A client with multiple sclerosis asks the nurse how to avoid exacerbation of the disease.
What statement is the most appropriate response by the nurse?

Choice A rationale

Administering oxygen is an important intervention during the postictal phase to ensure maternal and fetal oxygenation, but it cannot be performed effectively during the height of a generalized tonic-clonic seizure. The nurse must first ensure the patient is not alone and that additional medical assistance is on the way. Once the airway is protected and the seizure subsides, oxygen via a non-rebreather mask at 8 to 10 L/min is appropriate to correct any hypoxia.

Choice B rationale

Suctioning the mouth during an active seizure is contraindicated because it can cause oral trauma or stimulate the gag reflex, potentially leading to vomiting and aspiration. Suctioning equipment should be prepared and used immediately after the seizure ends to clear secretions or vomitus from the oropharynx. During the seizure, the nurse should turn the client to their side if possible to allow secretions to drain naturally from the mouth and maintain a patent airway.

Choice C rationale

Safety is the absolute priority during an eclamptic seizure. The nurse must remain with the client to prevent injury, such as falling out of bed, and must call for help to mobilize the rapid response team and obtain emergency medications like magnesium sulfate. The nurse should observe the seizure characteristics and timing while ensuring the environment is safe. Leaving the patient alone during a seizure increases the risk of airway obstruction, trauma, and unobserved status epilepticus.

Choice D rationale

Inserting an oral airway or any object into the mouth during an active seizure is strictly prohibited. It can lead to broken teeth, jaw injury, or complete airway obstruction if the object is pushed back into the throat. The masseter muscles are often tightly clenched during the tonic phase of a seizure. The nurse should never force anything between the teeth. Airway management focuses on positioning and postictal suctioning rather than mechanical insertion during the convulsive episode.

Choice A rationale

Ultrasound is a vital component of chorionic villus sampling (CVS) to provide real-time visualization of the placenta and the needle or catheter placement. This ensures that the clinician can safely obtain a sample of the chorionic villi without injuring the fetus or the mother. The use of ultrasound reduces the risk of procedural complications such as hemorrhage or accidental pregnancy loss. Seeing the fetus during the procedure also allows for the assessment of fetal heart tones.

Choice B rationale

This statement is incorrect because chorionic villus sampling is typically performed between 10 and 13 weeks of gestation. Performing the procedure at 18 to 20 weeks would be inappropriate, as amniocentesis is the standard diagnostic tool used during the second trimester. CVS is specifically designed for early first-trimester genetic screening. Performing CVS too early (before 10 weeks) is associated with limb reduction defects, while performing it too late loses the benefit of early diagnosis and decision-making for the parents.

Choice C rationale

This statement is incorrect because CVS involves the removal of a small piece of placental tissue (chorionic villi) rather than amniotic fluid. Amniotic fluid is obtained during an amniocentesis. While both tests provide genetic information, CVS does not evaluate for neural tube defects because it does not measure alpha-fetoprotein levels found in the amniotic fluid. The client must understand that the tissue sample is what will be analyzed for chromosomal abnormalities like Down syndrome or other genetic conditions.

Choice D rationale

Rho(D) immune globulin (RhoGAM) is required for Rh-negative clients undergoing CVS because the procedure carries a risk of fetomaternal hemorrhage. If fetal blood cells enter the maternal circulation, the mother could develop antibodies against the Rh factor, leading to hemolytic disease of the newborn in future pregnancies. Administering RhoGAM prevents this sensitization. This is a standard prophylactic measure for any invasive prenatal procedure where blood mixing might occur, regardless of whether the procedure is performed transabdominally or transcervically.

Choice E rationale

For a transabdominal CVS procedure, a full bladder is often required to help displace the uterus upward and provide a better acoustic window for the ultrasound. This improves the visualization of the placental site and allows for safer needle insertion. If the procedure is performed transcervically, the bladder requirements may vary, but a full bladder is a common preparatory step in early pregnancy imaging and procedures to optimize the view of pelvic structures and the developing gestational sac.