The nurse takes the history of a client, G2 P1001, at her first prenatal visit. Which of the following statements would indicate that the client should be referred to a genetic counselor?

Correct Answer: D

Rationale: The correct answer is D) My first child has cystic fibrosis. This statement indicates a need for referral to a genetic counselor because cystic fibrosis is a genetic disorder that can be inherited. Genetic counseling would be essential for the client to understand the genetic implications, risks, and options for future pregnancies. Option A) My first child has cerebral palsy does not necessarily indicate a need for genetic counseling as cerebral palsy is not typically a genetic condition but rather a result of brain injury or abnormal brain development. Option B) My first child has hypertension is a common medical condition that is not typically genetic and would not warrant genetic counseling. Option C) My first child has asthma is also not typically a genetic condition and does not require genetic counseling. In an educational context, understanding when to refer a client to a genetic counselor is crucial for nurses providing prenatal care. Genetic counselors can provide valuable information and support to clients with genetic concerns, helping them make informed decisions about family planning and genetic testing. By recognizing red flags like a child with a known genetic disorder, nurses can ensure their clients receive comprehensive care and appropriate referrals.

Correct Answer: A

Rationale: In the context of maternal monitoring during labor, the nurse should highlight the vital sign changes that indicate potential complications. Option A is the correct answer as it reflects a significant increase in blood pressure from the prepregnancy baseline to the third trimester, indicating gestational hypertension or preeclampsia, which are critical conditions requiring medical intervention. Option B is incorrect as a slight increase in respiratory rate can be a normal physiological adaptation to pregnancy due to increased oxygen demand, and it may not necessarily indicate a problem. Option C is incorrect because a modest increase in heart rate can also be normal during pregnancy as the body adapts to the increased demands of the growing fetus and placenta. Option D is incorrect as a slight elevation in temperature is not uncommon in pregnant women and may not be a cause for immediate concern unless it is accompanied by other symptoms of infection. Educationally, understanding the normal physiological changes during pregnancy and being able to identify abnormal vital sign trends are crucial for nurses caring for pregnant women. Highlighting the correct vital sign changes can help in early identification and management of complications, ensuring the well-being of both the mother and the baby.

Correct Answer: B

Rationale: In the context of maternal monitoring during labor, the correct position for a 31-week gestation client to lie on the examining table during a prenatal examination is the lateral-recumbent position (Option B). Explanation of why Option B is correct: 1. Lateral-recumbent position: This position is preferred during pregnancy as it helps prevent supine hypotensive syndrome by reducing pressure on the vena cava. This position allows for optimal blood flow to the uterus and placenta, promoting maternal and fetal well-being. Explanation of why the other options are wrong: 1. Orthopneic position (Option A): This position is more commonly used for patients experiencing respiratory distress, not for routine prenatal examinations. 2. Sims' position (Option C): Sims' position is typically used for rectal examinations or procedures, not for prenatal examinations. 3. Semi-Fowler's position (Option D): This position is a semi-upright position with the head of the bed elevated. While it can be used for some examinations, the lateral-recumbent position is more appropriate for prenatal examinations to avoid pressure on the vena cava. Educational context: Understanding the importance of positioning during prenatal examinations is crucial for nurses and healthcare providers caring for pregnant clients. Proper positioning not only ensures the comfort of the client but also promotes optimal maternal and fetal health by facilitating adequate blood flow and reducing the risk of complications. By selecting the appropriate position, nurses can contribute to a positive pregnancy experience and ensure the well-being of both the mother and baby.

Correct Answer: B

Rationale: In the context of maternal monitoring during labor, the correct answer is B) Rise in white blood cells from 5,000 cells/mm3 to 15,000 cells/mm3. This increase indicates a normal physiological response to stress and potential infection during pregnancy, known as leukocytosis. It signals the body's defense mechanism gearing up to protect both the mother and the fetus during labor. Option A) Rise in hematocrit from 34% to 38% is unlikely during pregnancy as there is a normal physiological hemodilution due to increased plasma volume. Option C) Rise in potassium from 3.9 mEq/L to 5.2 mEq/L is concerning as it could indicate hyperkalemia, which is not a typical finding during pregnancy. Option D) Rise in sodium from 137 mEq/L to 150 mEq/L is also abnormal and could indicate hypernatremia, which is not a typical finding during pregnancy. Understanding these physiological changes is crucial in maternal monitoring to differentiate between normal adaptations and potential complications during pregnancy and labor. It helps healthcare providers make informed decisions to ensure the well-being of both the mother and the baby.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Stay out of any rooms that are being renovated. This advice is critical because renovation work in an older home may disturb lead-based paint or asbestos, both of which can pose serious health risks to the unborn child. Lead exposure can lead to developmental delays and cognitive impairments, while asbestos exposure is linked to respiratory issues and cancer. Option B) Drink water only from the hot water tap is incorrect because lead contamination is more common in hot water due to lead leaching from pipes. Option C) Refrain from entering the basement is incorrect as the concern lies more with the renovation process and potential exposure to harmful substances rather than the location itself. Option D) Climb the stairs only once per day is unrelated to the risks associated with living in an older home. Educationally, it is important for healthcare providers to understand the potential environmental hazards that pregnant women may be exposed to and to provide appropriate guidance to ensure the health and safety of both the mother and the unborn child. By recognizing the specific risks associated with older homes and renovations, nurses can play a crucial role in promoting a healthy pregnancy environment for their patients.