A new mother asks the nurse why her baby needs a heel stick for screening tests.
She states, "My baby seems healthy, so why put her through this?" Which explanation by the nurse best describes the purpose of newborn screening?

It's required by the state to maintain accurate birth records.

The tests identify serious conditions early, when treatment can prevent disability or death.

It helps us document the number of births at this hospital.

The test results are needed before you can take your baby home.

Answer and Explanation

The Correct Answer is B

Choice B rationale

Newborn screening programs are designed to detect metabolic, endocrine, and genetic disorders that are not clinically apparent at birth. Disorders like phenylketonuria or congenital hypothyroidism can cause irreversible intellectual disability or even death if not identified and treated within the first few weeks of life. By performing a heel stick to collect blood, healthcare providers can intervene early with diet or medication, allowing the child to achieve normal growth and development despite having an underlying condition.

Choice A rationale

While state laws do mandate newborn screening, the primary clinical purpose is not the maintenance of birth records. Vital statistics and birth certificates serve the purpose of legal documentation. The screening itself is a public health intervention aimed at secondary prevention. Explaining the test as a mere clerical requirement fails to convey the life-saving medical necessity of the procedure. It is important for the parent to understand the health benefits rather than just the legal obligations.

Choice C rationale

The number of births at a specific hospital is tracked through admission and delivery logs, not through diagnostic screening tests. Each test performed on a newborn is a medical necessity for the individual patient rather than a census tool. Providing this explanation would misinform the mother about the value of the blood draw. The nurse should focus on how the screening specifically protects her baby's long-term health rather than hospital administrative or statistical data.

Choice D rationale

Although the screening is usually completed before discharge, stating that it is a requirement to leave the hospital can sound coercive or threatening to a new parent. This explanation does not address the mother's concern about why a healthy-looking baby needs a painful procedure. The goal of nursing communication is to provide a rationale based on the baby's well-being. Focusing on the prevention of hidden disabilities provides a more compassionate and scientifically accurate justification for the heel stick.

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Correct Answer is C

Explanation

Choice A rationale

Many medications, including over-the-counter drugs and herbal supplements, can be teratogenic, especially during the first trimester when organogenesis occurs. Preconception counseling must include a thorough review of all medications to ensure they are safe for a potential pregnancy. Some drugs have long half-lives or can cause fetal harm even shortly after conception. Therefore, advising a woman to continue all regular medications without a professional medical review is unsafe and scientifically unsound.

Choice B rationale

While the woman wants to get pregnant in three months, she does not necessarily need to discontinue all contraception immediately unless she is comfortable conceiving sooner. Some methods, like the copper IUD, allow for an immediate return to fertility, while others might require a short adjustment period. The focus of counseling should be on the timing of cessation relative to her goal, rather than an absolute command to stop all forms of birth control three months early.

Choice C rationale

Folic acid is a critical B vitamin required for DNA synthesis and the closure of the neural tube, which occurs within the first 28 days of pregnancy. Since many women do not realize they are pregnant during this vital window, starting a supplement of 400 to 800 micrograms daily at least one month before conception is vital. This prevents neural tube defects like spina bifida and ensures adequate folate levels are present during early embryonic development.

Choice D rationale

Intentional weight loss immediately before or during pregnancy should be approached with extreme caution and only under medical supervision. Restrictive dieting can lead to nutritional deficiencies in essential vitamins and minerals that are necessary for a healthy pregnancy. Instead of focusing on losing weight to gain more later, the emphasis should be on achieving a healthy body mass index and establishing balanced nutritional habits to support the metabolic demands of gestation.

A. Rupture of membranes. B. Decreased fetal movement. C. Exhaustion and inability to sleep. D. Lightening (baby dropping). E. Bloody show (mucousy pink discharge).

Correct Answer is ["D","E"]

Explanation

Choice A rationale

Rupture of membranes is the tearing of the amniotic sac, often resulting in a gush or a steady trickle of fluid. While this frequently occurs during labor or just before it starts, it is considered a sign of the onset of labor rather than a premonitory sign. Premonitory signs are subtle physiological changes that suggest the body is preparing for labor in the near future. This event usually marks a more immediate transition into the active birthing process.

Choice B rationale

Decreased fetal movement is never considered a normal premonitory sign of labor. In fact, a decrease in fetal activity is a concerning finding that requires immediate clinical evaluation to rule out fetal compromise or hypoxia. A healthy fetus should remain active up until the start of labor and even during the early stages. Nurses should educate patients that while the baby may have less room, they should still feel regular movement and kicks.

Choice C rationale

While many women feel fatigued at the end of pregnancy, exhaustion is not a specific premonitory sign of labor. Conversely, some women experience a sudden "nesting instinct" or a burst of energy shortly before labor begins. General inability to sleep is often related to physical discomfort, frequent urination, or anxiety. Because it is common throughout the third trimester for many different reasons, it lacks the specificity needed to be a reliable indicator of impending labor.

Choice D rationale

Lightening occurs when the fetal presenting part descends into the true pelvis. This usually happens about two weeks before labor in primigravidas and can happen just before labor in multigravidas. This shift relieves pressure on the diaphragm, allowing the woman to breathe more easily, which matches the patient's report. It is a classic premonitory sign indicating that the fetus is in position and the body is preparing for the eventual onset of uterine contractions.

Choice E rationale

Bloody show refers to the passage of a small amount of blood-tinged mucus from the vagina. This happens as the cervix begins to thin and dilate, causing the mucus plug to be expelled and small capillaries to bleed. The patient reported a mucousy pink discharge, which perfectly describes this phenomenon. It is one of the most common signs that labor may begin within the next 24 to 48 hours as the cervix undergoes preliminary changes.

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A new mother asks the nurse why her baby needs a heel stick for screening tests. She states, "My baby seems healthy, so why put her through this?" Which explanation by the nurse best describes the purpose of newborn screening?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice from the nurse:

Correct Answer is C

Explanation

Correct Answer is ["D","E"]

Explanation

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A new mother asks the nurse why her baby needs a heel stick for screening tests.
She states, "My baby seems healthy, so why put her through this?" Which explanation by the nurse best describes the purpose of newborn screening?