護理師正在教導一位懷孕 20 週的孕婦關於母體變化與胎兒發育。護理師應針對此階段討論哪些里程碑或變化？（選所有適合的）
A nurse is teaching a pregnant client about maternal changes and fetal development. The client is at 20 weeks gestation. Which milestones or changes should the nurse discuss for this stage? (Select all that apply.)
- AThe fundus of the uterus should be at the level of the umbilicus✓ 正解子宮底應位於肚臍水平
- BFetal heart tones can first be heard with a Doppler可首次使用多普勒聽診器聽到胎心音
- CThe mother may begin to feel fetal movement (quickening)✓ 正解母親可能開始感覺到胎動（初覺胎動）
- DFetal sex can often be determined via ultrasound✓ 正解常可透過超音波確定胎兒性別
- EThe fetus begins to produce surfactant in the lungs胎兒開始在肺部產生表面活性物質
懷孕 20 週是妊娠期的中點，也是健康促進評估的重要節點。核心概念包括母體解剖位置與胎兒發育。選項 A：20 週時，子宮底（Fundus）通常剛好到達肚臍高度，這是監測胎兒生長的簡易指標。選項 C：「胎動初感」（Quickening）通常出現在 18-20 週（初產婦），這是建立母嬰連結與確認胎兒活力的重要時刻。選項 D：20 週的大型超音波（Level II）通常能清楚辨識胎兒性別及器官構造。至於選項 B，都卜勒（Doppler）早在 10-12 週就能聽到心音，20 週才講太晚。選項 E：肺泡界面活性劑（Surfactant）通常要到 24 週才開始產生。臨床思路上，護理師應利用這些里程碑協助產婦減少焦慮，並透過測量宮底高度來確認發育是否符合週數。
At 20 weeks of pregnancy, the midpoint of gestation, this is an important checkpoint for health promotion assessment. Core concepts include maternal anatomical changes and fetal development. Option A: At 20 weeks, the fundus of the uterus typically reaches the level of the umbilicus, which is a simple indicator for monitoring fetal growth. Option C: 'Quickening' (the first sensation of fetal movement) usually occurs around 18–20 weeks in first-time mothers, and is an important time for establishing maternal-fetal bonding and confirming fetal vitality. Option D: A level II detailed ultrasound at 20 weeks can usually clearly identify fetal sex and organ structures. Regarding option B, fetal heart tones can be heard via Doppler as early as 10–12 weeks, so saying they 'can first be heard' at 20 weeks is too late. Option E: Pulmonary surfactant typically begins to be produced around 24 weeks. Clinically, the nurse should use these milestones to help reduce maternal anxiety and confirm that development matches gestational age through fundal height measurement.
美國護理實務中，助產師或護理師常獨立執行宮底高度測量與衛教。台灣多由醫師在診間進行超音波與測量，護理師則負責診後的營養與衛教。對於 20 週的「高層次超音波」，兩地皆視為排畸篩檢的關鍵時期。