A nurse is caring for a client in an antepartum clinic following a maternal serum alpha-fetoprotein screening.
The nurse should recognize that an elevated alpha-fetoprotein level is suggestive of which of the following?
Neural tube defects.
Phenylketonuria.
Trisomy 21.
Hemophilia.
The Correct Answer is A
Choice A rationale
An elevated maternal serum alpha-fetoprotein (MSAFP) level is a significant biomarker that can suggest an increased risk of open neural tube defects (NTDs), such as spina bifida or anencephaly. Alpha-fetoprotein is a protein produced by the fetal liver and yolk sac; in cases of open NTDs, larger amounts leak into the amniotic fluid and subsequently cross into the maternal bloodstream, resulting in higher MSAFP levels. Further diagnostic tests like ultrasound or amniocentesis are typically recommended to confirm the diagnosis.
Choice B rationale
Phenylketonuria (PKU) is an inherited metabolic disorder characterized by the inability to metabolize the amino acid phenylalanine. This condition is diagnosed through newborn screening tests that measure phenylalanine levels in the blood, not by maternal serum alpha-fetoprotein screening. MSAFP is not a marker for metabolic disorders like PKU, as it is primarily indicative of fetal structural anomalies, particularly neural tube defects.
Choice C rationale
Trisomy 21, also known as Down syndrome, is a chromosomal disorder caused by the presence of an extra copy of chromosome 21. While MSAFP is part of the "triple screen" or "quad screen" used for aneuploidy screening, an elevated MSAFP level alone is typically associated with neural tube defects. In cases of Trisomy 21, MSAFP levels are usually *lower* than normal, in conjunction with altered levels of other markers like human chorionic gonadotropin (hCG) and unconjugated estriol.
Choice D rationale
Hemophilia is a genetic bleeding disorder caused by a deficiency in specific clotting factors, primarily factors VIII or IX. This condition is inherited in an X-linked recessive pattern and is diagnosed through specialized blood tests that measure clotting factor activity. Maternal serum alpha-fetoprotein screening is not used to detect hemophilia, as it is a marker for fetal structural integrity, particularly concerning neural tube and abdominal wall defects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.5"]
Explanation
Calculation
400 mg ÷ 800 mg = 0.5 tablets.
The nurse should administer 0.5 tablets with each dose.
Correct Answer is C
Explanation
Choice A rationale
Hyperglycemia in gestational diabetes typically leads to increased urination, or polyuria, not decreased urination. Elevated blood glucose levels overwhelm the renal tubules' reabsorption capacity, leading to glucose spilling into the urine, which then draws water osmotically, increasing urine output.
Choice B rationale
Shallow respirations are not a direct manifestation of hyperglycemia in this context. While severe diabetic ketoacidosis (DKA), a complication of uncontrolled diabetes, can lead to Kussmaul respirations (deep, rapid breathing) due to metabolic acidosis, hyperglycemia alone typically does not cause shallow respirations.
Choice C rationale
Thirst, or polydipsia, is a classic manifestation of hyperglycemia. High blood glucose levels increase the osmolality of the blood, stimulating osmoreceptors in the hypothalamus, which then trigger the sensation of thirst as the body attempts to dilute the excess glucose and restore fluid balance.
Choice D rationale
While hunger (polyphagia) is a common symptom in uncontrolled type 1 diabetes due to cellular inability to utilize glucose, in gestational diabetes with hyperglycemia, hunger is not a predominant or consistent symptom. The body typically has sufficient insulin, but there is insulin resistance or insufficient production.
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