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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A rubella titer of 1: indicates the presence of antibodies against the rubella virus, but this does not confirm the absence of a current infection. The titer represents past exposure or vaccination rather than an active infection.
Choice B rationale
A rubella titer of 1: suggests immunity to the rubella virus, making vaccination unnecessary at this time. Vaccination is typically recommended for those without immunity to prevent future infection.
Choice C rationale
A titer of 1: indicates the presence of antibodies sufficient to confer immunity to the rubella virus. This level is generally considered protective, implying the client has either had the infection before or has been vaccinated.
Choice D rationale
A mild rubella infection would not typically be determined solely by the titer level. Clinical symptoms and further diagnostic tests are required to diagnose an active rubella infection accurately.
Correct Answer is B
Explanation
Choice A rationale
Maintaining a folic acid intake of 4 mcg per day is not sufficient. The recommended dose for pregnant women is 400-800 mcg to help prevent neural tube defects, but it is not specifically related to reducing the risk of preterm labor.
Choice B rationale
Increasing fluid intake to 8-10 (8 oz) glasses per day is recommended as it helps to maintain hydration, which is crucial in preventing preterm labor. Dehydration can cause uterine contractions, which can lead to preterm labor.
Choice C rationale
Consuming the recommended daily allowance of vitamin C (85 mg) is important for immune function and overall health but does not directly affect the risk of preterm labor.
Choice D rationale
Increasing caloric intake by 500 calories per day is typically recommended for breastfeeding mothers, not for preventing preterm labor during pregnancy. Proper nutrition is important, but overconsumption can lead to excessive weight gain.
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