A nurse is preparing to administer an opioid analgesic to a client who is in active labor.
Which of the following assessments should the nurse perform?

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

Consuming milk with iron supplements significantly inhibits iron absorption due to the high calcium content in milk. Calcium competes with iron for absorption sites in the small intestine, forming insoluble complexes that reduce the bioavailability of iron. This would counteract the intended therapeutic effect of the iron supplementation, leading to suboptimal iron levels.

Choice B rationale

Doubling an iron dose can lead to iron toxicity, which is dangerous, especially during pregnancy. Excessive iron intake can cause gastrointestinal distress, liver damage, and metabolic acidosis. Adhering to the prescribed dosage is crucial for safe and effective supplementation, preventing adverse effects while achieving therapeutic iron levels.

Choice C rationale

Maintaining adequate fiber intake (normal range 25-30 grams daily) is crucial during iron supplementation. Iron often causes constipation due to its effect on gastrointestinal motility. Dietary fiber adds bulk to stool, promoting regular bowel movements and alleviating constipation, which is a common and uncomfortable side effect of iron therapy.

Choice D rationale

Vitamin K is essential for blood coagulation, but taking 100 milligrams daily during pregnancy without a specific medical indication is excessive and potentially harmful. The normal recommended daily allowance for vitamin K during pregnancy is much lower, around 90 micrograms. High doses could interfere with anticoagulant medications or have unknown fetal effects.