A nurse in a provider’s office is collecting data from a client who is at 34 weeks of gestation and reports having a sudden gush of vaginal fluid.Which of the following manifestations is the priority?
Amniotic fluid with meconium noted.
Maternal temperature 38.3°C (101°F).
Foul smelling vaginal discharge.
Fetal heart tones 98/min.
The Correct Answer is D
Choice A rationale
Amniotic fluid with meconium noted can indicate fetal distress, but it is not the most immediate priority compared to fetal heart tones.
Choice B rationale
A maternal temperature of 38.3°C (101°F) can indicate infection, but it is not the most immediate priority compared to fetal heart tones.
Choice C rationale
Foul-smelling vaginal discharge can indicate infection, but it is not the most immediate priority compared to fetal heart tones.
Choice D rationale
Fetal heart tones of 98/min indicate fetal bradycardia, which is a sign of fetal distress and requires immediate intervention to ensure the well-being of the fetus.
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Correct Answer is B
Explanation
Choice A rationale
A large banana is not a significant source of dietary calcium. While bananas are nutritious and provide potassium and vitamin C, they do not contain enough calcium to meet the needs of a pregnant client who does not consume dairy products.
Choice B rationale
Kale is an excellent non-dairy source of calcium. Dark leafy greens like kale are rich in calcium, with approximately 90 mg of calcium per cup when cooked. Including kale in the diet can help pregnant women meet their calcium needs, especially if they do not consume dairy products.
Choice C rationale
A baked potato is not a significant source of dietary calcium. While potatoes provide several nutrients, including potassium and vitamin C, they do not contain enough calcium to be recommended as a primary source for a pregnant client who does not consume dairy products.
Choice D rationale
White corn is not a significant source of dietary calcium. While it can contribute to overall nutritional intake, it does not provide enough calcium to meet the needs of a pregnant client who does not consume dairy products.
Correct Answer is C
Explanation
Choice A rationale
A Papanicolaou test, commonly known as a Pap smear, is used to detect cervical cancer and precancerous changes in the cervix. It does not detect herpes simplex type 1. Herpes simplex virus (HSV) testing is typically done through a swab of the lesion or blood tests to detect antibodies.
Choice B rationale
A glucose tolerance test is performed during pregnancy to screen for gestational diabetes, not to predict hyperglycemia in the baby. This test helps identify how well the mother’s body is managing glucose and ensures that both mother and baby remain healthy during pregnancy.
Choice C rationale
A multiple marker screening, also known as a triple or quad screen, is performed during pregnancy to identify potential neural tube defects, such as spina bifida, and chromosomal abnormalities like Down syndrome. This test measures specific substances in the mother’s blood to assess the risk of these conditions.
Choice D rationale
Group B streptococcus (GBS) screening is performed to detect the presence of GBS bacteria in the mother’s body, not to determine the presence of sexually transmitted infections (STIs). GBS can cause serious infections in newborns, so it is important to identify and treat it before delivery.