A nurse in calculating the estimated date of birth using Nägele's rule for a client who is pregnant and whose last menstrual cycle started june 21. Which of the following is the estimated date of delivery in the next year?

A. Subcutaneous in the left vastus lateralis: Phytonadione is usually administered IM, not subcutaneously. The vastus lateralis muscle in the thigh is a common site for IM injections in newborns.

B. IM in the right deltoid: The deltoid muscle in the upper arm is not typically the recommended site for administering medications to newborns. The vastus lateralis muscle in the thigh is preferred for newborn IM injections due to better muscle development and blood flow.

C. IM in the left vastus lateralis: This is the correct option. Phytonadione, or Vitamin K, is routinely given to newborns to prevent vitamin K deficiency bleeding (VKDB). It's administered as an IM injection into the vastus lateralis muscle in the thigh, which is a standard practice for newborn vitamin K administration.

D. Subcutaneous in the right deltoid: Subcutaneous administration in the deltoid is not typically used for newborns, especially for medications like phytonadione that are commonly administered IM.

Correct Answer: B

B. Administer broad-spectrum antibiotics
Newborns with a leaking myelomeningocele are at a high risk for infection, especially meningitis, due to the exposure of cerebrospinal fluid (CSF). Administering broad-spectrum antibiotics helps reduce the risk of infection until the defect is surgically closed.

Incorrect answers:

A.Monitor the rectal temperature every 4 hr.Taking rectal temperatures is contraindicated in a newborn with a myelomeningocele due to the risk of trauma to the rectum and potential introduction of bacteria near the exposed spinal cord and CSF. Axillary temperatures should be used instead.

C.Prepare for surgical closure after 72 hr.Surgical repair of a myelomeningocele is typically performed within the first 24–48 hours of life to reduce the risk of infection and prevent further nerve damage.

D.Cleanse the site with povidone-iodine. Povidone-iodine is not appropriate for cleansing the exposed myelomeningocele site because it can be too harsh and toxic to neural tissue.