A nurse is reinforcing teaching with a 36-year-old client who is at 16 weeks of gestation and is scheduled for an amniocentesis. The nurse should include in the teaching that an amniocentesis is performed to identify which of the following findings?
Chromosomal abnormalities
Placental circulation
Rh incompatibility
Fetal breathing movements
The Correct Answer is A
Rationale:
A. Chromosomal abnormalities: Amniocentesis involves analyzing amniotic fluid to detect genetic and chromosomal disorders such as Down syndrome, trisomy 18, and neural tube defects. It is typically performed between 15 and 20 weeks gestation for diagnostic accuracy during this stage of fetal development.
B. Placental circulation: Assessment of placental blood flow and circulation is usually done via Doppler ultrasound, not amniocentesis. Amniocentesis does not evaluate the vascular function or perfusion status of the placenta.
C. Rh incompatibility: While amniocentesis may reveal fetal anemia due to Rh sensitization in rare cases, it is not the primary test used for diagnosing Rh incompatibility. Blood antibody screening and Doppler assessment of the middle cerebral artery are preferred for Rh-related concerns.
D. Fetal breathing movements: Fetal breathing is assessed through a biophysical profile or real-time ultrasound, not via amniotic fluid sampling. Amniocentesis does not provide information about the fetus’s respiratory activity or movement patterns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. "I should use a firm mattress in my baby's crib.": A firm mattress reduces the risk of sudden infant death syndrome (SIDS) and suffocation by providing a stable, flat surface for safe infant sleep. This is a key recommendation in safe sleep guidelines.
B. "I should set my hot water heater at 130 degrees Fahrenheit.": Setting the water heater at 130°F increases the risk of scald burns, especially for infants and young children. The recommended temperature to prevent burns is 120°F or lower.
C. “I should use a crib with side rails that drop": Drop-side cribs have been banned due to safety concerns, including risk of entrapment and suffocation. Using a crib with fixed side rails is safer and recommended.
D. "I should position my baby on their stomach to sleep during the day.": Placing infants on their stomach to sleep increases the risk of SIDS. The safest position for sleep is on the back, both during the day and night.
Correct Answer is ["C","D","E"]
Explanation
Rationale:
A. Reinforce client teaching about walking with crutches: Teaching or reinforcing client education is a nursing responsibility and should not be delegated to assistive personnel. It requires assessment, evaluation, and knowledge of the client's learning needs and physical limitations.
B. Plan care for a client who has dysphagia: Care planning involves critical thinking and individualized assessment, which fall under the registered nurse’s scope of practice. Dysphagia management also requires knowledge of aspiration risk and appropriate interventions.
C. Transfer a client who is receiving radiation therapy to radiology: Transferring stable clients to departments such as radiology is within the scope of assistive personnel, as long as the client does not require specialized monitoring or assessment during the transfer.
D. Record urine output for a client who has a suprapubic catheter: Measuring and documenting urinary output is a routine task that assistive personnel can perform. The catheter type does not affect the ability to carry out this basic observation.
E. Measure vital signs for a client who requires contact precautions: Assistive personnel are trained to take vital signs and follow isolation protocols. Measuring vital signs under contact precautions is appropriate as long as proper PPE and hygiene practices are followed.
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