A nurse manager on the labor and delivery unit is teaching a group of newly licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching?

"Lesions are visible on the mother's genitalia."

"Mothers will receive prophylactic treatment with acyclovir prior to delivery."

"This infection requires that airborne precautions be initiated for the newborn."

"Transmission can occur via the saliva and urine of the newborn."

Answer and Explanation

The Correct Answer is D

"Transmission can occur via the saliva and urine of the newborn." Maternal cytomegalovirus (CMV) is a viral infection that can be transmitted to the fetus during pregnancy or to the newborn during delivery or through breast milk. Lesions on the mother's genitalia are associated with herpes simplex virus, not CMV. Mothers with active CMV infection may not show any symptoms, and there is no specific prophylactic treatment with acyclovir for CMV infection. Airborne precautions are not necessary for newborns with CMV infection since the virus is primarily spread through contact with body fluids, such as saliva and urine.

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Correct Answer is D

Explanation

A. It is essential to regularly reposition the newborn (every 2-3 hours) to ensure even exposure to the phototherapy light and to prevent pressure sores. Keeping the newborn supine throughout the treatment is not recommended.

B. The newborn should be undressed, except for a diaper, during phototherapy to maximize skin exposure to the light. Lightweight clothing can reduce the effectiveness of the treatment.

C. Temperature monitoring should be more frequent than every 8 hours. Phototherapy can cause fluctuations in the newborn's temperature, including overheating or hypothermia, so checking every 2-4 hours is generally recommended.

D. Lotions or ointments should not be applied to the newborn's skin during phototherapy because they can absorb heat, potentially leading to burns or skin irritation. Phototherapy can dry out the skin, but moisturizing treatments should be avoided during the therapy itself.

A. Three uterine contractions within a 20-min period B. One acceleration of the FHR within a 20-min period C. Uterine contractions lasting 20 to 30 seconds each D. An FHR that peaks 20 beats above the baseline

Correct Answer is A

Explanation

Three uterine contractions within a 20-min period require intervention by the nurse during a nonstress test at 35 weeks of gestation. The nonstress test is used to assess fetal well-being by monitoring the fetal heart rate (FHR) response to fetal movement. The test is considered reactive if there are two or more accelerations of the FHR within a 20-min period, each lasting at least 15 seconds and peaking at least 15 beats above the baseline. In this scenario, the finding that requires intervention by the nurse is three uterine contractions within a 20-min period. This is because frequent or prolonged contractions can indicate preterm labor, which requires immediate intervention

to prevent premature delivery. The nurse should assess the client for signs and symptoms of preterm labor, such as pelvic pressure, low back pain, vaginal bleeding or discharge, and abdominal cramping. The nurse should also notify the provider and prepare the client for further evaluation and possible interventions, such as tocolytic therapy to stop the contractions.

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A nurse manager on the labor and delivery unit is teaching a group of newly licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a full-term newborn who is receiving phototherapy. Which of the following actions should the nurse include in the plan of care?

Correct Answer is D

Explanation

A nurse is monitoring a client who is undergoing a nonstress test at 35 weeks of gestation. Which of the following findings requires intervention by the nurse?

Correct Answer is A

Explanation

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