A nurse is reinforcing teaching about immunizations with a woman in her first trimester of pregnancy whose diagnostic testing indicates she does not have immunity to rubella. The nurse should recommend that the client receive a measles, mumps, rubella (MMR) vaccine at which of the following times?

Choice A rationale: An amniocentesis involves inserting a needle through the abdominal wall into the amniotic sac to obtain a sample of amniotic fluid. Emptying the bladder before the procedure reduces the risk of bladder puncture during the process.
Choice B rationale: Fasting is not typically necessary for an amniocentesis. It is generally done on an outpatient basis, and fasting is not required.
Choice C rationale: An enema is not necessary before an amniocentesis and is not part of the standard preparation.
Choice D rationale: While cleanliness is important, this instruction is not specific to an amniocentesis and is not a standard pre-procedure requirement.

The correct answer is Choice B, the nipple line.

Choice A rationale: The axillae, or underarms, are not used to measure chest circumference in a newborn. This area does not provide an accurate or consistent measurement of chest size due to the positioning and movement of the baby’s arms.

Choice B rationale: The nipple line is the correct anatomical landmark to use when measuring chest circumference in a newborn. This line is typically used because it provides a consistent and accurate measurement. It is located at the level of the nipples, which is approximately at the mid-chest level. This location allows for a measurement that is representative of the chest size, as it is at the broadest part of the chest.

Choice C rationale: The lower ribcage border is not the correct landmark for measuring chest circumference in a newborn. This area is too low and would not provide an accurate representation of the chest size. The measurement taken at this location would be smaller than the actual chest size, as it is below the broadest part of the chest.

Choice D rationale: The sternal notch is not an appropriate landmark for measuring chest circumference in a newborn. The sternal notch is located at the top of the sternum, near the base of the neck. A measurement taken at this location would not accurately represent the size of the chest, as it is above the broadest part of the chest.