A nurse is reinforcing teaching about laboratory testing with a client who is at 6 weeks of gestation.
Which of the following statements should the nurse include?
You will have a screening for gestational diabetes at 12 weeks of gestation.
You will have a group B strep culture at 36 weeks of gestation.
You will have to produce a clean catch urine specimen every 2 months.
You will have a maternal serum alpha-fetoprotein screening at 6 weeks of gestation.
The Correct Answer is B
Choice B rationale
A Group B Streptococcus (GBS) culture is routinely performed between 35 and 37 weeks of gestation. This is a screening test to determine if the client is colonized with the bacteria in the vagina or rectum. Positive status indicates the need for intrapartum antibiotic prophylaxis to prevent transmission of GBS to the newborn, which can cause severe neonatal infection.
Choice C rationale
A clean-catch urine specimen is typically collected at the initial prenatal visit to screen for asymptomatic bacteriuria, which can lead to pyelonephritis if untreated. It is not usually performed every two months. Subsequent urinalysis is often done with every prenatal visit to check for protein, glucose, and ketones, which indicate other potential complications.
Choice D rationale
The maternal serum alpha-fetoprotein (MSAFP) screening is a blood test to check for the risk of neural tube defects and chromosomal abnormalities. This test is typically offered between 15 and 20 weeks of gestation, with the optimal time being 16 to 18 weeks, not at 6 weeks. Fetal protein production is insufficient for reliable screening at 6 weeks.
Choice A rationale
A screening for gestational diabetes mellitus (GDM) is generally performed much later in pregnancy, specifically between 24 and 28 weeks of gestation. An earlier screening (e.g., at 12 weeks) is reserved only for clients identified as having significant risk factors (e.g., obesity, family history, previous GDM). The standard screening is the 1-hour glucose challenge test.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Transcutaneous electrical nerve stimulation (TENS) operates on the Gate Control Theory of Pain, where non-painful electrical stimuli are applied, attempting to block the transmission of pain signals. The intensity must be manually increased by the client during a contraction to override the escalating pain impulse and achieve maximum analgesic effect when the pain is most intense, providing the best pain modulation.
Choice B rationale
TENS is primarily used for the low back pain and abdominal pain experienced during the active phase of the first stage of labor (cervical dilation), providing a distraction and non-pharmacological pain relief option. It is less effective during the second stage (pushing) and is not typically indicated for the third stage of labor (placental expulsion), which has different pain mechanisms.
Choice C rationale
TENS works by stimulating large sensory nerve fibers to modulate or decrease the perception of pain (pain modulation), offering a sense of control and relief, but it does not eliminate the pain entirely, particularly the intense visceral pain of uterine contractions. It is a non-invasive pain coping mechanism, not an anesthetic agent that would abolish pain sensation.
Choice D rationale
Gestational diabetes mellitus (GDM) is a maternal metabolic condition and is not a contraindication for the use of TENS during labor. The primary contraindications for TENS include the use of a cardiac pacemaker, application over the heart or head, or in the presence of fetal electronic monitoring electrodes that could conduct the current, none of which are related to GDM.
Correct Answer is ["B","E"]
Explanation
Choice A rationale
The instruction to avoid urinating at bedtime is incorrect and potentially harmful. Urinary stasis (urine sitting in the bladder) is a major risk factor for bacterial growth and recurrence of a urinary tract infection (UTI). Complete and frequent bladder emptying, including right before bed, is essential to flush out potential pathogens and prevent the ascent of bacteria, thereby minimizing the opportunity for bacterial proliferation within the urinary tract.
Choice B rationale
Wearing cotton-crotch underwear is recommended because cotton is highly breathable and absorbent, promoting air circulation and minimizing moisture retention in the perineal area. A dry environment inhibits the growth of bacteria and yeast, which can ascend into the urethra, potentially leading to a recurrent urinary tract infection (UTI). Synthetic fabrics trap heat and moisture, creating a more favorable medium for pathogen proliferation.
Choice C rationale
The instruction to eliminate yogurt products from the diet is incorrect. Yogurt containing live and active cultures (probiotics, such as Lactobacillus) can actually be beneficial. These beneficial bacteria may help maintain the normal balance of flora, especially in the vagina and surrounding area, which can inhibit the overgrowth of pathogenic bacteria (E. coli) that commonly cause urinary tract infections.
Choice D rationale
Douching is generally discouraged as it can disrupt the normal vaginal flora (primarily Lactobacillus), altering the protective acidic pH (normal 3.5-4.5). This disruption can increase the risk of both vaginal infections and ascending infections that may lead to a recurrent urinary tract infection (UTI). The vagina is a self-cleaning organ, and douching can inadvertently push bacteria higher into the reproductive or urinary tracts.
Choice E rationale
Refraining from taking bubble baths is a correct instruction. Soaps, detergents, and chemicals in bubble baths can cause irritation to the urethral meatus and surrounding tissues. This irritation makes the area more susceptible to colonization by bacteria, such as those from the perianal region, which can then ascend the urethra and lead to the development or recurrence of a urinary tract infection (UTI).
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