A nurse is reviewing standard precautions with an assistive personnel (AP) who is new to the newborn nursery. For which of the following newborn care procedures should the nurse remind the AP to wear clean gloves?

A. Negative urine ketones: Diabetic ketoacidosis (DKA) is characterized by increased production of ketone bodies due to insulin deficiency and enhanced lipolysis. Ketones accumulate in the blood and spill into the urine, producing positive urine ketone results. The absence of urine ketones does not support the presence of ketoacidosis, as ketosis is a defining metabolic feature.

B. Kussmaul respirations: Kussmaul respirations are deep, rapid breathing patterns that occur as a compensatory response to metabolic acidosis. In DKA, excess ketone production leads to accumulation of hydrogen ions and decreased serum bicarbonate. The respiratory system compensates by increasing ventilation to eliminate carbon dioxide.

C. Hypoglycemia: DKA is associated with hyperglycemia due to insufficient insulin, which prevents glucose from entering cells and leads to elevated serum glucose levels. Hypoglycemia involves low blood glucose and does not trigger the ketone overproduction seen in DKA. The pathophysiology of DKA centers on insulin deficiency and high circulating glucose.

D. Hypertension: Clients with DKA often experience osmotic diuresis from severe hyperglycemia, leading to dehydration and volume depletion. This intravascular fluid loss more commonly results in hypotension rather than elevated blood pressure. The hemodynamic changes in DKA are primarily related to dehydration and electrolyte imbalance.

A. Assist the client with positioning for an ultrasound: Positioning for ultrasound is part of the preparation for amniocentesis, not a post-procedure intervention. After the procedure, the priority is monitoring the client for complications rather than repeating imaging unless clinically indicated.

B. Monitor the client for placental abruption: Amniocentesis carries a small risk of complications such as bleeding, cramping, or placental injury. Monitoring the client for signs of placental abruption, including vaginal bleeding, abdominal pain, and uterine tenderness, is an appropriate post-procedure action to ensure early detection and intervention.

C. Administer Rh.D immune globulin to the client: Administration of Rh.D immune globulin is indicated for Rh-negative clients to prevent isoimmunization. Since this client is Rh-positive, they do not require Rh immunoglobulin, so this action is not necessary.

D. Obtain an umbilical blood sample from the fetus: Umbilical blood sampling (cordocentesis) is a separate diagnostic procedure and is not part of routine amniocentesis. Post-procedure care focuses on maternal monitoring and fetal well-being rather than obtaining fetal blood immediately.