A 32 year-old G3P2 client is returning for her prenatal visit at 28 weeks.Her prenatal labs on record thus far are as follows: Type & Rh =A negative.
Antibody screen normal.
RPR = negative.
HIV = negative.
Rubella titer 1:16. Cervical smears negative for Gonorrhea & Chlamydia.
Hemoglobin/hematocrit = 11.0 mg/dl and 35%. Gestational diabetes glucose challenge test (GCT) Screen 26 wks = 120.
Urine analysis positive for leukocytes.
Today her plan of care should include which of the following: (Select all that apply)
Administer Rubella vaccine IM.
Instruct client on signs and symptoms of preterm labor.
Administer Rhogam IM.
Obtain a clean catch urine culture.
Order a 3-hour diagnostic glucose tolerance test.
Administer a blood transfusion.
Correct Answer : B,C,D,E
Choice A rationale
Rubella vaccination is contraindicated during pregnancy due to the risk of congenital rubella syndrome in the fetus. It should be administered postpartum if the client is non-immune.
Choice B rationale
Preterm labor is a concern at 28 weeks' gestation. Educating the client on signs and symptoms can help in early detection and management, potentially improving outcomes for both mother and baby.
Choice C rationale
Rh-negative mothers with a negative antibody screen should receive Rhogam at 28 weeks to prevent Rh sensitization. This is crucial to avoid hemolytic disease of the newborn in future pregnancies.
Choice D rationale
A positive urine analysis for leukocytes indicates a possible urinary tract infection. A clean catch urine culture is needed to identify the causative organism and guide appropriate antibiotic therapy.
Choice E rationale
The glucose challenge test result of 120 at 26 weeks is within normal limits, but a 3-hour diagnostic glucose tolerance test may be ordered if there's a high index of suspicion for gestational diabetes or other risk factors.
Choice F rationale
A blood transfusion is not indicated as the hemoglobin/hematocrit levels (11.0 mg/dl and 35%) are within acceptable limits for pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale: Administer IV fluids with electrolytes: This is crucial to rehydrate the client and correct electrolyte imbalances caused by excessive vomiting, a common complication of hyperemesis gravidarum.
Choice B rationale: Offer small, frequent meals high in protein: Small, frequent meals can help manage nausea and vomiting by preventing the stomach from becoming empty, while high-protein foods can provide necessary nutrients and energy.
Choice C rationale: Administer antiemetics as prescribed: Antiemetics can help control nausea and vomiting, improving the client's ability to tolerate oral intake and maintain hydration and nutrition.
Choice D rationale: Encourage the client to increase oral fluid intake immediately: While increasing oral fluid intake is beneficial, it may not be immediately feasible due to the severity of nausea and vomiting in hyperemesis gravidarum. Hence, initial IV fluid therapy is prioritized.
Choice E rationale: Perform continuous fetal monitoring: Continuous fetal monitoring is not typically necessary in the early stages of pregnancy, especially at 11 weeks of gestation. The primary focus should be on stabilizing the mother's condition to support overall pregnancy health.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"}}
Explanation
Choice A Rationale
Administer azithromycin 1 g PO one time: Anticipated. Azithromycin is commonly used to treat chlamydia infections during pregnancy and is considered safe.
Choice B Rationale
Administer ibuprofen 600 mg PO twice a day for pain: Contraindicated. Ibuprofen is generally avoided during pregnancy, especially in the third trimester, due to risks such as premature closure of the fetal ductus arteriosus.
Choice C Rationale
Notify all sexual partners within prior 30 days of the need for STI screening: Anticipated. Notification of sexual partners for STI screening is a standard public health practice to prevent the spread of infections.
Choice D Rationale
Administer ceftriaxone 250 mg IM now: Anticipated. Ceftriaxone is often used to treat gonorrhea infections during pregnancy and is considered safe for both mother and fetus.
Choice E Rationale
Repeat STI screening at next prenatal visit in 1 month: Anticipated. Repeating STI screening can help ensure that any new or untreated infections are identified and managed appropriately.
Choice F Rationale
Notify the appropriate public health agency: Anticipated. Reporting certain STIs to public health agencies is required by law to help track and control the spread of infections.
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