A nurse is providing teaching to a postpartum client who has a prescription for a rubella immunization.
Which of the following client statements indicates understanding of the teaching?
"I will receive a series of three immunizations and each one will be a month apart.”
"I will report joint pain that develops after the immunization to my provider immediately.”
"I should avoid becoming pregnant for at least 1 month following the immunization.”
"I should avoid breastfeeding for 2 weeks following the immunization.”
The Correct Answer is C
Rubella vaccine is a live atenuated vaccine and women should avoid pregnancy for at least 28 days after receiving the vaccine.
Choice A is incorrect because the rubella vaccine is given as a single dose, not a series of three immunizations.
Choice B is incorrect because joint pain is a common side effect of the rubella vaccine and does not need to be reported immediately to the provider.
Choice D is incorrect because breastfeeding is not contraindicated following rubella immunization.
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Related Questions
Correct Answer is D
Explanation
A nurse caring for a client who is receiving prenatal care and is at her 24-week appointment should plan to conduct a one-hour glucose tolerance test.
This test is done to screen for gestational diabetes that can develop during pregnancy.
Choice A, Group B strep culture, is not an answer because it is a test usually done between 35-37 weeks of pregnancy to check for the presence of Group B streptococcus bacteria.
Choice B, Rubella titer, is not an answer because it is a blood test usually done early in pregnancy to check for immunity to rubella.
Choice C, Blood type and Rh, is not an answer because it is a blood test usually done early in pregnancy to determine the mother’s blood type and Rh factor.
Correct Answer is B
Explanation
The correct answer is. Administering broad-spectrum antibiotics.
Cleansing the site with povidone-iodine is not recommended because it can be irritating and potentially harmful to the exposed neural tissue.
Monitoring the rectal temperature every 4 hours is not appropriate as it can increase the risk of infection and trauma to the site. Axillary temperature monitoring is preferred.
Preparing for surgical closure after 72 hours is incorrect. Surgical closure is typically performed within the first 24 to 48 hours to prevent infection and further damage to the neural tissue.
Administering broad-spectrum antibiotics is crucial to prevent infection, especially since the cerebrospinal fluid is leaking, which increases the risk of meningitis and other infections.
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