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
Hypoglycemia in a newborn, defined as a plasma glucose level typically below 40 to 50 mg/dL, starves the central nervous system of its primary energy source, glucose. This lack of fuel in the brain cells often presents with neurological symptoms. Jitteriness (or tremors) is a classic and early neurogenic sign of this metabolic disturbance, resulting from sympathetic nervous system activation.
Choice B rationale
Hypoglycemia typically results in an attempt by the body to conserve energy and may lead to poor peripheral perfusion and decreased metabolic rate, which often manifests as hypothermia (decreased temperature). Increased temperature (hyperthermia) is not a sign of hypoglycemia; instead, it is often associated with infection or environmental overheating.
Choice C rationale
Hypoglycemia causes central nervous system instability and depression, which generally results in a decrease in a newborn's reflexes and muscle tone (hypotonia), or can lead to lethargy and poor feeding. Therefore, brisk reflexes (hyperreflexia) are not a characteristic finding and would suggest other neurological or metabolic conditions.
Choice D rationale
The Moro reflex (or startle reflex) is a complex, primitive reflex that is present and intact in healthy newborns. While severe hypoglycemia can lead to generalized central nervous system depression, which could eventually suppress all reflexes, an absence of a Moro reflex is a more specific sign of a severe neurological injury or a congenital neurological disorder, not a typical early sign of hypoglycemia.
Correct Answer is D
Explanation
Choice A rationale
While the date of birth is essential information, asking a parent to state it only provides a detail from the medical record, which does not serve as a primary security confirmation of the newborn's identity for safe transport. The primary identification security relies on matching identifiers between the infant and the parent/guardian at the bedside.
Choice B rationale
The newborn's name is recorded in the medical record after birth, but verbal verification of the name alone is not a fail-safe security measure. Identification protocols require objective data comparison, such as unique numbers on corresponding identification bands, to prevent accidental mismatches and potential abduction.
Choice C rationale
The newborn's footprint sheet is typically used as a permanent record for identification purposes but is not the standard, immediate bedside method for confirming identity before transport. The process requires a direct comparison of unique numerical identifiers on the physical bands worn by the client and the newborn.
Choice D rationale
The most secure method is comparing the unique identification numbers (or codes) on the newborn's band with the band worn by the parent/guardian. This dual-band system, verified by the nurse and the parent, ensures positive identification and is a critical safety protocol to prevent misidentification and potential infant abductions.
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