Maternal serum alpha-fetoprotein (MSAFP) screening indicates an ...

[penza]

Maternal serum alpha-fetoprotein (MSAFP) screening indicates an elevated level. MSAFP screening is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?
 
  a. Percutaneous umbilical blood sampling (PUBS)
  b. Ultrasound for fetal anomalies
  c. Biophysical profile (BPP) for fetal well-being
  d. Amniocentesis for genetic anomalies

Question 2

A client asks her nurse, My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean? The best response by the nurse is:
 
  a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.
  b. Your placenta isn't working properly, and your baby is in danger.
  c. This means that we will need to perform an amniocentesis to detect if you have any placental damage.
  d. Don't worry about it. Everything is fine.

[l.stuut]

Answer to Question 1

ANS: B
If MSAFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated MSAFP screening, ultrasound examination, and possibly amniocentesis. Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. BPP is a method of assessing fetal well-being in the third trimester. Before amniocentesis is considered, the client first would have an ultrasound for direct visualization of the fetus.

Answer to Question 2

ANS: A
An accurate and appropriate response is, Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby. Although Your placenta isn't working properly, and your baby is in danger may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response Don't worry about it. Everything is fine is not appropriate and discredits the client's concerns.