Nokea
A newborn's mother is positive for the hepatitis B surface antigen. Which of the following should the infant receive?
- A. Hepatitis B immune globulin at 1 week followed by hepatitis B vaccine monthly for 6 months
- B. Hepatitis B vaccine monthly until the newborn tests negative for the hepatitis B surface antigen
- C. Hepatitis B immune globulin and hepatitis B vaccine within 12 hr of birth
- D. Hepatitis B vaccine at 24 hr followed by hepatitis B immune globulin every 12 hr for 3 days
Correct Answer: C
Rationale: In the scenario where a newborn's mother is positive for hepatitis B surface antigen, the infant should receive both hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth. This is crucial to provide passive and active immunity against the Hepatitis B virus. Hepatitis B immune globulin provides immediate protection by giving passive immunity, while the vaccine stimulates active immunity in the infant. Administering both within 12 hours of birth is important to prevent vertical transmission of the virus.
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A healthcare provider is caring for a group of clients on an intrapartum unit. Which of the following findings should be reported to the provider immediately?
- A. A tearful client who is at 32 weeks of gestation and is experiencing irregular, frequent contractions
- B. A client who is at 28 weeks of gestation and receiving terbutaline reports fine tremors
- C. A client who has a diagnosis of preeclampsia has 2+ proteinuria and 2+ patellar reflexes
- D. A client who has a diagnosis of preeclampsia reports epigastric pain and an unresolved headache
Correct Answer: D
Rationale: The correct answer is a client who has a diagnosis of preeclampsia reporting epigastric pain and an unresolved headache. These symptoms indicate severe preeclampsia, which requires immediate medical attention due to the potential risks of complications such as HELLP syndrome or eclampsia. The other options describe concerning situations but do not represent immediate life-threatening conditions like those seen in severe preeclampsia.
A newborn is born to a mother with poorly controlled type 2 diabetes. The newborn is macrosomic and presents with respiratory distress syndrome. The most likely cause of the respiratory distress is which of the following?
- A. Hyperinsulinemia
- B. Increased deposits of fat in the chest and shoulder area
- C. Brachial plexus injury
- D. Increased blood viscosity
Correct Answer: A
Rationale: The correct answer is hyperinsulinemia. In infants born to mothers with poorly controlled diabetes, the excess glucose crosses the placenta, leading to fetal hyperglycemia. This results in fetal hyperinsulinemia, which in turn can cause macrosomia (large birth weight), increasing the risk of respiratory distress syndrome due to the immature lungs' inability to handle the increased workload. Hyperinsulinemia, not increased deposits of fat, brachial plexus injury, or increased blood viscosity, is the most likely cause of respiratory distress in this scenario.
A client at 37 weeks of gestation with placenta previa asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?
- A. There is an increased risk of introducing infection.
- B. This could initiate preterm labor.
- C. This could result in profound bleeding.
- D. There is an increased risk of rupture of the membranes.
Correct Answer: C
Rationale: Performing an internal examination in a client with placenta previa can lead to significant bleeding due to the proximity of the placenta to the cervical os. This bleeding can be severe and potentially life-threatening. Therefore, it is crucial to avoid any unnecessary manipulation that could disrupt the delicate balance and lead to hemorrhage.
A client who experienced a cesarean birth due to dysfunctional labor expresses disappointment for not having a natural childbirth. Which response should the nurse make?
- A. Validate the client's feelings by saying, 'It sounds like you are feeling sad that things didn't go as planned.'
- B. Assure the client by stating, 'At least you know you have a healthy baby.'
- C. Encourage the client by suggesting, 'Maybe next time you can have a vaginal delivery.'
- D. Provide information by saying, 'You can resume sexual relations sooner than if you had delivered vaginally.'
Correct Answer: A
Rationale: The correct response is to acknowledge and validate the client's feelings of disappointment. This empathetic approach demonstrates understanding and support for the client's emotional state, fostering a therapeutic nurse-client relationship. Options B, C, and D do not address the client's emotional needs or provide appropriate support in this situation.
A client at 22 weeks of gestation with uncontrolled gestational diabetes mellitus may require medication. Which of the following medications would the provider likely prescribe?
- A. Acarbose
- B. Repaglinide
- C. Glyburide
- D. Glipizide
Correct Answer: C
Rationale: Glyburide is commonly prescribed for gestational diabetes mellitus when diet and exercise are insufficient to control blood sugar levels. It is considered safe and effective during pregnancy, making it a suitable choice for managing diabetes in pregnant individuals. Acarbose, Repaglinide, and Glipizide are not typically recommended for use in pregnancy due to potential risks to the fetus.