Question

A nurse is reinforcing teaching with a client who is at 38 weeks of gestation and has a positive group B streptococcus B-hemolytic screening Which of the following medications should the nurse discuss as the prophylaxis treatment during labor for this client?

Answer 1

Correct Answers:

Penicillin.

Rationale :

🌷 Penicillin is the first-line prophylactic antibiotic for clients who are GBS-positive at term.

🌷 Intrapartum administration of penicillin reduces the risk of early-onset GBS infection in the newborn, such as sepsis, pneumonia, or meningitis.

🌷 Cefazolin may be used for clients with a mild penicillin allergy, but penicillin is preferred due to its effectiveness and narrow spectrum.

🌷 Erythromycin and vancomycin are considered only for clients with severe penicillin allergies or in cases of resistant strains, making them less common for routine prophylaxis.

🌷 CDC guidelines recommend penicillin as the standard for GBS intrapartum prophylaxis to best protect the neonate.

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Answer 2

Correct Answers:

A client who received magnesium sulfate during labor.

Rationale :

🔷 Magnesium sulfate is used in obstetrics to prevent seizures in preeclampsia and treat preterm labor, but it has a narrow therapeutic range and can cause serious side effects such as respiratory depression, decreased deep tendon reflexes, hypotension, and cardiac arrest in the postpartum client.

🔷 Clients who have received magnesium sulfate require immediate, frequent, and focused assessments because they are at risk for life-threatening toxicity or complications, which can develop rapidly after delivery.

🔷 Early recognition of magnesium toxicity—such as monitoring for respiratory rate, urine output, and deep tendon reflexes—is essential to prevent severe outcomes, making this client the highest priority for the nurse.

🔷 The other clients are stable or do not have immediate life-threatening risks; for example, difficulty with newborn latching is not urgent, and a history of oligohydramnios or short labor duration does not present the same acute risks.

🔷 Timely intervention for magnesium toxicity can save the client's life, including the prompt administration of calcium gluconate if toxicity is suspected.

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Answer 3

Correct Answers:

Eat dry, bland foods in the morning.

Rationale :

🔸 Morning sickness is common in the first trimester and often improves by the second trimester, but early intervention is key to maternal comfort and nutrition.

🔸 Dry, bland foods (such as crackers or toast) help absorb gastric acid and reduce nausea, especially before getting out of bed in the morning.

🔸 This strategy prevents the stomach from being empty, which can trigger nausea due to increased gastric acid production.

🔸 Avoiding spicy, fatty, or strong-smelling foods further decreases the likelihood of worsening symptoms.

🔸 Other options—like antacids, increasing fruits, or restricting fluids—are not recommended as first-line management and may even exacerbate symptoms or risk dehydration.

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Answer 4

Correct Answers:

Chicken breast.

Rationale :

♦ Chicken breast is the best source of heme iron, which is more readily absorbed by the body compared to non-heme iron found in plant-based foods.

♦ Iron needs increase during pregnancy to support increased maternal blood volume and fetal development, making high-quality dietary sources essential.

♦ Carrots and apples are low in iron and are not significant sources of this mineral; they do not meet the increased demand for iron in pregnancy.

♦ Feta cheese contains minimal iron and is not considered a good dietary source for iron supplementation.

♦ Animal sources such as chicken, beef, and fish provide more efficient iron absorption, making them superior for addressing pregnancy-related iron needs.

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Answer 5

Correct Answers:

"I will apply witch hazel pads after urination.”. .

Rationale :

⭐ Witch hazel pads are commonly recommended for postpartum clients with episiotomies and hemorrhoids because they provide soothing relief from pain, itching, and swelling without irritating the perineal tissue.

⭐ Applying witch hazel after urination helps keep the area clean, reduces inflammation, and promotes comfort, especially after voiding when perineal tissues are most sensitive.

⭐ Witch hazel is a natural astringent that can decrease swelling and discomfort, making it an ideal choice for postpartum perineal care.

⭐ This practice also helps maintain perineal hygiene, which is essential for preventing infection in the presence of incisions or hemorrhoids.

⭐ Using witch hazel pads after urination is a simple and effective self-care measure, often included in standard postpartum teaching.

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Answer 6

Correct Answers:

1 cup cooked spinach.

Rationale :

🔷 Cooked spinach is exceptionally high in folate (folic acid), which is crucial for preventing neural tube defects in early pregnancy.

🔷 Just one cup of cooked spinach provides a large portion of the recommended daily folate intake for pregnant individuals, making it the most folate-rich option among those listed.

🔷 Orange juice contains some folate but in much lower amounts compared to leafy greens like spinach.

🔷 Eggs and pasta offer minimal folate and are not primary dietary sources for meeting the increased needs during the first trimester.

🔷 Including leafy green vegetables like spinach is consistently recommended in prenatal nutrition guidelines for optimal folate intake.

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Answer 7

Correct Answers:

Place breast shells in the client's bra.

Rationale :

🟢 Breast shells are specifically designed to help correct inverted nipples by gently applying pressure around the nipple, encouraging it to protrude.

🟢 This intervention can make it easier for a newborn to latch effectively during breastfeeding, reducing frustration for both mother and baby.

🟢 Breast shells are worn inside the bra and can be used between feedings; they do not treat or irritate the nipple surface.

🟢 Use of underwire bras is discouraged postpartum as it can impede milk flow and increase the risk of blocked ducts or mastitis.

🟢 Creams and plastic-lined pads do not address the anatomical issue of inversion and may cause additional problems such as irritation or reduced ventilation.

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Answer 8

Correct Answers:

Deafness.

Rationale :

⭐ Rubella exposure during pregnancy, especially in the first trimester, is a serious risk to the fetus because the virus can cross the placenta and disrupt organ development.

⭐ Congenital rubella syndrome (CRS) is associated with several birth defects, of which sensorineural deafness is the most common and often the earliest detected.

⭐ The developing auditory system is highly sensitive to rubella; damage can occur even if the mother’s infection was in early pregnancy, resulting in permanent hearing loss in the newborn.

⭐ Other classic CRS findings include cataracts, congenital heart defects (like patent ductus arteriosus), and sometimes microcephaly, but deafness is the most frequent sequela.

⭐ Routine newborn screening for hearing loss is important when there has been maternal rubella exposure, even if the infant appears otherwise healthy, to ensure early intervention if deafness is present.

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Answer 9

Correct Answers:

Move the seat as far away as possible from the steering wheel.

Rationale :

🟡 Moving the seat as far from the steering wheel as possible while still being able to reach the pedals and controls is the safest option for pregnant clients, especially in the first trimester and as the pregnancy progresses.

🟡 This position reduces the risk of abdominal trauma from the steering wheel or airbag in case of a collision, protecting both the mother and the fetus.

🟡 Airbags should not be disabled because they provide critical protection in an accident; instead, maintaining distance minimizes their force.

🟡 The lap belt should always be worn low, below the abdomen and over the hips, not high across the abdomen, to prevent injury to the uterus.

🟡 The shoulder harness should cross between the breasts and to the side of the uterus, not directly over the gravid uterus.

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Answer 10

Correct Answers:

Blurred vision.

Rationale :

◆ Blurred vision in a pregnant client at 41 weeks may signal preeclampsia, a serious hypertensive disorder that can develop in late pregnancy.

◆ This symptom is considered a danger sign because it can indicate neurological involvement, which may precede seizures (eclampsia).

◆ Preeclampsia often presents with additional signs such as headache, epigastric pain, and elevated blood pressure, all of which require immediate medical evaluation.

◆ Prompt recognition of blurred vision helps prevent progression to severe complications, including maternal and fetal morbidity.

◆ Clients at post-term gestation (over 40 weeks) are at increased risk for complications, making assessment for signs of preeclampsia vital

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QLexNursing

1 :
A nurse is reinforcing teaching with a client who is at 38 weeks of gestation and has a positive group B streptococcus B-hemolytic screening Which of the following medications should the nurse discuss as the prophylaxis treatment during labor for this client?

2 :
A nurse has just received change-of-shift report about four clients who are postpartum. Which of the following clients should the nurse plan to see first?

3 :
A nurse is caring for a client who is at 9 weeks of gestation and reports nausea in the morning that continues until midafternoon. Which of the following actions should the nurse encourage the client to take?

4 :
A nurse is reinforcing teaching with a client who is at 18 weeks of gestation and requires an increased intake of iron. Which of the following foods should the nurse recommend as the best source of iron?

5 :
A nurse is reinforcing teaching about perineal care to a client who is 2 hours postpartum and has an episiotomy and hemorrhoids. Which of the following statements by the client indicates understanding of the teaching?

6 :
A nurse is reinforcing teaching with a client who is in the first trimester of pregnancy about increasing their intake of foods that are high in folate. Which of the following should the nurse recommend as the food with the highest folate content?

7 :
A nurse is caring for a client who is postpartum and has inverted nipples. Which of the following actions should the nurse take?

8 :
A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse notes maternal exposure to rubella during pregnancy. After delivery, the nurse should monitor the newborn for which of the following conditions?

9 :
A nurse is reinforcing teaching about safety precautions to take when driving a car with a client who is in the first trimester of pregnancy. Which of the following instructions should the nurse include in the teaching?

10 :
A nurse is caring for a client who is at 41 weeks of gestation. The nurse should understand that which of the following findings can indicate a prenatal complication in this client?

QLexNursing

1 : A nurse is reinforcing teaching with a client who is at 38 weeks of gestation and has a positive group B streptococcus B-hemolytic screening Which of the following medications should the nurse discuss as the prophylaxis treatment during labor for this client?

2 : A nurse has just received change-of-shift report about four clients who are postpartum. Which of the following clients should the nurse plan to see first?

3 : A nurse is caring for a client who is at 9 weeks of gestation and reports nausea in the morning that continues until midafternoon. Which of the following actions should the nurse encourage the client to take?

4 : A nurse is reinforcing teaching with a client who is at 18 weeks of gestation and requires an increased intake of iron. Which of the following foods should the nurse recommend as the best source of iron?

5 : A nurse is reinforcing teaching about perineal care to a client who is 2 hours postpartum and has an episiotomy and hemorrhoids. Which of the following statements by the client indicates understanding of the teaching?

6 : A nurse is reinforcing teaching with a client who is in the first trimester of pregnancy about increasing their intake of foods that are high in folate. Which of the following should the nurse recommend as the food with the highest folate content?

7 : A nurse is caring for a client who is postpartum and has inverted nipples. Which of the following actions should the nurse take?

8 : A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse notes maternal exposure to rubella during pregnancy. After delivery, the nurse should monitor the newborn for which of the following conditions?

9 : A nurse is reinforcing teaching about safety precautions to take when driving a car with a client who is in the first trimester of pregnancy. Which of the following instructions should the nurse include in the teaching?

10 : A nurse is caring for a client who is at 41 weeks of gestation. The nurse should understand that which of the following findings can indicate a prenatal complication in this client?

1 :
A nurse is reinforcing teaching with a client who is at 38 weeks of gestation and has a positive group B streptococcus B-hemolytic screening Which of the following medications should the nurse discuss as the prophylaxis treatment during labor for this client?

2 :
A nurse has just received change-of-shift report about four clients who are postpartum. Which of the following clients should the nurse plan to see first?

3 :
A nurse is caring for a client who is at 9 weeks of gestation and reports nausea in the morning that continues until midafternoon. Which of the following actions should the nurse encourage the client to take?

4 :
A nurse is reinforcing teaching with a client who is at 18 weeks of gestation and requires an increased intake of iron. Which of the following foods should the nurse recommend as the best source of iron?

5 :
A nurse is reinforcing teaching about perineal care to a client who is 2 hours postpartum and has an episiotomy and hemorrhoids. Which of the following statements by the client indicates understanding of the teaching?

6 :
A nurse is reinforcing teaching with a client who is in the first trimester of pregnancy about increasing their intake of foods that are high in folate. Which of the following should the nurse recommend as the food with the highest folate content?

7 :
A nurse is caring for a client who is postpartum and has inverted nipples. Which of the following actions should the nurse take?

8 :
A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse notes maternal exposure to rubella during pregnancy. After delivery, the nurse should monitor the newborn for which of the following conditions?

9 :
A nurse is reinforcing teaching about safety precautions to take when driving a car with a client who is in the first trimester of pregnancy. Which of the following instructions should the nurse include in the teaching?

10 :
A nurse is caring for a client who is at 41 weeks of gestation. The nurse should understand that which of the following findings can indicate a prenatal complication in this client?