A 25-year-old primigravida at 40 weeks gestation with gestational diabetes is admitted for labor induction. The nurse is preparing to assist with amniocentesis to assess fetal lung maturity before induction. What is the most critical safety consideration the nurse must prioritize during this procedure?
1Ensuring the patient has signed informed consent for the procedure
2Positioning the patient in left lateral position to prevent supine hypotension
3Preparing emergency cesarean section equipment in case of complications
4Continuously monitoring fetal heart rate throughout the entire procedure✓ 정답
해설
Continuous fetal heart rate monitoring is critical during amniocentesis for immediate detection of fetal distress. Other options are important but secondary safety measures.
Clinical Judgment
This question assesses Clinical Judgment that prioritizes Fetal Safety. Amniocentesis is an invasive procedure, and as the needle passes through the uterine wall and amniotic membrane, acute fetal distress such as fetal bradycardia, cord compression, or placental abruption can occur. Therefore, continuous fetal heart rate (FHR) monitoring before, during, and after the procedure is the only way to immediately detect these life-threatening complications and promptly initiate necessary emergency interventions (such as emergency cesarean section). The other options are important preparatory steps, but their relative importance is lower compared to the most critical task of 'real-time safety surveillance' during the procedure.
Memory Tip:
Monitor First, Prepare Later (MFPL): In invasive fetal procedures like amniocentesis, Monitoring comes First, and other Preparations come Later.
KR vs US:
While the importance of fetal monitoring is the same in Korea, the US NGN/CJMM places greater focus on the Cognitive Skills of 'Recognize Cues' and 'Analyze Cues'—continuous assessment and intervention based on real-time data. The emphasis is on the nurse's ability to interpret monitoring data and anticipate potential risks, going beyond simply preparing the equipment.
Clinical Practice Guide
Nurse's role during amniocentesis:
1. Before the procedure: Check and record the FHR baseline and variability.
2. During the procedure: Continuously monitor the FHR, and immediately watch for bradycardia (less than 110 bpm), loss of variability, and persistent decelerations.
3. After the procedure: Continue FHR monitoring for at least 30-60 minutes to observe for delayed reactions.
Caution:
In SATA (Select All That Apply) questions asking about "nursing activities required during amniocentesis," multiple items such as verifying informed consent, maintaining proper positioning, FHR monitoring, and preparing emergency equipment may all be correct answers. However, in single-choice questions like this one that ask for the "MOST critical" or "FIRST" action, you should select real-time monitoring.
Amniocentesis — Amniocentesis. An invasive procedure in which a needle is inserted through the abdominal wall into the uterine cavity to collect amniotic fluid for diagnostic or therapeutic purposes.
Fetal Heart Rate (FHR) Monitoring — Fetal heart rate monitoring. The continuous recording of the fetal heart rate to assess the fetus's well-being and response to the intrauterine environment.
Post-term Pregnancy — Postterm pregnancy. A condition where the pregnancy exceeds 42 weeks (294 days) calculated from the first day of the last menstrual period.
Fetal Lung Maturity — Fetal lung maturity. An assessment of whether the fetal lungs have developed sufficiently to perform respiratory function. Measured by surfactant levels in the amniotic fluid.
Supine Hypotensive Syndrome — Supine hypotensive syndrome. Hypotension that occurs when a pregnant woman in late pregnancy lies on her back, causing the heavy uterus to compress the inferior vena cava and reduce venous blood return to the heart.