The nurse anticipates that the physician will most likely order a cervico-vaginal fetal fibronectin test for which patient?
1. The patient at 34 weeks' gestation with gestational diabetes
2. The patient at 32 weeks' gestation with regular uterine contractions
3. The patient at 37 weeks' multi-fetal gestation
4. The patient at 20 weeks' gestation with ruptured amniotic membranes
2
Rationale 1: Gestational diabetes does not predispose a client toward preterm labor.
Rationale 2: Fetal fibronectin is tested by swabbing the cervico-vaginal secretions. The presence of this substance is a strong predictor of preterm delivery, and thus is performed on women at risk for preterm delivery. Regular uterine contractions can be preterm labor. The patient experiencing preterm contractions should be tested for the presence of fetal fibronectin.
Rationale 3: Multi-fetal pregnancies often experience preterm delivery, but the patient at 37 weeks is at term.
Rationale 4: A pregnancy at 20 weeks has not reached the point of viability, and is treated as an impending spontaneous abortion, not preterm labor.
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