A nurse is attending to an antepartum client whose lab results show a negative rubella titer.
What is the correct interpretation of this data?
The client is immune to the rubella virus.
The client needs a rubella vaccination immediately.
The client should receive a rubella immunization post-delivery.
The client is not currently infected with the rubella virus.
The Correct Answer is C
Choice A rationale
A negative rubella titer indicates that the client does not have immunity to the rubella virus. Therefore, the statement that the client is immune to the rubella virus is incorrect.
Choice B rationale
While it is true that a person with a negative rubella titer needs a rubella vaccination, it is not recommended to administer the vaccine immediately during pregnancy due to the potential risks to the fetus. Therefore, this statement is not correct in this context.
Choice C rationale
The correct interpretation of a negative rubella titer in an antepartum client is that the client should receive a rubella immunization post-delivery. This is because rubella can cause serious complications if contracted during pregnancy, including congenital rubella syndrome in the newborn. Vaccination post-delivery will protect the client in future pregnancies.
Choice D rationale
A negative rubella titer does not provide information about whether the client is currently infected with the rubella virus. It only indicates that the client does not have immunity to the virus. Therefore, this statement is not a correct interpretation of the data.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While seeing a counselor could be beneficial for some women experiencing doubts and second thoughts about their pregnancy, it is not necessarily the first or only option. Many women experience a range of emotions during pregnancy, and these feelings are often temporary.
Choice B rationale
Telling a woman not to worry and that she will be fine once the baby is born may minimize her feelings and concerns. It’s important to validate her feelings and provide support.
Choice C rationale
While talking to a trusted family member or friend can be helpful, it’s not the only option. Some women may not feel comfortable discussing their feelings with family members.
Choice D rationale
Ambivalent feelings are quite common for women early in pregnancy. It’s a time of significant change, and it’s normal to have mixed feelings about it. It can be helpful to discuss these feelings with a healthcare provider, who can provide reassurance and resources.
Correct Answer is A
Explanation
Choice A rationale
Maintain the patient on bed rest. This is a common nursing intervention for a patient who is experiencing an inevitable abortion. Bed rest can help reduce the risk of further complications, such as heavy bleeding. It can also provide the patient with a chance to rest and recover physically and emotionally.
Choice B rationale
Offer the option to view products of conception. This intervention may not be appropriate for all patients. While some patients may find it helpful to view the products of conception, others may find it distressing. It’s important to discuss this option with the patient and respect her wishes.
Choice C rationale
Administer oxygen via a nasal cannula. This intervention may not be necessary for all patients experiencing an inevitable abortion. While oxygen therapy can be used to treat hypoxia in patients with heavy bleeding, it’s not typically required unless the patient shows signs of hypoxia.
Choice D rationale
Instruct the patient to increase potassium-rich foods in the diet. This intervention is not typically part of the care plan for a patient experiencing an inevitable abortion. While a balanced diet is important for overall health, there’s no specific need to increase potassium-rich foods in the diet in this situation.
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