Presentation Dx

Diagnostic TestsDiagnostic TestsDiagnostic TestsDiagnostic Tests

Doriden de Classica Ang- Fabre, Doriden de Classica Ang- Fabre, RN- LECTURERRN- LECTURER

Why are you here?• A.

• B.

• C.

• D.

DIAGNOSTIC TESTSA review…….

• *Diagnostic and laboratory tests are tools that provide information about the client.

• *tests maybe used as a part of wellness check• *helps confirm a diagnosis, monitor an illness,

and provide valuable information about a clients response to treatment

• Midwives needs knowledge of most lab test > role to teach a family or significant others how to prepare for the tests and care that may be required ff. the tests.

• Diagnostic testing occurs in many env’t:

• TRADITIONAL SITES: hosp, clinics and physicians office

• -many tests sites nowadays are moving to the community

• Ex. Home, workplace, shopping malls and mobile units

• The more complex dx are performed at diagnostic centers specifically built for those tests

PHASES:• PRETESTS• Major focus is client’s preparation.• Thorough assessment and data collection

( COMMUNICATION and TEACHING strategies)• Ex, prior to radiologic studies, it is important to ask a

female client for possible pregnancy> special precautions may be necessary or a need to postpone of the dx.

• Giving information• Need to know the equipment and supplies needed for

the specific tests.

• Ex of querries:• What type of sample will be needed ad how will it be

collected?• Does the client needs to stop oral intake for a certain

number of hours prior to the test?• Does the test include administration of a dye ( contrast

media)? If so, is it injected or swallowed?• Are fluid restricted or forced?• Are medications given or withheld?• How long is the test? Is a consent form required?• Answers to this question can help avoid inconvenience

and avoid costly mistakes

• INTRATESTS• -focuses on specimen collection and

performing or assisting with certain dx• -use standard precautions and sterile

techniques as appropriate• - provide emotional and physical support

while monitoring the client (VS)• Ensures correct labeling, storage, and

transportation of the specimen to avoid invalid test results

• POST TEST• follow up activities and observations• as appropriate, the nurse compares

the previous and current test results and modifies interventions as needed

• report to appropriate health team members

BODY FLUIDS AND ELECTROLYTES

• Water- vital to health and normal cellular function

• Medium for metabolic reaxns within the cell

• Transporter for nutrients, waste products and other subs

• A lubricant

• An insulator and shock absorber• One means of regulating and

maintaining BT

• Age, sex and body fat affects total body weight

• 70-80% of our body wt but it decreases with age

• 60 y/o- less than 50%• Fat tissue is free of H2O• Lean tissue- BW greater percentage of

water

• Woman who have proportionately more body fat than men hence lower % of BW

Regulating BODY FLUIDS

• FI= FL= balance• FLUID INTAKE-2500ml• Mod activity/mod. temp= 1500

ml /day only so get water from water food contents

• Fresh fruits, veggies, lean meat

THIRST MECHANISM• Primary regulator of FI• Thirst center is located in the

hypothalamus of the brain• FLUID OUTPUT• Urine• Insensible losses (fever, inc

metabolism and inc fluid loss)

• Feces, intestines• Ave daily FO for adults:• Urine- 1400/1500ml• Insensible- (lungs/skin)350-400ml• Sweat 100 ml• Feces- 100-200ml= 2300-2600ml

MAINTAINING HOMEOSTASIS

• Kidneys• ADH• RENIN- angiotensin aldosterone

mechanism• Atrial natriuretic factor

FACTORS AFFECTING F and E balance

• Age- older adult at risks of fluid e imbalance- thinner/fragile veins

• Gender and body size- 60% of mans weight, 52% womens wt.

• Obese= 30-40% persons wt.• ENV’TAL T= hot-inc sweat• = ins BT- at risk for exhaustion/

heatstroke (athletes, laborers)

TYPES of SOLUTION• ISOTONIC• .9% NaCL• Lactated ringers• D5LR• = no effect on cell

• HYPOTONIC- swells the cell• - not for pt. with inc. IICP or third

space fluid shift• -.45% Nacl• - .33% NaCL• = provive free water to tx cell DHN

• HYPERTONIC• Shrink cell• Draw fluid out of the ICF and interstitial

compartments into vascular compartment, expanding blood volume

• Not for kidney or heart dse clients who are DHN without hypervolemia

ELECTROLYTES

• Na ( Sodium)• Affects body H2O distribution, maintains osmotic pressure of

extracellular fluid and helps promote neuromuscular fxn• maintains acid base balance in the body• reg by kidneys and aldosterone in the adrenal glands• absorbed by kidneys• small amounts is loss thru the skin• normal value-135-145 meq/l• if increase, HYPERNATREMIA causes are:• inadequate water intake, water loss that exceeds Na loss (DI)

vomiting, diarrhea, excessive Na intake

• low: HYPONATREMIA causes are: inadequate Na itake, excessive Na loss caused by profuse sweating, GI suctioning, diuretic therapy, diarrhea, vomiting and burns

• proc: perform a venipuncture and collect the sample in a 7 ml clot activator tube

•  

• . POTASSIUM ‘K• -major intracellular cation• - normal value- 3.5-5 mEq/L• impt in maintaining cellular electrical neutrality• cardiac rhythms and transmission and conduction

of nerve impulses and muscle contraction• maintains normal function of smooth, skeletal

and cardiac muscle•  

• HYPERKALEMIA-increase• Occurs with:- inc. K intake• dec renal excretion• infusion of stored whole blood• replacement K• acidosis• insulin deficiency• burns• extensive surgery• MI and renal failure•  

• HYPOKALEMIA• GI and renal D/O, vomiting, diarrhea, gastric

suctioning, diuretics, excessive aldosterone secretion

• Tingling, numbness of extremities if depleted with potassium

• Regulated by kidneys, aldosterone, insulin, excreted by pancreas in betacells in the islet of langerhans

• MAGNESIUM• COMMONLY OVERLOOKED ELECTROLYTE VITAL TO

NEUROMUSCULAR FUNCTION• Activates many essential enzymes and affects

metabolism of nucleic acid, CHON and CHO• Used in digestion of the food we eat• Absorbed by SI and excreted in urine and feces•  • Normal value- 1.3- 2.1 mg/dl•  

• Chronic alcoholism decreases levels (HYPOMAGNESEMIA)

•  • Causes: malabsorption, prolonged bowel or gastric

aspiration, acute pancreatitis• Severe burns and use of diuretics• Renal failure- elevated magnesium levels

(HYPERMAGNESEMIA)• Causes: excrete inadequate amounts of magnesium

•  

• CALCIUM• vit D increases synthesis of calcium• function is for formation of bone sand teeth,

wound healing and blood clotting factor• approx. 1% in the blood 50% plasma CHON,

40% ionized or free and 99% stored in bones and teeth.

•  • TOTAL CA: 8.2- 10.2 mg/dl

• HYPERCALCEMIA- occurs in pt with hyperparathyroidism, parathyroid tumors, multiple fractures, prolonged immobilization, overuse of antacids

• HYPOCALCEMIA- results from hypoparathyroidism, malabsorption and renal failure

• CHLORIDE• helps maintan the osmotic pressure of blood and

therefore helps regulate blood volume and arterial pressure

• HCL acid production- digestion• Normal values: 100-108 mEq/L• Hyperchloremia- increase; caused by diarrhea, severe

DHN, head injury• HYPOCHLOREMIA- dec Na and dec K associated,

prolonged vomiting, heat failure, enema and gastric suctioning

• PHOSPHATES• - essential to the storage and utilization of energy, calcium

regulation, RBC function, AB balance, bone formation and metabolism of CHO, CHON and fats

• - linked to calcium• vit D necessary for absorption• NV 2.7-4.5 mg/dl• Dec- HYPOPHOSPHATEMIA- malnut’n, malabsorption>

suppress growth• Inc- HYPERPHOSPHATEMIA- results in skeletal dse renal failure•  

• BICARBONATE• NV- 22-26 mEq/L reg by kidneys- acid base

balance•  • PO4-Ca- contra• CL- Na- kadwa• Na- K- contra•  

SPUTUM EXAMINATION

• GROSS APPEARANCE- may indicate certain diseases• Sputum culture and sensitivity tests- to detect actual

microorganisms causing infection• Early morning sputum specimen is collected. Mucous

secretions accumulate during the night. This enables the client to expectorate adequate sputum specimen

• Rinse mouth with plain water. Do not use astringent mouthwash. Its alcohol content can destroy the microorganisms in the specimen.

• Use sterile container• Sputum specimen for C & S is collected before the first dose

of antimicrobial. To ensure that microorganisms present in the specimen can be accurately detected.

• Deep breaths and cough deeply

SKIN TESTS: Mantoux test

• -PPD ( Purified protein derivative is used• - Intradermal route of injection• -Read result 48-72 hoursafter injection• - (+ Mantoux Test) is induration of 10 mm or more• - For HIV positive clients, pt. with treated TB induration of 5

mm is considered positive• -+ mantoux tests signifies exposure to mycobacterium

tubercle bacilli• - BCG may cause false positive reaction• -Assess for previous PTB Exposure and report immediately to

the doctor.•  

Chest Xray

• -X ray beams penetrate the chest and react on specially sensitized film

• -normal pulmonary tissue is transluscent, such abnormalities as infiltrates, foreign bodies, fluids and tumors appear as densities on the film

• - Practice patient to hold his breath and to do deep breathing

• - Instruct the client to remove metals from the chest. Metals are radiopaque, This maybe mistaken as lesions.

•  

Bronchoscopy

• -the direct inspection and observation of the larynx, trachea and bronchi through a flexible or rigid bronchoscope

• DX use:• to collect secretions• To determine location and pathologic process and

collect specimen for biopsy• THERAPEUTIC USES:• remove aspirated foreign objects• excise lesions

• NURSING INTERVENTIONS BEFORE BRONCHOSCOPY

• informed consent/ permit needed• Atropine and valium preprocedure, topical

anesthesia sprayed followed by local anesthesia injected into the larynx

• NPO 6-8 hours to prevent aspiration and vomiting• Remove dentures, protheses, contact lenses to px

losses of valuables•  

• INTERVENTIONS AFTER:• Side lying- to promote drainage from

the mouth• Watch for cyanosis, hypotension,

tachycardia, arrythmias, hemoptysis, dyspnea. These signs and symptoms indicate perforation of bronchial tree.

ABG(Arterial Blood Gases)

• Provides important info. About the adeq. Of gas exchange in the lungs, ventilatory function, blood p and acid base balance

• Electrolyte levels provide valuable data about the body’s acid base balance and fluid balance

• Explain the procedure• Normal Values• pH- 7.35- 7.45• Pa CO2- 35-45 mmHg• PaO2- 80-100 mm Hg• HCO3- 22-26 meq/L• SaO2- 94-100%

• Tell the pt which site radial, brachial, or femoral artery has been selected for the puncture

• Tell pt to breath normally during the test, and warm him that he may feel brief cramping or throbbing pain at the puncture site.

• Include air or amount of oxygen and method of delivery ( for ex) 40% aerosol facial mask

• Monitor V/S and observe for signs of circulatory impairment such as swelling, discoloration, pain, numbness or tingling in the bandage arm or leg

• RESP ALKALOSIS• Cha by: PH=↑7.45 PaCO2=↓ 35 mmHg• - Hyperventilation- excessive blowing off CO2• RESP ACIDOSIS• pH= ↓7.35 meq/L• PaCO2=↑ 45 mmHG• retention of CO2> hypoventilation• METABOLIC ACIDOSIS• pH- ↓ 7.35• HCO3=↓ 22 mEq/L• headache, dec BP, cool clammy skin, dysrythmia• MET. ALKALOSIS• pH- ↑ 7.45 HCO3=↑26 mEq/ L• causes are vomiting, or gastric suctioning, hypokalemia, ingestions of antacids• decrease RR,tingling sensation, hypokalemia, dysrythmia

HEMATOLOGY

• test to determine whether spe. Blood levels are higher or lower than the normal and can be useful in diagnosing of diseases as anemia, leukemia and infections.

• CBC- evaluation of general health status• A. WBC-LEUKOCYTE- measures the WBC in a microliter

of whole blood• dx of infection and inflammation• monitoring a pt. response to a chemotherapy or

radiation therapy• normal value-4000- 10000• *Leukocytosis/ Inc WBC count signals infxn such as

abscess, meningitis, appendicitis or tonsillitis

• Increase count may indicate leukemia, or tissue necrosis cause by burns MI or gangrene

• *LEUKOPENIA/dec. WBC• Indicates bone marrow depression ,which may result from

viral infectios of from toxic reactions, ingestion of mercury or other heavy metals or exposure to benzene or arsenicals

• Accompanies influenza, Ty, measles, infections heap, rubella• DIFFERENTIAL COUNTS:• Neutrophils-60-70%• Eosinophils- 1-4%• Basophils-0-.5%• Lymphocytes- 20-30%• Monocytes 2-6%

RBC/ ERYTRHOCYTE COUNTS

• main component of the blood• helps assess the bloods oxygen carrying capacity and can be useful in

dx anemia, protein deficiency, and dehydration• male-4.5-5.5 millium/ ul• female 4-5• inc may indicate absolute or relative polycythemia• dec. may indicate anemia, fluid overload or hemorrhage lasting 24 H• C. hemoglobin• - transport oxygen, main component of a RBC• Males- 14-17.4• Females- 12-16• D. hematocrit• Male -42-52%• Female- 36-48%

PLATELET/ THROMBOCYTES

• -For coagulation.• Normal value 140000-400000/ul in adult• 150-450K/ ul in children• increase/ thrombocytosis - hmge,

infection, IDA, pregnancy or splenectomy• decrease/ thrombocytopenia – aplastic

anemia

BUN/ blood urea nitrogen

• Indicator of renal function• Normal range is 10-20 mg/dl• BLOOD LIPIDS• Cholesterol- NPO for 10-12 hours normal

range is 150-200mg/dl• Triglycerides- client should fast 10-12 hours;

nr- 140-200mg/dl• Blood cultures -px contamination of specimen;

to assist in dx of infectious dses of the heart

ECHOCARDIOGRAPHY• uses ultrasound to assess cardiac

structure and mobility• the client is instructed to remain

still in supine pos’n slightly turned to left side, with HOB elevated 15-20 degrees

ECG/ ELECTROCARDIOGRAM • records electrical waves of the heart• keypoints:• instruct the patient to lie still, breath

normally during the procedure• Let the patient refrain from talking

during the test• ST segment elevation and T wave

inversion indicates MI

ULTRASOUND • - can diagnose pregnancy as early as 6 weeks• - confirm presence size and location of placenta and amniotic fluid• - established that the fetus is growing and has no gross defects such as

hydrocephalus, anencephaly, spinal cord, heart, kidney and bladder defects

• - presentation and pos’n of the fetus• -sex• - predict maturity by measurement of the by parietal diameter• - complication of pregnancy- hydramnios, oligo, poly, ectopic, missed

abortion, multiple preg, genetic abnormalities, neural tube defects• - abdominal or transvaginal• -monitor• -explain procedure• - urinate tvs(invasive)/ abd(non invasive)- full bladder• 15-30 mins.• - aftercare

URINE TESTS • - urine is one of the primary functions of the

urinary system• - screen pt. for kidney and urinary tract dses• - detect metabolic or systemic diseases• - evaluate the color, odor and opacity of the

urine• - determine the urines specific gravity and pH• - detect CHON, glucose and ketones• - eamine urine sediments for blood cells, casts,

crystals

• NORMAL :• Color- pale to dark yellow• Odor- slightly aromatic• Appearance- clear• Spgr- 1.005-1.035• pH- 4.5-8.0• no glucose, ketones, CHON, RBC, WBC,

yeast, parasites, bacteria

• *color change due to- diet, drugs or disease• unusual odor- infxn• turbidity/ cloudiness- kidney infxn• low spgr- DI, pyelonephritis• increase spgr- heart failure, liver failure, DHN• pH- increase- UTI, resp or met. Alkalosis• decrease- renal TB acidosis• proteinuria-renal failure• sugar- DM• blood cells- infxn, trauma, tumor• bacteria-contamination, UTI• Tell pt to avoid stress and strenuous exercise before the test• Check for drugs influence ua- rifam, levodopa, metronidazole• 1st voided specimen, midstream

CT SCAN- • provides photograph of tissue densities with

use of radiation• contrast medium- asses for allergy to dye

(iodine- shellfish)• NPO 4 hours prior to procedure• Assess for any fears of close spaces

(claustrophobia)• The procedure is contraindicated for pregnant

and obese indv greater than 300 lbs• Lie still- whole procedure

CYSTOSCOPY • assess bladder and urethra• - informed consent-secure• - if general anesthesia is to be used- NPO; local- liquid diet• - monitor I and O• - after, forced fluids as prescribed- to prevent ascending UTI• - pink tinged or tea colored urine expected within 24-48 hours

> irritation of tissue and mucus memnbrane• -hot sitz bath to relievepelvic discomfort as ordered• -notify the doctor if bright red urine clots occur.• - inform that desire to void is felt as cystoscope is inserted• - lithotomy pos’n• -after proc, bedrest until VS are stable• -

EEG(electroencephalogram)

• - records electrical activities of the brain and detects activity of brain, intracranial hmge and tumors

• - advise client to shampoo hair before and after procedure

• - if electrode gel is to be used and not removed by shampooing, use acetone

• - withhold stimulants, antidepressant, tranquilizers and anticonvulsants for 24-48hrs before tests

Mammography • detects breast tumors• - instruct pt not to use deodorant, talcum

powder, lotion perfume or any ointment on the day of exam- false positive result

• breast is compressed between two x ray plates

• -provide teaching rel to BSE- done 7 days after menses

• -lying or sitting down-raising hands- palpate for mass

MRI • - provides a more detailed sectional images of

the brain• keypoints:• contraindicated in pregnancy• obese• claustrophobic pt• unstable VS• pt. with metal implants like pacemaker, hip

replacement and jewelries

Stool Analysis • - Assessment of bacteria, viruses

malabsorption and blood• key points:• -avoid aspirin, indomethacin,

steroids, dark colored foods, red meat, and Vit. C 3 days before the exam- false positive results

Snellen chart• - tests visual acuity• - right eye first before the left eye• -normal is20/20• - the numerator indicates a the distance of client from

the chart• - the denominator indicates the distance the normal

eye can read the letters• result of 20/200 indicates legal blindness; disqualifies a

pt. from driving• -myopia or near sightedness 20/30 or greater• - hyperopia or farsightedness 20/15 or less

TUNNING FORK TEST • * Rinnes test-compares air conduction from bone

conduction, differentiates conductive and sensorineural hearing loss

• the vibrating tuning fork is placed against the mastoid bone (bone conduction) then it is placed 2 inches from ear canal (air conduction)

• result:• Normal-air conduction is better than bone conduction-

the tone is louder infront of the ear• Conductive hearing loss- bone conduction is better than

air conduction – the tone is louder behind the ear

WEBERS TEST

• the rounded tip of the handle of the vibrating fork is placed in the center of the clients head

• interpretation of results is as follows: • NORMAL- tone is heard at the center of the head or

equally in both ears• CONDUCTIVE hearing loss- tone is heard better in

poorer ear (otosclerosis)• SENSORY HEARING LOSS-tone is heard in better ear.

This is valuable in dx of menieres diesease• The test is useful in cases of unilateral hearing loss.

ROLL OVER TESTS•Helps to detect patients

who will develop PIH•Can be performed bet 28-

32nd week gestation

PROC:• Check BP in the lateral recumbent

pos’n until stable (10 mins)• Roll patient to supine position• Check BP immediately• Wait for 5 minutes• Check BP again

Interpretation:• (+) more than 20 mmHG or more

in the diastolic pressure at 5 minutes interval

• (-) less than 20 mmHG rise in diastolic BP at the 5 minutes reading

• RECORD and report

AMNIOCENTHESIS• Test to assess fetal growth and

maturity and to det genetic disorders and sex of fetus

• Done bet 14-16weeks if purpose is to assess chromosomal abberations and done after 35 weeks to assess fetal lung maturity

• Void if gestation is greater than 20 weeks

• Posn- supine.

….. Amnio-• Painless, cramping sen’n- local

anesthesia• VS, left lateral pos’n after

FHR ASSESSMENT• DOPPLER UTZ• - FHR DETECTED AT 10-12 weeks• FETOSCOPE• - detects FHR by 18-20 weeks• Rate should be: 120-160 bpm

CHORIONIC VILLI SAMPLING

• PURPOSE- determines some genetic aberrations

• ALERT: Instruct the patient to drink water to fill the bladder to aid in the attainment of the desired position of the uterus

• Explain to the patient the risks involved includes spontaneous abortion, infection, hematoma and intrauterine death

• Chorionic villus sampling (CVS) is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails getting a sample of the chorionic villus (placental tissue) and testing it. CVS can be carried out 10-13 weeks after the last period, earlier than amniocentesis (which is carried out as early as 14-16 weeks).

• Possible reasons for having a CVS can include:• Mother's age of 35 years or greater • Abnormal first trimester screen results • Increased nuchal translucency or other

abnormal ultrasound findings • Family history of a chromosomal abnormality

or other genetic disorder • Parents are known carriers for a genetic

disorder

• CVS carries a higher risk of harming the fetus than amniocentesis (miscarriages occur in around 1 in 100 to 1 in 200 cases with CVS, versus around 1 in 1,600 with amniocentesis). Apart from a risk of miscarriage, there is a risk of infection and amniotic fluid leakage. The resulting amniotic fluid leak can develop into a condition known as oligohydramnios which is low amniotic fluid level. If the resulting oligohydramnios is not treated and the amniotic fluid continues to leak it can result in the baby developing hypoplastic lungs (underdeveloped lungs). Additionally, there is a risk of CVS causing digit-reduction defects in the fetus if performed before 11 weeks (0.07%-0.10%).

• It is important after having a CVS that the OB/GYN follow the patient closely to ensure the patient does not develop infection.

NON STRESS TEST• Assess fetal activity and well being• Reactive test acceleration of fetal

heart rate of more than 15 beats per minute above baseline FHR lasting 15 seconds or more. NON reactive test- acceleration of FHR of less than 15 beats per minute above baseline FHR. May indicate fetal jeopardy

NST…• NON INVASIVE electronic

monitoring of fetal response in terms of acceleration in FHR and fetal movement

SHAKE TESTS• FOAM STABILITY TEST• - simple and inexpensive test for

determining fetal lung maturity based on the ability of the surfactant in the amniotic fluid to form bubbles or foam in the presence of ethanol.

• 15-30 minutes

• Place an exact amount of 95% ethanol, isotonic saline and amniotic fluid in a glass test tube

• Shake the mixture for 15 seconds until foam or bubbles form on the surface

• Let it stand for 15 minutes

• INTERPRETATION:• Persistent or stable ring on the

surface of the mixture after 15 minutes indicates a + shake tests- LUNG MATURITY

QUESTIONS• After counselling jana, 1 37 y/o client

about BSE and mammography, the HCP determines that the client has understood the instructions when the client states which of the ff?

• A. I should have mammography every year once I’m 40 y/o

• B. I should have mammo at my menses time

• C. its an inexpensive proc.• D. it’s a extremely painful

procedure

• Ans:

• 2. an ultrasound is typically performed during the third tri for w/c of the ff reasons?

• A. evaluate fetal congenital anomalies• B. determine fetal pos/n and estimate

fetal size• C. confirm multiple gestation• D. to evaluate pelvis adequacy• ANS:

• 3. a client has an induration of 12 mm mantoux test, the nurse should explain that:

• A. test result negative and no ff care needed• B. screening is alright just stay calm and relax• C. repeat it in the next 7 weeks• D. The result needs further tests, including a X

ray film

• ans:

• 4. the Physician orders sputum tests The specimen should be:

• A. cough up from deep to the lungs• B. Collected in early morning hours• C. copious in amount for adeq testing• D. refrigerated first

• Ans:

• 5. A hemoglobin level of 14 g/dl indicates that the pt has

• A. abnormal level• B. normal level• C. depend largely on gender• D. has hypoxia• Ans:

• 6. In planning care the nurse is aware that the greatest risk of urinary catheterization is:

• A. UTI• B. bladder puncture• C. mental retardation• D. bladder irrigation• Ans:

• 7. the establishment of data base for a newly admitted patient forms which phase of the nursing process?

• A. assessment• B. implementation• C. diagnosing• D. planning• Ans:

• 8. BUN levels are measured to:• A. monitor CHON DIET on kidneys• B. evaluate blood samples• C. evaluate liver enzymes• D. evaluate kidney function

• Ans:

• 9. amniocenthesis can be performed as early as which of the following?

• A. 8 weeks• B. 10 weeks• C. 12 weeks• D. 14 weeks• Ans:

• 10.Barbie 8 weeks pregnant asks the nurse when she will be able to hear the fetal heart best. The nurse would respond by stating to the client that the fetal heart beat can be heard with a doppler ULTZ device when the gestation is as early as:

• A. 4-8 weeks• B. 8-10 weeks• C. 15 weeks• D. 18 weeks

• Ans:

• 11. Which of the following statements by a primigravid client scheduled for chorionic villi sampling indicates understanding of the procedure?

• A. A fiberoptic fetoscope will be inserted through a small incision into my uterus

• B. I can’t have anything to eat or drink after midnight on the day of procedure

• C. the procedure involves the insertion of a thin catheter into my uterus

• D. I need to drink a glass of fluid to 1-2 hours before the procedure

• 12. A positive NST means• A. Prematurity• B. Drug addiction• C. FHR DECELERATION• D. FHR ACCELERATION• Ans:

• 13. A patient suspected with PIH is to undergo the Roll over test, A well verse midwife should know that Roll over tests is performed during:

• A. 40th week d. anytime• B. 28-32nd week• C. 20 weeks• Ans:

• 14. When preparing to listen to the FHT at 12 weeks AOG, the nurse would use which of the following?

• A. Stethoscope is placed midline at the umbilicus

• B. Doppler placed midline at the suprapubic region

• C. Fetoscope placed midway between the umbilicus and xiphoid process

• D. external electronic placed at the umbilicus

• Ans:

• 15. A patient is suffering from moderate Dehydration, knowing the different types of fluid solutions, a midwife should know that the best fluid to administer is which of the following?

• A. hypertonic solution

• B. hypotonic solution• C. isotonic solution• D. plain water

• Ans:

WE ARE DONE……