A 3-month-old baby has been diagnosed with cystic fibrosis. The mother states, 'How could this happen? I had an amniocentesis during my pregnancy and everything was supposed to be normal!' What does the nurse understand about this situation?

Correct Answer: B

Rationale: In this scenario, option B is correct: "The baby may have an uncommon genetic variant of the disease." This answer is correct because cystic fibrosis can result from various genetic mutations, and not all genetic variants associated with the condition may be detectable through standard prenatal testing like amniocentesis. Option A, "Cystic fibrosis cannot be diagnosed by amniocentesis," is incorrect because while amniocentesis can detect certain genetic disorders, it may not identify all possible genetic variations linked to cystic fibrosis. Option C, "The amniocentesis results were likely inaccurate," is incorrect as it assumes a fault in the testing process, which may not necessarily be the case. Amniocentesis results are generally reliable for the conditions they are designed to detect. Option D, "Cystic fibrosis develops after birth and cannot be detected prenatally," is incorrect as cystic fibrosis is a genetic condition that is present from birth, although symptoms may manifest later. Educationally, this question highlights the complexities of genetic testing and the limitations of prenatal screening methods. It underscores the importance of genetic counseling and the need for parents to understand that not all genetic variations may be identified through prenatal testing, emphasizing the value of ongoing medical surveillance and care for infants at risk for genetic conditions like cystic fibrosis.

Correct Answer: A

Rationale: In this scenario, option A, "Thin cervix," is the correct answer. When the nurse palpates a thin cervix during a vaginal examination, it indicates cervical dilation. In the given scenario, the client is 5 cm dilated, which aligns with a thin cervix. Option B, "Bulging fetal membranes," is incorrect as this typically occurs when the client's water breaks, and the amniotic sac protrudes into the vaginal canal. Option C, "Head at the pelvic outlet," is incorrect because at station 2, the fetal head is not yet engaged in the pelvis but is still higher up in the birth canal. Option D, "Closed cervix," is incorrect as the scenario states the client is 5 cm dilated, so the cervix is not closed. Educationally, understanding the significance of findings during a vaginal examination in labor is crucial for nurses caring for laboring clients. It helps in assessing the progress of labor, determining the stage of labor, and making informed decisions regarding the client's care and possible interventions. Palpating and interpreting cervical dilation, effacement, and fetal station are key skills for nurses in providing safe and effective care during childbirth.

Correct Answer: C

Rationale: The correct answer is C) She may have a hidden laceration. In this scenario, the client's complaint of severe perineal pain despite receiving ibuprofen and the presence of edema suggest that there may be an underlying issue such as a hidden laceration that is causing the pain. It is crucial for the nurse to consider this possibility and further assess the client to rule out any complications that may require medical intervention. Option A) She should be assessed by her doctor is incorrect because the nurse should first assess the client herself to determine the cause of the pain before involving the doctor unnecessarily. Option B) She should have a sitz bath is incorrect as a sitz bath may provide comfort but it does not address the underlying issue of severe perineal pain that persists despite pain medication. Option D) She needs a narcotic analgesic is incorrect as the first step should be to investigate the cause of the pain rather than automatically escalating to a stronger pain medication. In an educational context, this question highlights the importance of thorough assessment and critical thinking in postpartum care. It emphasizes the need for nurses to consider all possible causes of a client's symptoms and to prioritize appropriate interventions based on assessment findings rather than jumping to conclusions or treatments. This scenario also underscores the significance of vigilance in detecting potential complications following childbirth, especially in cases where the client's symptoms are not improving as expected.

Correct Answer: A

Rationale: Rationale: The correct answer is A) Serial grip strengths. When a client is on magnesium sulfate therapy for severe preeclampsia, monitoring for signs of magnesium toxicity is crucial. Serial grip strength assessments are important because magnesium toxicity can lead to neuromuscular complications such as muscle weakness or loss of deep tendon reflexes. By assessing grip strength regularly, the nurse can detect these early signs of toxicity and intervene promptly to prevent further complications. Option B) Kernig assessments are used to assess for meningitis, not magnesium sulfate toxicity. Option C) Pupillary responses are important for assessing neurological status but are not specific to monitoring magnesium toxicity. Option D) Apical heart rate checks are important for monitoring cardiac function but do not specifically indicate magnesium toxicity. Educational context: Understanding the signs and symptoms of magnesium sulfate toxicity is essential for nurses caring for clients with severe preeclampsia. By regularly assessing grip strength, nurses can identify early signs of magnesium toxicity and prevent serious complications. This knowledge and skill are critical for providing safe and effective care to perinatal clients at risk for complications related to hypertension in pregnancy.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Foul-smelling lochia. This sign indicates a possible infection, specifically endometritis, which is a common complication postpartum. Rupture of membranes for an extended period increases the risk of infection. Reporting foul-smelling lochia promptly is crucial for early intervention to prevent serious complications like sepsis. Option B) Engorged breasts is a common postpartum occurrence due to increased blood flow and milk production and does not require immediate intervention unless associated with severe pain or signs of mastitis. Option C) Cracked nipples are common breastfeeding issues that can be managed with proper technique and support and do not pose immediate health risks. Option D) Cluster of hemorrhoids is not directly related to the prolonged rupture of membranes and spontaneous vaginal delivery scenario, and while uncomfortable, it does not require immediate intervention. Educationally, understanding the significance of different postpartum signs and symptoms is vital for nurses to provide safe and effective care. Recognizing abnormal findings promptly and taking appropriate actions can prevent complications and promote positive outcomes for both the mother and newborn.