A nurse is caring for a client who is in active labor with a fetus in the occipitoposterior position. The nurse assists the client into a hands-and-knees position. Which of the following questions should the nurse ask to evaluate the effectiveness of this intervention?

A. Administering broad-spectrum antibiotics is important because a leaking myelomeningocele increases the newborn’s risk for infection, including meningitis. Early prophylactic antibiotic therapy helps prevent serious complications.

B. Cleansing the site with povidone-iodine is not recommended because antiseptics can irritate neural tissue and worsen leakage. The sac should be kept sterile and moist using a saline-soaked sterile dressing instead.

C. Monitoring rectal temperature is contraindicated because rectal manipulation can risk trauma to the myelomeningocele sac. Noninvasive temperature monitoring, such as axillary measurement, is safer.

D. Surgical closure should be performed as soon as possible, ideally within 24–48 hours after birth, rather than waiting 72 hours, to reduce the risk of infection and further neurologic damage.

Rationale:

A. Raw carrots are not a significant source of vitamin B12, which is typically lacking in a vegan diet.

B. Brown rice is a healthy grain but does not contain vitamin B12, which is necessary for those following a vegan diet.

C. Fresh citrus fruits provide vitamin C but not vitamin B12, which is important for individuals following a vegan diet.

D. Fortified soy milk is often enriched with vitamin B12, making it a suitable recommendation for individuals practicing a vegan diet who need to increase their intake of this nutrient.