Family History: breast cancer, heart disease. Allergy: Penicillin.
Multiple sexual partners.
A nurse in a prenatal clinic is reviewing the laboratory results for a client who is at 12 weeks of gestation.
Which of the following actions should the nurse take?
Administer rubella vaccine.
Administer ceftriaxone IM.
Obtain a blood culture.
Obtain a maternal serum alpha-fetoprotein specimen.
The Correct Answer is D
The nurse should obtain a maternal serum alpha-fetoprotein (MSAFP) specimen for a client at 12 weeks of gestation.
MSAFP is a screening tool used to identify fetal neural tube defects (NTDs) such as spina bifida and anencephaly.
Elevated levels of MSAFP indicate an increased risk for NTDs, while low levels indicate an increased risk for chromosomal abnormalities such as Down syndrome.
Administering rubella vaccine (A) is contraindicated during pregnancy as it is a live vaccine and can cause fetal harm.
Administering ceftriaxone IM (B) and obtaining a blood culture (C) are not indicated based on the information provided about the client.
The client's allergy to penicillin is not relevant to the nurse's immediate action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Do not retract the foreskin to clean your baby’s penis during each diaper change.
The foreskin should not be retracted for cleaning during infancy.
Choice A is incorrect because you should clean around the umbilical cord stump with plain water and blot dry until it falls off naturally.
Choice B is incorrect because swaddling a baby tightly with their legs extended is not recommended.
Choice C is incorrect because a newborn should urinate at least six times a day.
Correct Answer is A
Explanation
“I should increase my calcium intake while taking this medication.” A client who is receiving medroxyprogesterone IM for contraception should increase their calcium intake while taking this medication .
Medroxyprogesterone can cause loss of bone mineral density which can increase the risk of osteoporosis. Increasing calcium intake can help maintain bone health.
Choice B, “I should discontinue this medication if I experience spotting,” is not an answer because spotting is a common side effect of medroxyprogesterone and does not require discontinuation of the medication.
Choice C, “I will need to return to the clinic in 8 weeks for my next injection,” is not an answer because medroxyprogesterone IM is given every 3 months, not every 8 weeks.
Choice D, “I will get two shots each time I receive this medication,” is not an answer because only one injection is given at a time.
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