A nurse in an obstetrics office is reviewing the medical record of a 28-year-old female primigravida client at 14 weeks of gestation.

For each client finding, click to specify if the finding is a biophysical, psychosocial, or environmental risk factor that increases the client's risk for pregnancy complications. There must be at least 1 selection in every row..

Choice A rationale

Initial diagnostic steps for inflammatory breast cancer symptoms like redness, dimpling, and skin thickening usually involve imaging to differentiate between an abscess and a solid mass. Ultrasound is the preferred first-line tool because it is non-invasive, cost-effective, and highly effective at characterizing localized tissue changes and identifying fluid-filled versus solid lesions. It provides real-time guidance and helps the medical team determine the necessity and precise location for more invasive follow-up procedures like biopsies.

Choice B rationale

Magnetic resonance imaging is a sophisticated diagnostic tool that provides detailed cross-sectional views of breast tissue, but it is typically reserved for high-risk screening or further characterization after an initial ultrasound or mammogram. It is not the first step because it is expensive and may show false positives. While excellent for determining the extent of a known disease, it is considered a secondary imaging modality in the initial diagnostic workup of new breast symptoms.

Choice C rationale

A core needle biopsy is the definitive method for obtaining a tissue sample to confirm a diagnosis of malignancy. However, imaging must be performed first to visualize the area of concern and provide a roadmap for the needle. Skipping straight to a biopsy without prior imaging like an ultrasound is not standard practice, as the imaging helps ensure the biopsy is taken from the most suspicious and representative area of the affected breast tissue.

Choice D rationale

Staging is a process used to determine the extent of cancer spread throughout the body once a definitive diagnosis of malignancy has already been established. It involves various scans and tests to check lymph nodes and distant organs. Because the client has not yet been diagnosed with cancer, performing staging procedures would be premature. The priority is to first confirm whether the clinical signs of dimpling and redness actually represent a malignant process.

Choice A rationale

Fetal eyebrows typically begin to appear during the second trimester, specifically between weeks 17 and 20. By week 15, the fetus is developing fine hair called lanugo over the body, but distinct facial features like eyebrows are not yet fully visible. The development of hair follicles is a complex genetic process, and the timing of visible eyebrows is a key milestone for clinicians to estimate gestational age during ultrasound imaging or physical assessment.

Choice B rationale

Surfactant is a critical lipoprotein produced by Type II alveolar cells in the lungs that reduces surface tension to prevent alveolar collapse during exhalation. Production generally starts around week 20 of gestation but does not reach sufficient levels for independent breathing until much later, usually around week 35. Normal fetal lung development requires this early initiation to prepare the respiratory system for the transition to extrauterine life and to ensure effective gas exchange.

Choice C rationale

Breathing movements, which are rhythmic contractions of the diaphragm and chest wall, typically begin late in the first trimester or early in the second trimester, usually around weeks 10 to 12. These movements are essential for lung development and the circulation of amniotic fluid through the respiratory tract. At week 9, the embryo has just transitioned to a fetus, and while basic structures are present, these coordinated muscular respiratory efforts have not yet been fully established.

Choice D rationale

While ossification of the fetal skeleton begins early in the first trimester, the bones are not fully developed or hardened by week 34. In fact, many bones, particularly the long bones and the skull, remain flexible and contain significant amounts of cartilage to allow for growth and to facilitate passage through the birth canal. The final hardening and fusion of many bones do not occur until well after birth, continuing into childhood and adolescence.