A nurse is collecting data from a newborn who has an infection of Candida albicans.
Which of the following findings should the nurse expect?

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.

✅ Anticipated Interventions – Rationales

• Encourage frequent ambulation Ambulation can promote labor progression in clients with stable vital signs, reassuring fetal status, and no contraindications such as active bleeding or abnormal fetal presentation.
• Check client’s temperature every hour After rupture of membranes, the risk of ascending infection increases. Hourly temperature monitoring helps detect early signs of chorioamnionitis.
• Obtain CBC blood sample A baseline complete blood count is useful to assess for infection (e.g., elevated white blood cells) or anemia, especially in the setting of ruptured membranes.
• Check FHR every 30 min Intermittent fetal heart rate monitoring is appropriate in early labor for low-risk clients. It ensures fetal well-being and detects early signs of distress.

⚪ Nonessential Interventions – Rationales

• Prepare the client for catheterization The client is able to void independently (50 mL at 0830), so catheterization is not currently necessary unless urinary retention develops or continuous bladder monitoring is required later.
• Perform a Nitrazine test This test has already been performed and confirmed rupture of membranes. Repeating it is not essential unless there is uncertainty or new symptoms arise.

❌ Contraindicated Intervention – Rationale

• Ensure the client maintains a supine position while in bed Supine positioning can compress the inferior vena cava, reducing placental perfusion and causing maternal hypotension. Left lateral or upright positions are preferred to optimize uteroplacental blood flow.

? Take-home points

• Rupture of membranes increases the risk of infection, making temperature monitoring and fetal surveillance critical.
• Supine positioning should be avoided in labor due to the risk of supine hypotensive syndrome and compromised fetal oxygenation.
• Ambulation is beneficial in early labor unless contraindicated by maternal or fetal conditions.
• Nitrazine testing is a one-time diagnostic tool for confirming membrane rupture and should not be repeated unnecessarily.