A pregnant client is undergoing a quad screen test and inquires about the possible results.
Which of the following responses is most appropriate?

The test examines fetal DNA to determine the fetus’s gender.

The test uses fetal tissue to examine the fetus’s genetic makeup for potential anomalies.

The test examines maternal alpha-fetoprotein to assess maternal liver function.

The test examines maternal alpha-fetoprotein to determine if the levels are high or low, indicating specific disorders.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Incorrect. The quad screen test does not examine fetal DNA to determine gender. That is the role of other tests, such as amniocentesis or chorionic villus sampling (CVS).

Gender determination is not a primary objective of the quad screen test.

Focusing on gender unnecessarily narrows the scope of the test's potential findings.

Choice B rationale:

Incorrect. The quad screen test does not use fetal tissue. It is a non-invasive blood test that measures levels of four substances in the mother's blood: alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A.

Fetal tissue sampling is more invasive and carries risks, while the quad screen is a safer alternative.

Clarifying the non-invasive nature of the test is crucial for informed consent and patient understanding.

Choice C rationale:

Incorrect. While AFP levels can be affected by maternal liver function, that is not the primary focus of the quad screen test.

Liver function tests are specifically designed to assess liver health, and they are not part of the quad screen panel.

Distinguishing between liver function assessment and AFP's role in screening for fetal anomalies is essential for accurate interpretation.

Choice D rationale:

Correct. The quad screen test measures levels of AFP, hCG, uE3, and inhibin A in the mother's blood. These substances can provide information about the risk of certain fetal chromosomal abnormalities and neural tube defects.

Elevated AFP levels can indicate an increased risk for neural tube defects such as spina bifida or anencephaly.

Low AFP levels can be associated with Down syndrome or other chromosomal abnormalities.

Understanding the specific disorders that can be indicated by AFP levels is crucial for patient counseling and further testing decisions.

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Correct Answer is ["B","C","E","F"]

Explanation

The correct answers are B, C, E, and F.

Rationale for each choice:

Albuterol

Mechanism of action: Albuterol is a beta-2 agonist that stimulates beta-2 receptors in the cell membranes of skeletal muscle, liver, and adipose tissue. This stimulation causes an increase in intracellular cyclic AMP (cAMP), which activates protein kinase A (PKA). PKA then phosphorylates a number of proteins, including the sodium-potassium ATPase pump. This pump is responsible for transporting potassium ions into cells and out of the bloodstream. By increasing the activity of this pump, albuterol can help to lower serum potassium levels.

Onset of action: Albuterol has a rapid onset of action, typically within 30 minutes.

Duration of action: The duration of action of albuterol is relatively short, usually 4-6 hours.

Dosage: The dosage of albuterol for hyperkalemia is typically 10-20 mg nebulized every 4-6 hours.

Additional considerations: Albuterol can cause tachycardia and tremors. It should be used cautiously in patients with heart disease or hyperthyroidism.

Kayexalate

Mechanism of action: Kayexalate is a cation exchange resin that binds to potassium ions in the gastrointestinal tract. This prevents the potassium from being absorbed into the bloodstream.

Onset of action: Kayexalate has a relatively slow onset of action, usually 1-2 hours.

Duration of action: The duration of action of Kayexalate is relatively long, usually 4-6 hours.

Dosage: The dosage of Kayexalate for hyperkalemia is typically 15-30 grams orally or rectally every 6 hours.

Additional considerations: Kayexalate can cause constipation and hypocalcemia. It should be used cautiously in patients with bowel obstruction or kidney disease.

Insulin & dextrose

Mechanism of action: Insulin promotes the movement of potassium into cells, thus lowering serum potassium levels. Dextrose is given along with insulin to prevent hypoglycemia.

Onset of action: Insulin has a rapid onset of action, typically within 30 minutes.

Duration of action: The duration of action of insulin is relatively short, usually 4-6 hours.

Dosage: The dosage of insulin for hyperkalemia is typically 10 units of regular insulin IV push, followed by an infusion of 5-10 units per hour. The dosage of dextrose is typically 50 grams IV push, followed by an infusion of 10% dextrose at 100 mL/hour.

Additional considerations: Insulin can cause hypoglycemia. It should be used cautiously in patients with diabetes mellitus.

A. Infertility will most likely not be an issue for this patient. B. If the patient gets pregnant, she is more likely to have multiples. C. The patient should take acetaminophen for pain relief. D. Oral contraceptives may be helpful for this patient.

Correct Answer is D

Explanation

Choice A rationale:

Infertility is a common issue for women with endometriosis. The endometrial tissue that grows outside the uterus can cause scarring and inflammation, which can block fallopian tubes and prevent eggs from being released or fertilized. Studies have shown that 30-50% of women with endometriosis experience infertility.

It is important to address this potential issue with the patient and discuss options for fertility preservation if desired.

Choice B rationale:

There is no evidence to suggest that women with endometriosis are more likely to have multiples. The likelihood of having multiples is primarily influenced by factors such as genetics, maternal age, and the use of fertility treatments.

Choice C rationale:

Acetaminophen may not be effective for pain relief in women with endometriosis. The pain associated with endometriosis is often severe and can be unresponsive to over-the-counter pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are often more effective in managing endometriosis-related pain.

In some cases, stronger pain medications such as opioids may be necessary.

Choice D rationale:

Oral contraceptives can be helpful for women with endometriosis by:

Suppressing ovulation, which can reduce the amount of endometrial tissue that grows and bleeds each month.

Thinning the uterine lining, which can also reduce pain and bleeding.

Slowing the growth of endometrial tissue.

Oral contraceptives are not a cure for endometriosis, but they can help to manage symptoms and improve quality of life.

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A pregnant client is undergoing a quad screen test and inquires about the possible results. Which of the following responses is most appropriate?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is ["B","C","E","F"]

Explanation

The nurse is examining a female patient in an OB clinic who complains of severe pain during menstruation and intercourse. The nurse suspects endometriosis. Which of the following is true?

Correct Answer is D

Explanation

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A pregnant client is undergoing a quad screen test and inquires about the possible results.
Which of the following responses is most appropriate?