A newborn tests positive for the hepatitis B surface antigen. Which of the following should the nurse administer?

Hepatitis B vaccine monthly until the newborn tests negative for the hepatitis B surface antigen.

Hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth.

Hepatitis B immune globulin at 1 week followed by hepatitis B vaccine monthly for 6 months.

Hepatitis B vaccine at 24 hours followed by hepatitis B immune globulin every 12 hours for 3 days.

Answer and Explanation

The Correct Answer is B

Choice A rationale
While the hepatitis B vaccine is an important part of preventing hepatitis B infection, it is not typically given on a monthly basis until the newborn tests negative for the hepatitis B surface antigen. Instead, the vaccine is usually given in a series of three to four doses over a six-month period.
Choice B rationale
For newborns who test positive for the hepatitis B surface antigen, the current recommendation is to administer both the hepatitis B immune globulin (HBIG) and the

hepatitis B vaccine within 12 hours of birth. The HBIG provides immediate, short-term protection against the virus, while the vaccine stimulates the newborn’s immune system to provide long-term protection.
Choice C rationale
While the hepatitis B immune globulin (HBIG) and the hepatitis B vaccine are both important for preventing hepatitis B infection in newborns, they are not typically administered in the manner described in this choice. The HBIG is usually given once, within 12 hours of birth, while the vaccine is given in a series of three to four doses over a six-month period.
Choice D rationale
The hepatitis B vaccine is typically given within 24 hours of birth, but it is not followed by doses of the hepatitis B immune globulin (HBIG) every 12 hours for three days. Instead, a single dose of HBIG is usually given within 12 hours of birth, along with the first dose of the vaccine.

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Correct Answer is C

Explanation

Choice A rationale

Assisting the family to identify prior use of positive coping skills in family crises can be helpful, but it’s not the priority action in this situation.
Choice B rationale
Anticipating a prescription by the provider for an antidepressant might be necessary if the client is diagnosed with postpartum depression. However, the nurse first needs to assess the risk to the client and her newborn.
Choice C rationale
Asking the client if she has considered harming her newborn is the priority action. This question is crucial in assessing for postpartum depression and the safety of the newborn.
Choice D rationale
Reinforcing postpartum and newborn care discharge teaching is important, but it’s not the priority action when the client is expressing feelings of sadness and lack of energy.

A. Encourage the client to perform Kegel exercises. B. Assist the client to the bathroom to void. C. Ask the client to rate her pain. D. Encourage the client to move to the left lateral position.

Correct Answer is B

Explanation

Choice A rationale
Encouraging the client to perform Kegel exercises can help strengthen pelvic floor muscles, but it does not address the immediate problem of a displaced and boggy uterus.
Choice B rationale
Assisting the client to the bathroom to void is the correct action. A full bladder can displace the uterus and prevent it from contracting properly, which can lead to uterine atony and increased risk of postpartum hemorrhage.
Choice C rationale
Asking the client to rate her pain is important, but it does not address the immediate problem of a displaced and boggy uterus.
Choice D rationale
Encouraging the client to move to the left lateral position can improve venous return and cardiac output, but it does not address the immediate problem of a displaced and boggy uterus

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A newborn tests positive for the hepatitis B surface antigen. Which of the following should the nurse administer?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a clinic is caring for a client who is 3 weeks postpartum following the birth of a healthy newborn. The client reports feeling “down”, sad, having no energy, and wanting to cry. Which of the following is a priority action by the nurse?

Correct Answer is C

Explanation

A nurse is caring for a client who is postpartum and finds the fundus slightly boggy and displaced to the right. Based on these findings, which of the following actions should the nurse take?

Correct Answer is B

Explanation

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