A nurse is caring for a pregnant client who has a nonreactive or nonreassuring result on a nonstress test (NST).

The healthcare provider orders a biophysical profile (BPP) to further assess fetal well-being.

What components are included in a BPP? (Select all that apply.)

Maternal medications and technical errors can contribute to a nonreactive nonstress test (NST), which means that the fetal heart rate (FHR) does not increase with fetal movement.Some medications, such as narcotics, antihypertensives, and magnesium sulfate, can affect the FHR and its variability.Technical errors, such as poor transducer placement or loose belts, can also interfere with the accuracy of the NST.

Choice B is wrong because a fetal sleep cycle usually lasts 20 to 40 minutes, and the NST can be extended or repeated if the FHR is not reactive within 20 minutes.

Choice C is wrong because maternal obesity does not affect the FHR or its reactivity, but it may make it harder to obtain a clear signal from the transducer.

Choice D is wrong because fetal breathing movements are a sign of fetal well-being and do not cause a nonreactive NST.

A normal NST will show a baseline FHR between 110 and 160 beats per minute with moderate variability (5 to 25 interbeat variability) and two qualifying accelerations in 20 minutes with no decelerations.An acceleration is defined as an increase in the FHR of at least 15 beats per minute for at least 15 seconds.

A biophysical profile (BPP) is a prenatal test that evaluates the well-being of the fetus by combining an ultrasound examination with a nonstress test.The test assesses five components: fetal heart rate, breathing, movement, tone, and amniotic fluid volume.Each component is scored as 2 (normal) or 0 (abnormal), and a total score of 8 or 10 is normal, 6 is equivocal, and 4 or less is abnormal.

Choice C is wrong because fetal heart rate is not part of the ultrasound assessment, but rather the nonstress test.The nonstress test evaluates fetal heart rate and response to fetal movement.

Normal ranges for each component are as follows:

• Fetal heart rate: At least two accelerations in 20 minutes

• Fetal breathing: At least one episode of > 30s or >20sin 30 minutes

• Fetal movement: At least three discrete body/limb movement in 30 minutes

• Fetal tone: At least one episode of active extension with return to flexion of fetal limb(s) or trunk, opening and closing of hand considered to be normal tone

• Amniotic fluid volume: At least one vertical pocket > 2 cm in the vertical axis or AFI of 5 cm