A client’s prenatal laboratory findings reveal no immunity to rubella.
The health care provider orders the rubella vaccine.
The nurse concludes that teaching about this medication is effective when the client states which of the following?

“I should not get pregnant for at least 4-12 weeks after the vaccine.”.

“I need another shot after each baby I have with Rh-positive blood.”.

“I need another shot in 1 month and again in 6 months.”.

“This shot may cause a fever and make me vomit.”.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The rubella vaccine is a live vaccine, which means it contains a weakened version of the virus. Because the virus is still active, live vaccines are not safe for pregnant people. There is a small chance they may pass the virus to the baby. Therefore, it is recommended that adults of childbearing age should avoid getting pregnant for at least four weeks after receiving the MMR vaccine. This is to ensure the safety of both the mother and the baby.

Choice B rationale

This statement is incorrect. The rubella vaccine does not require additional shots after each baby with Rh-positive blood. The rubella vaccine is typically administered in childhood and provides long-term protection.

Choice C rationale

This statement is also incorrect. The rubella vaccine does not require additional shots in 1 month and again in 6 months. The vaccine provides long-term protection and does not typically require frequent boosters.

Choice D rationale

While it’s true that some vaccines can cause side effects such as fever and vomiting, these are not common side effects of the rubella vaccine. Therefore, this statement is not entirely accurate.

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Correct Answer is B

Explanation

Choice A rationale

Returning the platelet bag and tubing to the blood bank is not the immediate action to take when a client reports having lower back pain and feeling chilled and itchy during a PRBC transfusion. These symptoms could indicate a transfusion reaction, which is a serious complication that requires immediate intervention.

Choice B rationale

Stopping the infusion is the first action the nurse should take when a client reports symptoms of a transfusion reaction. This is because continuing the transfusion could worsen the reaction and potentially lead to more serious complications.

Choice C rationale

While notifying the provider is an important step in managing a transfusion reaction, it is not the first action the nurse should take. The nurse should first stop the infusion to prevent further exposure to the blood product.

Choice D rationale

Collecting a urine sample from the client is not the immediate action to take when a client reports having lower back pain and feeling chilled and itchy during a PRBC transfusion. These symptoms could indicate a transfusion reaction, which requires immediate intervention.

A. Cocaine use. B. Hypertension. C. Cigarette smoking. D. Blunt force trauma.

Correct Answer is B

Explanation

Choice B rationale

Hypertension is the most common risk factor for placental abruption. Hypertension can cause constriction of the blood vessels, including those in the placenta, which can lead to detachment of the placenta from the uterine wall.

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A client’s prenatal laboratory findings reveal no immunity to rubella.The health care provider orders the rubella vaccine.The nurse concludes that teaching about this medication is effective when the client states which of the following?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is administering Packed Red Blood Cells (PRBC) to a client who reports having lower back pain and feeling chilled and itchy.Which of the following actions should the nurse take first?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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A client’s prenatal laboratory findings reveal no immunity to rubella.
The health care provider orders the rubella vaccine.
The nurse concludes that teaching about this medication is effective when the client states which of the following?