A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

Choice A Reason:

Applying povidone-iodine to the client's perineum after she voids is inappropriate. Povidone-iodine is an antiseptic solution commonly used for wound cleansing, but it is not typically indicated for application to perineal lacerations. Applying povidone-iodine to the perineum may cause irritation and delay wound healing. Instead, perineal care for a fourth-degree laceration usually involves gentle cleansing with warm water and patting dry.

Choice C Reason:

For a client who is 12 hours postpartum with a fourth-degree laceration, providing a cool sitz bath is an appropriate action. This can help reduce swelling, provide comfort, and promote healing in the perineal area. Cool sitz baths can be particularly soothing and beneficial in managing discomfort associated with perineal lacerations.

Choice C Reason:

Administering methylergonovine 0.2 mg IM is inappropriate .Methylergonovine is a medication used to prevent or treat postpartum hemorrhage by causing uterine contractions. However, it is not indicated for pain relief or wound management in clients with perineal lacerations. Administering methylergonovine to a client with a fourth-degree laceration without appropriate indication could lead to adverse effects such as increased uterine tone or hypertonic contractions.

Choice D Reason:

While warm compresses can promote comfort and healing, applying a warm compress immediately after childbirth and with a fourth-degree laceration may not be appropriate as it can increase swelling. Generally, cool therapies are recommended initially for acute swelling and pain relief.

Explanation

Choice A Reason:

Large deposits of subcutaneous fat is incorrect. Postterm newborns may have less subcutaneous fat compared to full-term newborns because they have fewer nutritional resources in the uterus during the extended pregnancy. Therefore, large deposits of subcutaneous fat would not typically be expected in postterm newborns.

Choice B Reason:

Nails extending over tips of fingers is correct. This is a characteristic commonly seen in postterm newborns. As the fetus continues to grow in utero beyond the typical gestational period, the nails may become more prominent and extend over the tips of the fingers.

Choice C Reason:

Pale, translucent skin is incorrect. Postterm newborns may have dry, cracked, or peeling skin due to prolonged exposure to the amniotic fluid. However, pale, translucent skin is not typically associated with postterm birth.

Choice D Reason:

Thin covering of fine hair on shoulders and back is correct. This is a characteristic commonly seen in preterm newborns. It is known as lanugo, a fine layer of hair that covers the shoulders and back of the fetus and typically sheds before birth.