Doppler ultrasound pregnancy for nclex12/27/2023 Rationale: Biophysical profile is a comprehensive test that would be used to assess the client’s fetal status at 28 weeks gestation. The nurse should notify the physician of the newborn’s current temperature since it is outside normal parameters. Observation would be inappropriate because lack of action may lead to a further lowering of the temperature. Assessment of gestational age is completed regardless of the newborn’s temperature. Since this newborn’s temperature is significantly lower, the nurse should gradually institute measures to rewarm the newborn. Rationale: A newborn’s temperature is typically maintained at 36.5 to 37.5 degrees C (97.7 to 99.7 degrees F). It is not associated with maturing the sucking reflex, encouraging the development of maternal antibodies, or aiding in clearing the newborn’s respiratory passages. This contact also reduces maternal bleeding and stabilizes the newborn’s temperature, blood glucose level, and respiratory rate. This immediate mother-newborn contact takes advantage of the newborn’s natural alertness and fosters bonding. Rationale: Breastfeeding can be initiated immediately after birth. Teeth form hard tissue (enamel) at 18 weeks gestation. Soft earlobes with little cartilage develop at 36 weeks gestation. Myelination of the spinal cord begins at 20 weeks gestation. Rationale: Differentiation of hard and soft palate are structures developed by 16 weeks gestation. hCG reaches its maximum level at 50-70 days gestation. After 10 weeks, the placenta takes over the production of progesterone. Progesterone must be present in high levels for implantation to occur. Rationale: Progesterone decreases the contractility of the uterus, thus preventing uterine contractions that might cause spontaneous abortion. Some of the amniotic fluid is contributed by the fetus’s excreting urine. After 20 weeks of pregnancy, the fluid volume ranges from 700-1000 mL. Rationale: During pregnancy, the amniotic fluid protects against injury. By 35 weeks gestation, an L/S ratio of 2:1 (also reported as 2.0) is usually achieved in the normal fetus. At about 32 weeks gestation, sphingomyelin levels begin to fall, and the amount of lecithin begins to increase. Rationale: Early in pregnancy, the sphingomyelin concentration in amniotic fluid is greater than the concentration of lecithin, and so the L/S ratio is low (lecithin levels are low, and sphingomyelin levels are high). Other complications include fetal limb defects and abnormalities of the fetal face and jaw. CVS testing has a higher rate of spontaneous abortion than amniocentesis. Rationale: Risks of CVS include failure to obtain tissue, rupture of membranes, leakage of amniotic fluid, bleeding, intrauterine infection, maternal tissue contamination of the specimen, and Rh alloimmunization. These growth and development milestones are frequently included in questions on the licensure examination. Rationale: In the normal infant, the anterior fontanel closes at 12 to 18 months of age, and the posterior fontanel closes by the end of the second month (D). (B and D) are normal signs during the first trimester of pregnancy. (E) could be a sign of an ectopic pregnancy, which could be fatal if not discovered in time before rupture. A decrease of tenderness in the breast is a sign that hormone levels have declined and that a miscarriage is imminent. Cramping with bright red bleeding is a sign that the client’s menstrual cycle is about to begin. Rationale: (A and C) are signs of a possible miscarriage. (B and D) ignore the threat to client safety posed by a significant increase in blood pressure. Additional data are needed to confirm an emergency situation as described in (A). Epigastric pain can be a sign of an impending seizure (eclampsia), a life-threatening complication of gestational hypertension. A blood pressure exceeding 140/90 mm Hg is indicative of preeclampsia. Rationale: Checking the blood pressure for an elevation (C) is the best instruction to give at this time. Early pregnancy classes often include nutrition, physiologic changes, coping with normal discomforts of pregnancy, fetal development, maternal and fetal risk factors, and evolving roles of the mother and her significant others. At these times, they will have other teaching needs. (A, B, and C) are not the best times during pregnancy for the couple to attend childbirth education classes. (D) is closest to the time when parents would be ready for such classes. The couple is most interested in childbirth toward the end of the pregnancy, when they anticipate the onset of labor and the birth of their child. Rationale: Learning is facilitated by an interested pupil.
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