A nurse is caring for a client who has hyperemesis gravidarum.
Which of the following laboratory tests should the nurse anticipate?

Choice A rationale

Positioning the newborn supine on a radiant warmer is appropriate for maintaining thermoregulation. However, applying only a sterile gauze dressing to a large abdominal wall defect that is not covered by a membrane does not adequately protect the exposed organs from contamination, drying, or injury. This increases the risk of infection and fluid loss.

Choice B rationale

Placing the newborn into a sterile bowel bag up to the axilla is the recommended immediate action for an abdominal wall defect such as gastroschisis (protrusion without a membrane). The sterile bag helps to maintain a moist environment, prevent heat and fluid loss, and protect the exposed organs from trauma and contamination until surgical repair can be performed.

Choice C rationale

While breastfeeding promotes bonding and provides essential nutrients, it is not the priority action for a newborn with a large, uncovered abdominal wall defect immediately after birth. The immediate focus should be on protecting the exposed organs and stabilizing the newborn. Breastfeeding can be initiated once the newborn is stable and the abdominal defect is appropriately managed.

Choice D rationale

Providing intermittent suction via an orogastric tube may be necessary later to decompress the gastrointestinal system, but it is not the immediate priority for a newborn with a large, uncovered abdominal wall defect. The initial action should focus on protecting the exposed organs.

Choice A rationale

Monitoring uterine contractions is important during labor, but in the context of late pregnancy bleeding, the immediate priority is to assess the well-being of both the mother and the fetus. Contractions may or may not be present at this stage.

Choice B rationale

Placing clean disposable pads is a reasonable action to manage bleeding and assess its characteristics. However, it does not address the immediate need to evaluate the maternal and fetal status, which is critical in a bleeding episode during late pregnancy.

Choice C rationale

Assessing fetal heart rate (FHR) is crucial to determine fetal well-being in the presence of bleeding. Maternal vital signs (blood pressure, heart rate, respiration) are equally important to evaluate the mother's hemodynamic stability. Bleeding in late pregnancy can compromise both maternal and fetal oxygenation and perfusion, making this assessment the highest priority. Normal maternal heart rate is typically 60-100 beats per minute, and normal maternal blood pressure is typically 90/60 mmHg to 120/80 mmHg. The normal fetal heart rate range is 110-160 beats per minute.

Choice D rationale

Performing a venipuncture for hemoglobin and hematocrit levels will provide information about the extent of blood loss and the mother's oxygen-carrying capacity. While this is an important assessment, it is not the immediate priority compared to evaluating the fetal heart rate and maternal vital signs, which provide real-time information about their current status. Normal hemoglobin for pregnant women typically ranges from 10.5 to 14 g/dL in the first and third trimesters and slightly lower in the second trimester due to hemodilution. Normal hematocrit for pregnant women typically ranges from 32% to 42%.