The nurse is teaching a pregnant client about fetal kick counts.
Which statement made by the client indicates a need for further instruction?

Choice A rationale:

Epicanthal folds: These are skin folds that cover the inner corners of the eyes. They are a common characteristic of Trisomy 21, also known as Down syndrome.

Heart murmur: A heart murmur is an abnormal sound heard during a heartbeat. It can be caused by a variety of conditions, including Trisomy 21. Approximately half of babies with Down syndrome have a heart defect.

Low-set ears: This means that the ears are positioned lower on the head than usual. This is another common characteristic of Trisomy 21.

Poor muscle tone: This means that the muscles are weak and floppy. This is also a common characteristic of Trisomy 21.

Choice B rationale:

Cystic fibrosis: This is a genetic disorder that affects the lungs and digestive system. It is not typically associated with the physical features observed in this newborn. Newborns with cystic fibrosis typically present with meconium ileus, failure to thrive, and recurrent respiratory infections.

Choice C rationale:

Tay-Sachs disease: This is a rare genetic disorder that affects the nervous system. It is not typically associated with the physical features observed in this newborn. Infants with Tay-Sachs disease typically appear normal at birth, with symptoms developing around 6 months of age. These symptoms can include developmental delays, muscle weakness, seizures, and blindness.

Choice D rationale:

Marfan syndrome: This is a genetic disorder that affects the connective tissue. It is not typically associated with the physical features observed in this newborn. Individuals with Marfan syndrome typically have tall stature, long limbs, and hypermobile joints. They may also have eye problems, such as lens dislocation, and heart problems, such as aortic aneurysm.

Choice A rationale:

Incorrect. The quad screen test does not examine fetal DNA to determine gender. That is the role of other tests, such as amniocentesis or chorionic villus sampling (CVS).

Gender determination is not a primary objective of the quad screen test.

Focusing on gender unnecessarily narrows the scope of the test's potential findings.

Choice B rationale:

Incorrect. The quad screen test does not use fetal tissue. It is a non-invasive blood test that measures levels of four substances in the mother's blood: alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A.

Fetal tissue sampling is more invasive and carries risks, while the quad screen is a safer alternative.

Clarifying the non-invasive nature of the test is crucial for informed consent and patient understanding.

Choice C rationale:

Incorrect. While AFP levels can be affected by maternal liver function, that is not the primary focus of the quad screen test.

Liver function tests are specifically designed to assess liver health, and they are not part of the quad screen panel.

Distinguishing between liver function assessment and AFP's role in screening for fetal anomalies is essential for accurate interpretation.

Choice D rationale:

Correct. The quad screen test measures levels of AFP, hCG, uE3, and inhibin A in the mother's blood. These substances can provide information about the risk of certain fetal chromosomal abnormalities and neural tube defects.

Elevated AFP levels can indicate an increased risk for neural tube defects such as spina bifida or anencephaly.

Low AFP levels can be associated with Down syndrome or other chromosomal abnormalities.

Understanding the specific disorders that can be indicated by AFP levels is crucial for patient counseling and further testing decisions.