A 32 year-old G3P2 client is returning for her prenatal visit at 28 weeks.Her prenatal labs on record thus far are as follows: Type & Rh =A negative.
Antibody screen normal.
RPR = negative.
HIV = negative.
Rubella titer 1:16. Cervical smears negative for Gonorrhea & Chlamydia.
Hemoglobin/hematocrit = 11.0 mg/dl and 35%. Gestational diabetes glucose challenge test (GCT) Screen 26 wks = 120.
Urine analysis positive for leukocytes.
Today her plan of care should include which of the following: (Select all that apply)
Administer Rubella vaccine IM.
Instruct client on signs and symptoms of preterm labor.
Administer Rhogam IM.
Obtain a clean catch urine culture.
Order a 3-hour diagnostic glucose tolerance test.
Administer a blood transfusion.
Correct Answer : B,C,D,E
Choice A rationale
Rubella vaccination is contraindicated during pregnancy due to the risk of congenital rubella syndrome in the fetus. It should be administered postpartum if the client is non-immune.
Choice B rationale
Preterm labor is a concern at 28 weeks' gestation. Educating the client on signs and symptoms can help in early detection and management, potentially improving outcomes for both mother and baby.
Choice C rationale
Rh-negative mothers with a negative antibody screen should receive Rhogam at 28 weeks to prevent Rh sensitization. This is crucial to avoid hemolytic disease of the newborn in future pregnancies.
Choice D rationale
A positive urine analysis for leukocytes indicates a possible urinary tract infection. A clean catch urine culture is needed to identify the causative organism and guide appropriate antibiotic therapy.
Choice E rationale
The glucose challenge test result of 120 at 26 weeks is within normal limits, but a 3-hour diagnostic glucose tolerance test may be ordered if there's a high index of suspicion for gestational diabetes or other risk factors.
Choice F rationale
A blood transfusion is not indicated as the hemoglobin/hematocrit levels (11.0 mg/dl and 35%) are within acceptable limits for pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
A possible sign of pregnancy includes symptoms that are suggestive but not definitive, such as amenorrhea (absence of menstruation) or fatigue. These signs can have multiple causes and are not conclusive proof of pregnancy.
Choice B rationale
A positive sign of pregnancy includes objective evidence like fetal movement felt by the examiner, fetal heart sounds detected, or visualization of the fetus on ultrasound. These signs provide direct confirmation of pregnancy.
Choice C rationale
Presumptive signs of pregnancy are subjective experiences reported by the patient, such as nausea, breast tenderness, or quickening (feeling fetal movement). These signs are not confirmatory as they can occur in other conditions.
Choice D rationale
Probable signs of pregnancy include objective findings observed by a healthcare provider, such as uterine enlargement, but they are not definitive as they can also be caused by conditions like fibroids.
Correct Answer is A
Explanation
Choice A rationale
Intrauterine growth restriction (IUGR) is a significant risk for newborns of mothers who smoke. Smoking affects placental blood flow, reducing the supply of oxygen and nutrients to the fetus, leading to poor growth.
Choice B rationale
Smoking is not a direct cause of gestational diabetes. Gestational diabetes is primarily related to hormonal changes in pregnancy that affect insulin regulation.
Choice C rationale
Congenital heart defects are not directly linked to smoking. They are usually caused by genetic and environmental factors during early fetal development, not smoking specifically.
Choice D rationale
Vision loss is not directly associated with maternal smoking. Smoking affects fetal growth and development, but vision loss is not a common outcome.
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