glucose metabolism and placental dysfunction. Antepartum testing is indicated especially if insulin or oral hypoglycemics are used, or if poor glycemic control is present. Normal fasting glucose should be <95 mg/dL, 1-hour postprandial <140 mg/dL.

Choice B:

Iron-deficiency anemia with hemoglobin <11 g/dL in the first and third trimesters or <10.5 g/dL in the second trimester can impair oxygen delivery to the fetus. Severe anemia (<8 g/dL) is associated with fetal growth restriction and increased perinatal morbidity, warranting surveillance.

Choice C:

Mild asthma without hypoxia or exacerbations does not typically impair placental function or oxygen delivery to the fetus. Well-controlled asthma with normal maternal oxygen saturation (>95%) does not necessitate routine antepartum testing. No evidence of increased risk for fetal compromise in mild cases.

Choice D:

Hypothyroidism, especially if untreated, can lead to fetal neurodevelopmental delay, low birth weight, and placental insufficiency. TSH levels should be <2.5 mIU/L in the first trimester and <3.0 mIU/L in the second and third trimesters. Elevated TSH or low free T4 requires monitoring and fetal assessment.

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Question 4:

Which of the following are indications for recommending antepartum diagnostic testing? Select all that apply

A. Advanced maternal age (≥35 years at delivery) B. Normal first-trimester ultrasound findings C. Family history of cystic fibrosis D. Abnormal maternal serum screening results E. Maternal history of seasonal allergies

Answer and Explanation

Choice A:

Advanced maternal age (≥35 years) significantly increases the risk of chromosomal abnormalities such as trisomy 21. This is a standard indication for diagnostic testing such as amniocentesis.

Choice B:

Normal first-trimester ultrasound findings are reassuring and do not warrant further diagnostic testing. Diagnostic testing is only indicated if abnormalities are detected or other risk factors are present.

Choice C:

A family history of cystic fibrosis, an autosomal recessive genetic disorder, is an indication for prenatal diagnostic testing to assess carrier status or confirm fetal genetic status.

Choice D:

Abnormal maternal serum screening results, such as elevated alpha-fetoprotein or abnormal quad screen values, require confirmatory diagnostic testing to determine the presence of chromosomal or structural abnormalities.

Choice E:

Maternal history of seasonal allergies is not associated with fetal genetic or chromosomal abnormalities and does not indicate the need for antepartum diagnostic testing.

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Question 5:

Which of the following ethical principles guide nursing care in antepartum diagnostic testing? Select all that apply

A. Autonomy B. Beneficence C. Paternalism D. Non-maleficence E. Utilitarianism

Answer and Explanation

Choice A:

Autonomy guides care by supporting the patient’s right to make independent decisions after receiving full, unbiased information.

Choice B:

Beneficence directs nurses to promote maternal-fetal well-being, balancing medical benefits against potential risks.

Choice C:

Paternalism involves providers making decisions for the patient, which contradicts ethical standards of respecting autonomy and informed consent.

Choice D:

Non-maleficence ensures avoidance of unnecessary harm, requiring careful consideration of procedural risks before recommending testing.

Choice E:

Utilitarianism focuses on outcomes that benefit the majority, not the individual patient. Nursing ethics prioritize patient-centered care, not population-based utility.

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Practice Exercise 1

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