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IM in right deltoid:The deltoid muscle is not typically used for IM injections in newborns. Additionally, the vastus lateralis muscle in the thigh is preferred over the deltoid muscle for IM injections in infants.

Subcutaneous in the right deltoid:Subcutaneous administration is not the preferred route for phytonadione in newborns. Additionally, the deltoid muscle is not commonly used for subcutaneous injections in newborns.

Subcutaneous in the left vastus lateralis:Subcutaneous administration is not the preferred route for phytonadione in newborns. Additionally, the vastus lateralis muscle is typically used for IM injections rather than subcutaneous injections in infants.

An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40-min testing period:This finding is reassuring.A reactive NST (with accelerations in FHR) indicates that the baby is healthy and responsive to movement.

No late decelerations in the fetal heart rate noted with three uterine contractions of 60 seconds in duration within a 10-min testing period.
The absence of late decelerations during uterine contractions is a positive finding during an NST. Late decelerations, which occur after the peak of the contraction, can indicate uteroplacental insufficiency and fetal hypoxia. Therefore, not observing late decelerations during contractions is reassuring and does not typically necessitate further testing.

Three fetal movements perceived by the client in a 20-min testing period.Perceiving fetal movements during the testing period is generally considered reassuring during an NST. Fetal movements are indicative of fetal well-being and activity. Therefore, this finding is typically interpreted as a positive sign and does not typically require further evaluation during the NST.

Human papillomavirus (HPV) vaccine:The HPV vaccine is not recommended during pregnancy because there is limited safety data regarding its use in pregnant women. It is typically administered to individuals before they become sexually active to prevent HPV infections, which can lead to cervical cancer and other HPV-related diseases. Since the client is currently pregnant, administering the HPV vaccine would not be appropriate due to the lack of safety data during pregnancy.

Rubella vaccine:The rubella vaccine is a live attenuated vaccine, and its administration during pregnancy is contraindicated due to the risk of congenital rubella syndrome (CRS) if the vaccine were to cause rubella infection in the pregnant woman. Rubella vaccination should be provided to non-pregnant individuals, particularly women of childbearing age, to prevent CRS. Administering the rubella vaccine to a pregnant woman at 28 weeks of gestation would pose a risk to both the mother and the developing fetus.

Varicella vaccine:
Similar to the rubella vaccine, the varicella (chickenpox) vaccine is a live attenuated vaccine and is contraindicated during pregnancy due to the risk of varicella infection in the pregnant woman, which can lead to severe complications for both the mother and the fetus. Varicella vaccination is recommended for individuals who have not had chickenpox or received the vaccine previously but should not be administered to pregnant women.

. Apply an ice pack to the incision site.
Applying an ice pack to the incision site is not the appropriate action for addressing vaginal bleeding. Ice packs are typically used to reduce swelling and provide comfort after surgery, but they are not effective for controlling bleeding. In this scenario, the primary concern is the steady trickle of vaginal bleeding, which could indicate postpartum hemorrhage (PPH). Therefore, applying an ice pack would not address the underlying issue and is not the correct action to take at this time.

Administer 500 mL lactated Ringer's IV bolus.Administering a lactated Ringer's IV bolus may be necessary if the client is experiencing hypovolemia due to excessive bleeding. However, before administering fluids, it is important to address the source of bleeding. While IV fluids may be indicated as part of the treatment for postpartum hemorrhage, they should be given after assessing the extent of bleeding and determining the appropriate management. Therefore, while fluid resuscitation may eventually be necessary, it is not the immediate priority in this scenario.

Replace the surgical dressing. This action addresses the surgical site but does not directly relate to managing vaginal bleeding.

Move the client onto their hands and knees.This action refers to the Gaskin maneuver, which involves changing the maternal position to help alleviate shoulder dystocia during childbirth. By positioning the client on their hands and knees, gravity assists in changing the orientation of the pelvis, potentially allowing more space for the baby to be delivered. While the Gaskin maneuver can be effective in some cases of shoulder dystocia, it is not the McRoberts maneuver.

Press firmly on the client's suprapubic area.This action describes the Rubin maneuver, another technique used to address shoulder dystocia. With the Rubin maneuver, pressure is applied to the anterior shoulder of the fetus, aiming to rotate it into an oblique diameter, which may help dislodge the shoulder from behind the symphysis pubis. While the Rubin maneuver can be helpful in certain cases of shoulder dystocia, it is not the McRoberts maneuver.

Apply pressure to the client's fundus.
Applying pressure to the client's fundus is not part of the McRoberts maneuver. In fact, this action is not recommended for managing shoulder dystocia as it could potentially worsen the situation by causing further impaction of the baby's shoulder against the mother's pubic bone.

Instruct the client not to use donor oocytes:Donor oocytes (eggs) are commonly used in IVF procedures, particularly for clients who have infertility related to egg quality or production issues. The decision to use donor oocytes should be based on individual circumstances and preferences. It is not appropriate for the nurse to instruct the client not to use donor oocytes without knowing the client's specific situation and preferences.

Instruct the client to avoid freezing embryos for possible use in the future:
Freezing embryos for future use, known as embryo cryopreservation, is a common practice in IVF. It allows for the preservation of embryos that are not transferred during the initial IVF cycle for potential use in subsequent cycles. Embryo cryopreservation can improve the chances of pregnancy without the need for additional ovarian stimulation and egg retrieval procedures. Therefore, instructing the client to avoid freezing embryos would not be appropriate advice.

Inform the client that sperm will be introduced to the uterus during ovulation:This statement is incorrect. In IVF, fertilization typically occurs outside the body in a laboratory setting. The eggs retrieved from the ovaries are fertilized with sperm in a dish, and the resulting embryos are then transferred to the uterus. Sperm is not introduced to the uterus during ovulation in the context of IVF.

. A client who reports lochia rubra requiring changing perineal pads every 3 hr:
This finding is consistent with normal postpartum lochia patterns, particularly in the early postpartum period. Lochia rubra is the initial bright red vaginal discharge that occurs after childbirth, and changing perineal pads every 3 hours is within the expected range. There is no immediate concern requiring notification of the provider for this client.

A client who reports abdominal cramping during breastfeeding:Abdominal cramping during breastfeeding, also known as afterpains, is a common occurrence in the postpartum period, especially for multiparous clients. These cramps are caused by the release of oxytocin during breastfeeding and help the uterus to contract and return to its pre-pregnancy size. While uncomfortable, afterpains are considered normal and do not typically require notification of the provider unless they are severe or accompanied by other concerning symptoms.

A client who has a urinary output of 300 mL in 8 hr:This urinary output is below the expected range for a postpartum client, and it may indicate inadequate fluid intake, urinary retention, or other issues. While it is important to monitor urinary output and address any potential concerns, this finding alone may not require immediate notification of the provider. However, continued monitoring and assessment are warranted to ensure adequate urinary function.

Previous delivery of a newborn weighing 2.5 kg (5.5 lb):A newborn weighing 2.5 kg (5.5 lb) at birth suggests that the infant was small for gestational age (SGA). While SGA infants may be at risk for various complications, such as intrauterine growth restriction (IUGR), it does not directly indicate an increased risk for preterm delivery in subsequent pregnancies. Therefore, this choice is not indicative of preterm delivery risk.

Previous reactive non-stress test:
A reactive non-stress test (NST) is a reassuring finding during pregnancy and indicates that the fetus is receiving adequate oxygenation and is not under distress. While the absence of a reactive NST might indicate fetal compromise and the need for further evaluation, a previous reactive NST does not necessarily indicate an increased risk for preterm delivery.

Previous delivery at 37 weeks gestation:A delivery at 37 weeks gestation is considered full-term and does not indicate an increased risk for preterm delivery. In fact, delivering at 37 weeks is within the normal range of gestational age and is not typically associated with preterm birth risk factors. Therefore, this choice does not indicate an increased risk for preterm delivery.

A. "Hypnosis can be beneficial if you practiced it during the prenatal period":
This statement is accurate. Hypnosis techniques for pain management during labor can be more effective if the client has practiced and familiarized themselves with the techniques during the prenatal period. Regular practice can help the client achieve a deeper state of relaxation and better utilize hypnosis for pain control during labor.

B. "Synchronized breathing will be required during hypnosis":
While synchronized breathing techniques can be part of hypnosis practice, it is not necessarily a requirement for hypnosis to be effective for pain management during labor. Different hypnosis techniques may focus on various aspects such as visualization, deep relaxation, or suggestion to manage pain.

C. "Focusing on controlling body functions will be helpful during hypnosis":
While focusing on controlling body functions, such as breathing or muscle tension, can be part of hypnosis techniques, it is not the only focus. Hypnosis for pain management during labor often involves guiding the mind to a state of deep relaxation and altering perceptions of pain rather than directly controlling body functions.

A. "Hypnosis can be beneficial if you practiced it during the prenatal period":
This statement is accurate. Hypnosis techniques for pain management during labor can be more effective if the client has practiced and familiarized themselves with the techniques during the prenatal period. Regular practice can help the client achieve a deeper state of relaxation and better utilize hypnosis for pain control during labor.

B. "Synchronized breathing will be required during hypnosis":
While synchronized breathing techniques can be part of hypnosis practice, it is not necessarily a requirement for hypnosis to be effective for pain management during labor. Different hypnosis techniques may focus on various aspects such as visualization, deep relaxation, or suggestion to manage pain.

C. "Focusing on controlling body functions will be helpful during hypnosis":
While focusing on controlling body functions, such as breathing or muscle tension, can be part of hypnosis techniques, it is not the only focus. Hypnosis for pain management during labor often involves guiding the mind to a state of deep relaxation and altering perceptions of pain rather than directly controlling body functions.

A. "Hypnosis can be beneficial if you practiced it during the prenatal period":
This statement is accurate. Hypnosis techniques for pain management during labor can be more effective if the client has practiced and familiarized themselves with the techniques during the prenatal period. Regular practice can help the client achieve a deeper state of relaxation and better utilize hypnosis for pain control during labor.

B. "Synchronized breathing will be required during hypnosis":
While synchronized breathing techniques can be part of hypnosis practice, it is not necessarily a requirement for hypnosis to be effective for pain management during labor. Different hypnosis techniques may focus on various aspects such as visualization, deep relaxation, or suggestion to manage pain.

C. "Focusing on controlling body functions will be helpful during hypnosis":
While focusing on controlling body functions, such as breathing or muscle tension, can be part of hypnosis techniques, it is not the only focus. Hypnosis for pain management during labor often involves guiding the mind to a state of deep relaxation and altering perceptions of pain rather than directly controlling body functions.