A nurse is planning care for a client who is 12 hr postpartum and has a third-degree perineal laceration. Which of the following interventions should the nurse include in the plan?

Place a witch hazel pad on the client's perineal pad after each voiding

Apply hydrogel pads to the perineum every 4 hr

Prepare the client for a pudenal nerve block

Encourage the client to apply a warm pack to the perineum for discomfort

Answer and Explanation

The Correct Answer is B

A. Place a witch hazel pad on the client's perineal pad after each voiding: Witch hazel pads can provide relief from perineal discomfort, but they are typically used in the immediate postpartum period for general comfort rather than specifically for third-degree perineal lacerations.

B. Apply hydrogel pads to the perineum every 4 hr: Hydrogel pads can help soothe and cool the perineal area, providing relief from pain and discomfort. This intervention is appropriate for third-degree perineal lacerations.

C. Prepare the client for a pudendal nerve block: Pudendal nerve blocks are typically used for pain relief during the second stage of labor and delivery. They are not a standard intervention for managing third-degree perineal lacerations postpartum.

D. Encourage the client to apply a warm pack to the perineum for discomfort: While warm packs can provide comfort, they are generally not recommended for third-degree perineal lacerations. Cold packs or hydrogel pads are often more appropriate for reducing swelling and providing relief in this situation.

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Correct Answer is D

Explanation

A. This test determines if your baby is at risk for developing hypoglycemia after birth: The indirect Coombs' test is not related to assessing the risk of hypoglycemia in the baby. It specifically focuses on Rh sensitization.

B. The test will determine the amount of amniotic fluid around the fetus: The indirect Coombs' test does not assess the amount of amniotic fluid around the fetus. It is specifically aimed at detecting antibodies in the maternal blood.

C. The test studies blood flow in the fetus and placenta using ultrasound waves: This description is more indicative of a Doppler ultrasound or other tests that assess blood flow. The indirect Coombs' test is a blood test and does not involve ultrasound waves.

D. This test will detect the presence of Rh-positive antibodies in your blood

The indirect Coombs' test is performed during pregnancy to detect the presence of Rh antibodies in the maternal bloodstream. Rh antibodies can develop if an Rh-negative mother is carrying an Rh-positive baby, and there is a risk of hemolytic disease of the newborn (HDN) in subsequent pregnancies. The test helps identify if the mother has developed antibodies against Rh-positive blood, which could potentially affect the fetus.

A. Human papillomavirus B. Varicella C. Rubella D. Tetanus

Correct Answer is D

Explanation

A. Human papillomavirus (HPV): The HPV vaccine is generally not administered during pregnancy. It is recommended for routine vaccination before sexual activity begins to provide protection against certain types of HPV that can lead to cervical cancer and genital warts.

B. Varicella (chickenpox): The varicella vaccine is also typically not administered during pregnancy. If a woman is not immune to varicella and is planning pregnancy, vaccination is recommended before conception.

C. Rubella : The rubella vaccine is crucial for individuals who have not been immunized against rubella during childhood, especially in the context of pregnancy. Rubella (German measles) is a viral infection that can cause serious congenital abnormalities, known as congenital rubella syndrome, if a pregnant woman becomes infected. Administering the rubella vaccine during pregnancy is not appropriate, but vaccination before conception or in the postpartum period is recommended to prevent future rubella infections.

D.The tetanus vaccine is safe to administer during pregnancy, typically given as part of the Tdap (tetanus, diphtheria, and pertussis) vaccine. It is recommended during pregnancy, preferably between 27 and 36 weeks of gestation, to protect the newborn from pertussis.

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A nurse is planning care for a client who is 12 hr postpartum and has a third-degree perineal laceration. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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