A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care?

Instruct the client to stop taking the antiretroviral medications at 32 weeks of gestation.

Use a fetal scalp electrode during labor and delivery.

Bathe the newborn before initiating skin-to-skin contact.

Administer a pneumococcal immunization to the newborn within 4 hr following

Answer and Explanation

The Correct Answer is C

The purpose of bathing the newborn before initiating skin-to-skin contact is to decrease the risk of transmission of the virus from the mother to the newborn. Instructing the client to stop taking the antiretroviral medications at 32 weeks of gestation is incorrect as these medications should be taken throughout pregnancy to decrease the risk of transmission to the fetus.

Using a fetal scalp electrode during labor and delivery is also not an appropriate action as it increases the risk of transmission of the virus to the newborn. Administering a pneumococcal immunization to the newborn within 4 hours following birth is not specific to HIV positive newborns and is not related to preventing transmission of the virus.

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Correct Answer is C

Explanation

The nurse should include in the teaching that clients who use a diaphragm for birth control should have an annual examination to assess its fit and effectiveness. The nurse should also educate clients on the proper use and care of the diaphragm.

Spermicide should be used no more than 30 minutes prior to sexual intercourse, not 3 hours prior.

Emergency contraception does not provide ongoing protection against pregnancy, so clients will need to use another form of birth control immediately after taking the medication.

Fertility can return quickly after the removal of an IUD, usually within a few weeks to a month.

A. The client has a fundal height of 38 cm B. The client has a fasting blood glucose of 90 mg/dL. C. The client reports 12 fetal movements in 1 hr. D. The client has non pitting pedal edema.

Correct Answer is A

Explanation

Gestational diabetes mellitus (GDM) is a condition in which a pregnant woman develops high blood sugar levels during pregnancy. Complications of GDM can include macrosomia (a larger-than-average baby), polyhydramnios (an excessive amount of amniotic fluid), and preterm labor. One of the ways to monitor for these complications is through regular fundal height measurements. A fundal height measurement that is significantly larger than expected can indicate macrosomia or polyhydramnios, which can lead to complications during delivery.

Option B is incorrect because a fasting blood glucose of 90 mg/dL is within the normal range for a non-pregnant individual, and it is lower than the target range for a pregnant woman with GDM.

Option C is also incorrect because a fetal movement count of 12 in 1 hour is within the normal range.

Option D is incorrect because non-pitting pedal edema is a common finding in pregnancy and is not typically a cause for concern.

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A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is conducting a class for a group of clients about birth control. Which of the following information should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is caring for a client who is at 32 weeks of gestation and has gestational diabetes mellitus. Which of the following findings should the nurse report to the provider?

Correct Answer is A

Explanation

A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain. Which of the following nursing interventions are appropriate to reduce pain? (Select all that apply.)

A nurse is performing an assessment of a newborn's Babinski reflex. Which of the following findings should the nurse expect?

A nurse is reviewing the electronic medical record of a postpartum client. The nurse should identify which of the following factors places the client at risk for an infection?

A nurse is reviewing the chart of a client who is 2 days postpartum following a vaginal delivery and reports constipation. Which of the following findings should the nurse identify as a contraindication to the use of a suppository?

A nurse is caring for a client who is at 30 weeks of gestation. The nurse should plan to immunize the client with which of the following vaccines? (Select all that apply.)

A nurse is caring for a client who is postpartum and experiencing hypovolemic shock. Which of the following findings should the nurse expect?

A nurse is assessing the results of a nonstress test for an antepartal client at 35 weeks of gestation. Which of the following findings should indicate to the nurse the need for further diagnostic testing?