A nurse is preparing to administer gentamicin 2 mg/kg IM to a client who has pelvic inflammatory disease and weighs 132 lb. Available is gentamicin injection 40 mg/mL. How many mL should the nurse administer?

(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Ultrasonography is a diagnostic imaging technique that uses high-frequency sound waves to create images of the internal structures of the body. It is a safe and noninvasive method that can provide valuable information about the pregnancy, such as the number, size, location, and health of the fetus(es), the placenta, the amniotic fluid, and the uterus.
Ultrasonography can be performed at any time during pregnancy, but it is especially useful in the first trimester (the first 12 weeks of pregnancy) for several reasons, such as:

- To confirm the pregnancy and rule out ectopic pregnancy (a pregnancy that occurs outside the uterus) or molar pregnancy (a pregnancy that develops into an abnormal mass of tissue)
- To determine gestational age (the length of time since the first day of the last menstrual period) and estimate due date (the expected date of delivery)
- To screen for chromosomal abnormalities (such as Down syndrome) or structural defects (such as spina bifida) in the fetus
- To identify multiple gestations (such as twins or triplets) or complications (such as miscarriage or
bleeding)
One of the main uses of ultrasonography in the first trimester is to determine gestational age. This is important because it can affect many aspects of prenatal care and delivery, such as:
- The timing and accuracy of other tests and procedures
- The monitoring and evaluation of fetal growth and development
- The identification and management of potential problems or complications
- The planning and preparation for labor and delivery
Gestational age can be determined by measuring the crown-rump length (CRL) of the fetus, which is the distance from the top of the head to the bottom of the spine. The CRL can be measured by using a transvaginal ultrasound (an ultrasound probe that is inserted into the vagina) or a transabdominal ultrasound (an ultrasound probe that is moved over the abdomen). The CRL can be compared to a standard growth chart to estimate gestational age. The CRL measurement is most accurate between 7 and 13 weeks of pregnancy .
Therefore, the newly licensed nurse who says that ultrasound is used to determine gestational age in the first trimester indicates an understanding of the teaching.

The other statements show a lack of knowledge or misunderstanding of the uses of ultrasonography in the first trimester:
- a) "Ultrasound is used to observe for placental maturity in the first trimester." This is not correct because placental maturity is not assessed in the first trimester. Placental maturity refers to the changes that occur in the placenta as it ages and prepares for delivery. Placental maturity can be evaluated by using a grading system that ranges from 0 to 3, based on the appearance of calcifications (deposits of calcium) in the placenta. Placental maturity can be assessed by using a transabdominal ultrasound in the third trimester (after 28 weeks of pregnancy).
- b) "Ultrasound is used to detect intrauterine growth restriction in the first trimester." This is not correct because intrauterine growth restriction (IUGR) is not detected in the first trimester. IUGR is a condition in which the fetus does not grow as expected and has a low birth weight for its gestational age. IUGR can be caused by various factors, such as placental insufficiency, maternal malnutrition, infection, or chronic disease. IUGR can affect fetal development and increase the risk of complications, such as hypoxia, hypoglycemia, or stillbirth. IUGR can be diagnosed by measuring fetal growth parameters, such as abdominal circumference, head circumference, femur length, and estimated fetal weight. These measurements can be obtained by using a transabdominal ultrasound in the second or third trimester (after 20 weeks of pregnancy).

- d) "Ultrasound is used to perform a biophysical profile in the first trimester." This is not correct because a biophysical profile (BPP) is not performed in the first trimester. A BPP is a test that evaluates fetal well-being by assessing five parameters: fetal movement, fetal tone, fetal breathing, amniotic fluid volume, and fetal heart rate. A BPP can help detect fetal distress or hypoxia and guide management decisions. A BPP can be performed by using a combination of transabdominal ultrasound and nonstress test (NST) in the third trimester (after 32 weeks of pregnancy).

Listeriosis is a foodborne illness that can be very dangerous during pregnancy. It is caused by eating foods contaminated with the bacterium Listeria monocytogenes, which can grow well at refrigerator temperatures. Listeriosis can cause miscarriage, stillbirth, preterm labor, and serious illness or death in newborns. Pregnant women are 10 times more likely than other people to get Listeria infection¹.
To prevent listeriosis, pregnant women should avoid certain types of food that are more likely to be contaminated with Listeria, such as:
- Hot dogs and deli meats, unless they are reheated until steaming hot

- Soft cheeses made from unpasteurized milk, such as feta, brie, camembert, blue-veined cheeses, and
queso fresco
- Refrigerated pâtés or meat spreads
- Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel
- Raw or undercooked meat, poultry, seafood, or eggs
- Unpasteurized milk or dairy products
- Unwashed fruits and vegetables
Grilled chicken on a bun is a safe choice for lunchtime because the chicken is cooked and the bun is not likely to be contaminated with Listeria. However, the other options are not safe for pregnant women because they may contain Listeria or other harmful bacteria. A hot dog at the ballpark may not be reheated enough to kill Listeria. A seafood salad from the grocery store may contain refrigerated smoked seafood or mayonnaise made from raw eggs. Soft cheese is often made from unpasteurized milk and can harbor Listeria.

The other options are incorrect because they may expose the client to Listeria or other harmful bacteria, as I explained in my previous response. Let me summarize the reasons for you:

b) "I can still have a hot dog at the ballpark. This is incorrect because hot dogs and deli meats may contain Listeria unless they are reheated until steaming hot. A hot dog at the ballpark may not be hot enough to kill the bacteria.
c) "I can purchase a seafood salad from the grocery store." This is incorrect because seafood salad may contain refrigerated smoked seafood or mayonnaise made from raw eggs. Refrigerated smoked seafood can harbor Listeria and raw eggs can contain Salmonella or other bacteria that can cause food poisoning.
d) "I can have a mid-day snack with soft cheese.” This is incorrect because soft cheese made from unpasteurized milk can be contaminated with Listeria. Examples of soft cheese are feta, brie, camembert, blue-veined cheeses, and queso fresco.