care for a pregnant woman who has a decreased MSAFP (maternal serum alpha-fetoprotein), an increase in hCG (human chorionic gonadotropin), and a decreased Estriol level

Which of these strategies would nurse Paul include when planning care for a pregnant woman who has a decreased MSAFP (maternal serum alpha-fetoprotein), an increase in hCG (human chorionic gonadotropin), and a decreased Estriol level?
a. Refer to the physician
b. Tell the woman to increase her folic acid intake
c. Refer for amniocentesis
d. Order a plasma glucose level

Answer A. The combination of results presented in this situation may be the result of a fetus with Down syndrome.
A neural tube defect can be detected with MSAFP but once the defect has occurred an increase in folic acid will not change it.
Taking folic acid before becoming pregnant and continuing through the pregnancy can be beneficial to prevent neural tube defects.
The physician needs to be notified of the results and the nurse could anticipate referral for an amniocentesis.

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