Question 71.
A nurse is caring for a client who has gestational diabetes and is scheduled for an amniocentesis at 37 weeks of gestation due to suspected fetal compromise.
What is the nurse’s best response to the client’s question as to why the amniocentesis test is being done?.
“To determine fetal lung maturity.”.
“To assess the degree of fetal renal function.”.
“To test the amniotic fluid glucose level.”.
“To detect the presence of fetal congenital anomalies.”.
The Correct Answer is A
The correct answer is choice A. “To determine fetal lung maturity.” An amniocentesis at 37 weeks of gestation can be done to measure the lecithin/sphingomyelin (L/S) ratio in the amniotic fluid, which indicates the level of surfactant production and the readiness of the fetal lungs for breathing. A low L/S ratio can indicate fetal compromise due to gestational diabetes.
Choice B is wrong because fetal renal function is not assessed by amniocentesis, but by ultrasound or biophysical profile.
Choice C is wrong because amniotic fluid glucose level is not a reliable indicator of fetal well-being or gestational diabetes control.
Choice D is wrong because congenital anomalies are usually detected earlier in pregnancy by ultrasound, maternal serum screening, or chorionic villus sampling.
Normal ranges for L/S ratio are 2:1 or higher for term fetuses and 1.5:1 or higher for preterm fetuses.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Braxton Hicks contractions are irregular, painless uterine contractions that occur throughout pregnancy, but are more noticeable in the third trimester.They do not indicate labor, but rather help in softening and ripening the cervix.
Choice A is wrong because the patient does not need to time the contractions unless they become regular, painful, and closer together, which are signs of true labor.
Choice B is wrong because documenting fetal activity daily is not related to Braxton Hicks contractions.Fetal activity is monitored to assess fetal well-being and detect any signs of fetal distress.
Choice C is wrong because losing the mucus plug is also not related to Braxton Hicks contractions.The mucus plug is a thick plug of mucus that seals the cervical canal during pregnancy and may be expelled before or during labor.
Correct Answer is B
Explanation
The correct answer is choice B. Dry off the newborn.This is the priority nursing action because it prevents heat loss and hypothermia in the newborn.
The newborn has a large surface area and a thin layer of subcutaneous fat, making it vulnerable to cold stress.Drying off the newborn also stimulates breathing and crying, which helps clear the airways.
Choice A is wrong because obtaining a serum sample is not a priority action and may cause unnecessary pain and bleeding in the newborn.
Choice C is wrong because assessing the newborn’s Moro reflex is not a priority action and may be done later during the physical examination.Choice D is wrong because obtaining the newborn’s footprints is not a priority action and may be done after the bonding and breastfeeding period.
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