A nurse is reinforcing teaching with a client who is at 23 weeks of gestation and will return to the facility the following week for an amniocentesis. Which of the following instructions should the nurse include?

Empty her bladder immediately prior to the procedure.

Refrain from eating breakfast on the day of the procedure.

Give herself a hypertonic enema the day before the procedure.

Wash her abdomen with soap and water the morning of the procedure.

Answer and Explanation

The Correct Answer is A

Choice A rationale: An amniocentesis involves inserting a needle through the abdominal wall into the amniotic sac to obtain a sample of amniotic fluid. Emptying the bladder before the procedure reduces the risk of bladder puncture during the process.
Choice B rationale: Fasting is not typically necessary for an amniocentesis. It is generally done on an outpatient basis, and fasting is not required.
Choice C rationale: An enema is not necessary before an amniocentesis and is not part of the standard preparation.
Choice D rationale: While cleanliness is important, this instruction is not specific to an amniocentesis and is not a standard pre-procedure requirement.

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Correct Answer is D

Explanation

Choice A rationale:
A protruding abdomen is not specifically associated with being small for gestational age and can have various other causes in newborns.
Choice B rationale:
A gray umbilical cord is not a typical finding associated with being small for gestational age. Choice C rationale:
Moist skin is not a specific finding associated with being small for gestational age and can be observed in all newborns.
Choice D rationale:
Wide skull sutures are associated with being small for gestational age, as the skull bones may not fully close due to restricted growth in the womb.

A. "This test determines if kernicterus will occur in the newborn." B. "This test detects Rh-positive antibodies in the mother's blood." C. "This test detects Rh-negative antibodies in a newborn who is Rh-positive." D. "This test determines the presence of maternal antibodies in the newborn's blood."

Correct Answer is C

Explanation

Choice A rationale: Kernicterus is a severe form of jaundice that can result from untreated hyperbilirubinemia in a newborn. The indirect Coombs test does not assess the risk of kernicterus specifically.
Choice B rationale: The indirect Coombs test detects Rh-negative antibodies in the mother's blood, not Rh-positive antibodies.
Choice C rationale: The indirect Coombs test, also known as the indirect antiglobulin test (IAT), is performed on a pregnant woman to detect the presence of Rh-negative antibodies in her blood. If the mother is Rh-negative and has been sensitized to Rh-positive blood, these antibodies can cross the placenta and attack the red blood cells of an Rh-positive fetus, potentially causing hemolytic disease of the newborn (HDN) or erythroblastosis fetalis.
Choice D rationale: The direct Coombs test (direct antiglobulin test) is used to detect the presence of maternal antibodies that have already been attached to the newborn's red blood cells. The indirect Coombs test is used to identify the presence of these antibodies in the mother's blood before they have attached to the newborn's red blood cells.

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A nurse is reinforcing teaching with a client who is at 23 weeks of gestation and will return to the facility the following week for an amniocentesis. Which of the following instructions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a newborn who is small for gestational age. Which of the following findings is associated with this condition?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with a newly licensed nurse about the purpose of an indirect Coombs test. Which of the following statements should the nurse include in the teaching?

Correct Answer is C

Explanation

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