A nurse is performing a contraction stress test (CST) on a client who is at 40 weeks of gestation. The results of the test indicate a negative CST.
Which of the following actions should the nurse take?

Choice A rationale

A positive phenylketonuria (PKU) test indicates an inability to metabolize the amino acid phenylalanine, not galactose. Galactosemia is a separate metabolic disorder characterized by the body's inability to break down galactose, a sugar found in milk. Both are inborn errors of metabolism, but their biochemical pathways and dietary interventions differ significantly.

Choice B rationale

A positive PKU test does not indicate a slow metabolism in general. Instead, it specifically points to a deficiency in the enzyme phenylalanine hydroxylase (PAH), which is necessary for converting phenylalanine into tyrosine. This enzymatic defect leads to an accumulation of phenylalanine in the blood and tissues, which can become neurotoxic if untreated.

Choice C rationale

A positive finding for phenylketonuria (PKU) signifies a genetic disorder where the body lacks or has insufficient amounts of the enzyme phenylalanine hydroxylase. This enzyme is crucial for metabolizing the essential amino acid phenylalanine into tyrosine. Without proper enzyme function, phenylalanine accumulates in the blood, leading to neurotoxic effects if a specialized diet is not initiated promptly.

Choice D rationale

A positive PKU finding, if left untreated, directly leads to severe intellectual disability and other neurological problems due to the accumulation of phenylalanine, which is toxic to the developing brain. Therefore, it indicates an increased risk for neurologic anomalies if the condition is not managed through a strict low-phenylalanine diet from early infancy. .

Choice A rationale

Placing the newborn under a radiant warmer is crucial for thermoregulation, preventing cold stress, which can lead to increased metabolic rate and oxygen consumption. While important, assessing for potential airway compromise due to meconium aspiration takes immediate precedence over maintaining temperature, as respiratory status is critical for survival.

Choice B rationale

Providing tactile stimulation can encourage respiratory effort in a depressed newborn. However, in the presence of meconium-stained amniotic fluid, initial assessment of the airway and the need for suctioning must occur before stimulating the newborn to breathe deeper, which could potentially draw meconium further into the lungs.

Choice C rationale

When meconium-stained amniotic fluid is present, the primary concern is meconium aspiration syndrome. Determining if the mouth and nose require bulb suctioning is the first action to clear any meconium from the upper airway, preventing its aspiration into the lungs upon the newborn's first breaths, thereby mitigating respiratory distress.

Choice D rationale

Initiating skin-to-skin contact promotes maternal-newborn bonding and can stabilize the newborn's temperature and blood glucose. While beneficial, it is not the immediate priority when meconium is present. Airway management and respiratory stabilization must be ensured before initiating skin-to-skin contact to prevent complications from meconium aspiration.