Family History: breast cancer, heart disease. Allergy: Penicillin.
Multiple sexual partners.
A nurse in a prenatal clinic is reviewing the laboratory results for a client who is at 12 weeks of gestation.
Which of the following actions should the nurse take?
Administer rubella vaccine.
Administer ceftriaxone IM.
Obtain a blood culture.
Obtain a maternal serum alpha-fetoprotein specimen.
The Correct Answer is D
The nurse should obtain a maternal serum alpha-fetoprotein (MSAFP) specimen for a client at 12 weeks of gestation.
MSAFP is a screening tool used to identify fetal neural tube defects (NTDs) such as spina bifida and anencephaly.
Elevated levels of MSAFP indicate an increased risk for NTDs, while low levels indicate an increased risk for chromosomal abnormalities such as Down syndrome.
Administering rubella vaccine (A) is contraindicated during pregnancy as it is a live vaccine and can cause fetal harm.
Administering ceftriaxone IM (B) and obtaining a blood culture (C) are not indicated based on the information provided about the client.
The client's allergy to penicillin is not relevant to the nurse's immediate action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
When a client is receiving magnesium sulfate by continuous IV infusion for preterm labor, it is important for the nurse to review the serum medication level to ensure that the client is receiving an appropriate dose and to monitor for signs of magnesium toxicity.
Choice A is not an answer because an indirect Coombs test is used to detect antibodies against red blood cells and is not relevant to magnesium sulfate therapy.
Choice C is not an answer because liver enzymes are not directly relevant to magnesium sulfate therapy.
Choice D is not an answer because uric acid levels are not directly relevant to magnesium sulfate therapy.
Correct Answer is C
Explanation
“This medication prevents seizures.” Magnesium sulfate is a mineral that is given intravenously to women with preeclampsia to reduce the risk of seizures or eclampsia.
Preeclampsia is a condition of high blood pressure and protein in the urine during pregnancy.
Choice A is incorrect because magnesium sulfate does not stabilize the fetal heart rate.
Choice B is incorrect because magnesium sulfate does not improve tissue perfusion.
Choice D is incorrect because magnesium sulfate does not increase cardiac output.
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