A client at 20 weeks gestation reports discomfort after amniocentesis procedure to the nurse. Which of the following assessment findings warrants priority action by the nurse?
Braxton Hicks contraction
Amniotic fluid contains fetal urine
Prolonged vaginal bleeding
Lab results reveal abnormal chromosome cells
The Correct Answer is C
Explanation:
A. Braxton Hicks contraction
Braxton Hicks contractions are often referred to as "practice" contractions and are common during pregnancy. They are typically irregular and do not cause cervical changes. While discomfort after an amniocentesis procedure can sometimes trigger Braxton Hicks contractions, they are not usually a cause for immediate concern unless they become frequent, intense, or are accompanied by other signs of preterm labor, such as regular contractions, lower back pain, pelvic pressure, or changes in vaginal discharge.
B. Amniotic fluid contains fetal urine
The presence of fetal urine in the amniotic fluid is a normal and expected process during pregnancy. Fetal urine production contributes to the volume and composition of amniotic fluid, helping maintain the environment in the uterus and supporting fetal development. This finding is not directly related to the client's discomfort after an amniocentesis procedure and is not a cause for immediate concern unless there are other complications or abnormalities related to the amniotic fluid composition.
C. Prolonged vaginal bleeding
Prolonged vaginal bleeding after an amniocentesis procedure is a significant finding that requires immediate attention. While some spotting or mild bleeding can occur after the procedure, prolonged or significant bleeding may indicate complications such as uterine injury, placental abruption, or other issues that need urgent assessment and intervention by healthcare providers.
D. Lab results reveal abnormal chromosome cells
Abnormal chromosome cells found in the amniotic fluid sample obtained during amniocentesis may indicate genetic abnormalities or conditions in the fetus. While this finding is significant and requires follow-up and further evaluation, it is not an immediate concern in terms of the client's discomfort or the need for priority action by the nurse unless it is associated with other urgent clinical signs or symptoms.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Explanation:
A. Acarbose:
Acarbose is an oral antidiabetic medication that works by slowing down the digestion and absorption of carbohydrates in the intestines. It is typically used in the management of type 2 diabetes but is not commonly prescribed for gestational diabetes mellitus (GDM). Acarbose is not usually recommended during pregnancy, especially since there are other safer options available for managing GDM.
B. Repaglinide:
Repaglinide is another oral antidiabetic medication that stimulates insulin release from the pancreas. While it is effective in lowering blood sugar levels, it is not commonly used as a first-line treatment for gestational diabetes. Repaglinide may have a more rapid onset of action compared to other oral antidiabetic drugs, but its use during pregnancy is not as common as other medications like glyburide or insulin.
C. Glipizide:
Glipizide is an oral sulfonylurea medication used primarily in the management of type 2 diabetes. It stimulates insulin secretion from the pancreas. However, like other sulfonylureas, glipizide is not typically recommended for use during pregnancy due to safety concerns for the developing fetus. It may also have a higher risk of hypoglycemia compared to other options.
D. Glyburide:
Glyburide is an oral sulfonylurea medication that helps lower blood sugar levels by stimulating insulin release from the pancreas. It is one of the commonly used medications for managing gestational diabetes when diet and exercise alone are not sufficient. Glyburide is generally considered safe for use during pregnancy, especially after the first trimester, and it has been found to effectively control blood glucose levels in many pregnant individuals with GDM.
Correct Answer is C
Explanation
Explanation:
A. Pattern of contractions: While the pattern of contractions is important in assessing labor progress, it alone may not differentiate between true labor and false labor (also known as Braxton Hicks contractions). True labor contractions typically become longer, stronger, and more frequent over time, but other factors must also be considered to confirm true labor.
B. Rupture of the membranes: Rupture of the membranes (water breaking) can occur during both true labor and false labor. However, it is not a definitive sign of true labor on its own, as it can also happen spontaneously or due to other reasons.
C. Changes in the cervix: This is the correct answer. True labor is characterized by progressive changes in the cervix, including effacement (thinning) and dilation (opening). These changes can be confirmed through a cervical examination performed by a healthcare provider.
D. Station of the presenting part: The station of the presenting part refers to the position of the baby's head in relation to the mother's pelvis. While the station can provide information about the progress of labor, it is not a specific sign of true labor by itself.
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