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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A rationale

Weighing a newborn's wet diaper is an essential component of monitoring fluid balance and renal function, which is critical as neonatal abstinence syndrome (NAS) infants may have diarrhea leading to fluid loss. However, it is not the first priority action. NAS symptoms, caused by central nervous system hyperexcitability, necessitate stabilization of vital functions, with respiratory status being paramount. Normal urine output for a newborn is typically 1-3 mL/kg/hr.

Choice B rationale

Swaddling provides non-pharmacological comfort by simulating the confined uterine environment, reducing excessive stimulation, and minimizing the hyperirritability and tremors associated with central nervous system dysfunction in neonatal abstinence syndrome. While a beneficial and frequent intervention, stabilizing the newborn's physiological status, specifically respiratory effort and rate, must be assessed and secured as the immediate priority due to potential for respiratory distress.

Choice C rationale

Determining the newborn's respiratory rate is the highest priority because respiratory depression and distress are critical potential complications in a newborn experiencing neonatal abstinence syndrome, often associated with poly-drug exposure or direct effects of opioids. NAS can lead to hyperthermia and increased metabolic demand, escalating oxygen consumption. A normal newborn respiratory rate is typically 30 to 60 breaths per minute; deviations require immediate intervention.

Choice D rationale

Auscultating the newborn's bowel sounds assesses gastrointestinal motility, which can be affected by the hyper-excitability seen in NAS, potentially leading to diarrhea, poor feeding, and fluid-electrolyte imbalances. However, this assessment is secondary to ensuring adequate oxygenation and ventilation, which is always the initial and most crucial step in the hierarchy of needs for any compromised neonate experiencing withdrawal symptoms.

A. Instruct the client to move their car seat forward, close to the steering wheel. B. Advise the client to wear the shoulder harness snug across their stomach. C. Direct the client to position the lap belt across their navel. D. Encourage the client to take a break and walk at least once every hour during long trips.

Correct Answer is D

Explanation

Choice A rationale

. Instructing a pregnant client to move their car seat close to the steering wheel is unsafe. The steering wheel poses a significant trauma risk to the abdomen and uterus, especially in the event of airbag deployment or a collision. The ideal distance is at least 10 inches between the chest and the steering wheel to prevent blunt abdominal trauma and protect the fetus.

Choice B rationale

. Advising the client to wear the shoulder harness snug across their stomach is incorrect and potentially dangerous. The shoulder harness must be positioned above the pregnant abdomen, across the middle of the chest and between the breasts, to distribute crash forces across the bony structures (clavicle and sternum) and away from the fetus and the uterus.

Choice C rationale

. Directing the client to position the lap belt across their navel is incorrect and must be avoided. The lap belt should be worn snugly and low, under the pregnant abdomen, across the bony pelvis (hips and pubic bone), not the soft tissue of the abdomen. This prevents the forces of a collision from being directed toward the uterus and fetus.

Choice D rationale

. Encouraging frequent breaks and walking is crucial during long car trips to promote venous return and prevent venous stasis. The gravid uterus compresses the inferior vena cava, impairing blood flow from the lower extremities, which increases the risk of developing a deep vein thrombosis (DVT), a life-threatening complication, making this an essential safety instruction.

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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?

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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?