A nurse is assisting with the care of a newborn whose mother has hepatitis B. Which of the following actions should the nurse plan to take when administering the hepatitis B vaccine?

Insert the needle at a 45° angle

Obtain parental consent

Give the first dose at 24 hr after birth.

Administer the medication into the dorsal gluteal muscle

Answer and Explanation

The Correct Answer is C

A) Incorrect- The angle of insertion for the hepatitis B vaccine is typically 90 degrees.

B)   Incorrect- Obtaining parental consent is important for any medical procedure involving a minor, but it is not specific to the administration of the hepatitis B vaccine.
C)   Correct - The first dose of the hepatitis B vaccine is usually given within the first 24 hours after birth to newborns whose mothers are hepatitis B positive to prevent vertical transmission.
D)   Incorrect- The hepatitis B vaccine is usually administered into the vastus lateralis muscle in the newborn's thigh, not the dorsal gluteal muscle.

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Correct Answer is C

Explanation

A) Incorrect- Terbutaline is a tocolytic medication used to relax uterine muscles and inhibit contractions, not to treat an ectopic pregnancy.
B) Incorrect- Magnesium sulfate is used to prevent seizures in clients with preeclampsia, not to treat ectopic pregnancies.
C) Correct - Methotrexate is often used to treat unruptured ectopic pregnancies in the early stages by inhibiting the growth of trophoblastic tissue.
D) Incorrect- Calcium gluconate is used to treat magnesium toxicity and other conditions related to calcium imbalance, not to treat ectopic pregnancies.

A. Apply oxygen via a non-rebreather mask at & L/min. B. Administer methylergonovine 0.2 mg IM C. Encourage the client to empty her bladder D. Initiate fundal massage.

Correct Answer is D

Explanation

Rationale:

A) Incorrect - Applying oxygen is not the priority action in the case of excessive vaginal bleeding and a boggy uterus. Oxygen therapy would be appropriate if there were signs of respiratory distress or decreased oxygen saturation, but it does not directly address the primary concern of uterine atony and bleeding.
B) Incorrect - Administering methylergonovine might be appropriate, but the priority is to address the uterine atony with fundal massage first. Fundal massage helps stimulate uterine contractions and control bleeding, which is crucial in this scenario.
C) Incorrect - Encouraging the client to empty her bladder is important, but it is not the first action to take in the case of excessive bleeding and uterine atony. Immediate intervention to control the bleeding takes precedence.
D) Correct - Initiating fundal massage is the priority action in this situation. A boggy uterus with excessive vaginal bleeding indicates uterine atony, which is a potentially life-threatening condition requiring immediate intervention to prevent further bleeding.
Fundal massage helps the uterus contract and control bleeding. Addressing uterine atony is critical to prevent further hemorrhage and stabilize the client's condition.

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A nurse is assisting with the care of a newborn whose mother has hepatitis B. Which of the following actions should the nurse plan to take when administering the hepatitis B vaccine?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting in the care of a client who is experiencing an unruptured ectopic pregnancy that is at 8 weeks of gestation. Which of the following medications should the nurse expect the provider to prescribe?

Correct Answer is C

Explanation

A nurse is caring for a client who is postpartum. The client is experiencing excessive vaginal bleeding and has a boggy uterus. Which of the following actions should the nurse take first?

Correct Answer is D

Explanation

A nurse on a postpartum unit is caring for a client who delivered vaginally 24 hr ago. Which of the following should the nurse expect to find when collecting data?

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