A nurse is reinforcing teaching with a client who is at 36 weeks of gestation and is about to undergo an amniocentesis.
Which of the following information should the nurse include in the instructions?
"I will need to give you Rh(D) immune globulin because you are Rh positive.”
"You will need to have an empty bladder for the test.”
"You will have to lie on your left side during the test.”
"You will have to drink 50 grams of oral glucose before the test.”
The Correct Answer is B
Choice A rationale:
The administration of Rh(D) immune globulin (RhoGAM) is typically indicated for Rh-negative mothers who are carrying Rh-positive fetuses to prevent sensitization to Rh antigens. It is not directly related to the amniocentesis procedure. Therefore, this information is not necessary for the client undergoing an amniocentesis.
Choice B rationale:
This is the correct answer. Having an empty bladder is crucial during an amniocentesis procedure because a full bladder can obscure visualization of the fetus and the needle placement. It is essential for a successful and safe procedure. The nurse should instruct the client to empty their bladder before the test.
Choice C rationale:
The position during an amniocentesis is typically dorsal recumbent or semi-Fowler's position to allow for proper visualization of the fetus and needle placement. Lying on the left side is not a standard position for this procedure, so this information is incorrect and not necessary for the client.
Choice D rationale:
Drinking 50 grams of oral glucose is not a requirement for an amniocentesis procedure. This information is unrelated to the amniocentesis and can be confusing for the client. Therefore, it is not necessary to include this in the instructions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Using iodine to disinfect cuts on the feet is not recommended for individuals with diabetes. Iodine can be harsh and may delay wound healing. It's better to clean cuts with mild soap and water and consult a healthcare professional for proper wound care.
Choice B rationale:
Wearing a clean pair of cotton socks each day is an excellent practice for someone with diabetes. Cotton socks can help absorb moisture and reduce the risk of fungal infections and pressure sores.
Choice C rationale:
Soaking feet in warm water every morning is not recommended for individuals with diabetes, as it can lead to skin drying and cracking. It's better to soak feet in lukewarm water occasionally, not daily, and to moisturize afterward.
Choice D rationale:
Attempting to remove ingrown toenails at home is not advisable for individuals with diabetes, as it can lead to infection and complications. Clients with diabetes should seek professional foot care for any foot issues, including ingrown toenails.
Correct Answer is C
Explanation
Choice A rationale:
Tilt your head forward while inhaling is not an appropriate instruction for using an albuterol metered-dose inhaler (MDI) In fact, it is recommended to keep the head in a neutral position while using an MDI to ensure proper delivery of the medication to the lungs. Tilted head positions can lead to ineffective inhalation and may result in the medication being deposited in the mouth or throat rather than reaching the lungs. Therefore, choice A is not the correct answer.
Choice B rationale:
Exhale immediately after inhaling is not an accurate instruction for using an albuterol MDI. The correct sequence is to inhale slowly and deeply through the mouth while pressing down on the canister to release the medication, hold the breath for a few seconds (usually 10 seconds), and then exhale slowly. Exhaling immediately after inhaling would not allow the medication to reach the lower airways effectively. Therefore, choice B is not the correct answer.
Choice C rationale:
"Close your mouth around the mouthpiece" is an essential instruction for using an albuterol MDI correctly. It ensures that the medication
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