A nurse is reinforcing teaching with a client who is at 35 weeks of gestation and has a prescription for a lecithin/sphingomyelin ratio. Which of the following statements should the nurse make?

"This test will detect possible birth defects."

"This test will reveal the sex of the fetus."

"This test will identify your risk for preterm labor."

"This test will determine fetal lung maturity."

Answer and Explanation

The Correct Answer is D

A.   The lecithin/sphingomyelin (L/S) ratio test is not used to detect birth defects. It specifically assesses fetal lung maturity by measuring the ratio of two phospholipids present in fetal lung surfactant.
B.   The L/S ratio test does not reveal the sex of the fetus. It is unrelated to fetal gender determination.

C.   While preterm labor risk can be assessed through other methods, such as cervical length

measurement or fetal fibronectin testing, the L/S ratio test is specifically focused on fetal lung maturity.
D. The L/S ratio test is primarily used to determine fetal lung maturity, as an increased ratio indicates lung maturity and readiness for extrauterine life.

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Correct Answer is A

Explanation

A. A decreased level of consciousness and vomiting may indicate a potentially serious condition such as increased intracranial pressure, electrolyte imbalance, or metabolic disorder. Immediate assessment and intervention are necessary to determine the cause and provide appropriate treatment.
B. Cellulitis accompanied by a low-grade fever is concerning but may not require immediate attention compared to a decreased level of consciousness and vomiting.
C. A pain rating of 7 after receiving analgesia 30 minutes ago is important to address, but it may not be as urgent as assessing a client with a decreased level of consciousness and vomiting.
D. A blood glucose level of 160 mg/dL in a client with type 2 diabetes mellitus may require monitoring and intervention, but it may not be as urgent as assessing a client with a decreased level of consciousness and vomiting.

A. Suggest the family persuade the client to take the medication. B. Recommend that the medication be delivered intramuscularly. C. Remind the newly licensed nurse that the client has a right to refuse medication. D. Suggest the newly licensed nurse contact the pharmacy to inquire about compatible foods.

Correct Answer is C

Explanation

A. Suggest the family persuade the client to take the medication: This option involves coercion, which is not ethically appropriate. Clients have the right to refuse medication, and persuasion from family members should not be used to override this right.
B. Recommend that the medication be delivered intramuscularly: Administering medication against a client's will through an invasive route like intramuscular injection is not appropriate and may constitute assault.
C. Remind the newly licensed nurse that the client has a right to refuse medication: This response upholds the client's autonomy and right to refuse treatment. Nurses must respect a client's decision to decline medication, provided they are competent to make that decision.
D. Suggest the newly licensed nurse contact the pharmacy to inquire about compatible foods: This response does not address the ethical issue of respecting the client's autonomy and right to refuse medication.

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A nurse is reinforcing teaching with a client who is at 35 weeks of gestation and has a prescription for a lecithin/sphingomyelin ratio. Which of the following statements should the nurse make?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Correct Answer is C

Explanation

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