A nurse in a prenatal clinic is caring for a client. Using Leopold's maneuvers, the nurse palpates a round, firm, movable part in the fundus of the uterus and a long smooth surface on the client's right side. In which abdominal quadrant should the nurse expect to auscultate fetal heart tones?

Choice A reason:
Initiating pushing in a client with suspected placenta previa is contraindicated. Placenta previa is a condition where the placenta covers the cervix, and pushing could lead to severe bleeding and compromise both the mother and the fetus. The normal labor process involves pushing only after full cervical dilation, and in the case of placenta previa, this could exacerbate the condition.

Choice B reason:
Preparation for cesarean birth is the correct action when placenta previa is suspected. With placenta previa, vaginal delivery could cause significant hemorrhage due to the placenta's position over the cervical opening. A cesarean birth bypasses the cervix, thereby avoiding disruption of the placenta and preventing excessive bleeding.

Choice C reason:
Magnesium sulfate is used in obstetrics to prevent seizures in preeclampsia and to delay preterm labor, not for placenta previa. While it is important to manage the client's overall condition, magnesium sulfate would not address the immediate concern of potential hemorrhage due to placenta previa.

Choice D reason:
An examination to determine cervical status in the presence of placenta previa should be avoided unless absolutely necessary and performed under controlled conditions, such as in an operating room where a cesarean delivery can be performed if needed. Digital cervical examinations can dislodge the placenta and cause bleeding.

Choice A reason:
This choice is incorrect because the hepatitis B vaccine is recommended to be given within 24 hours of birth, but there is no recommendation for hepatitis B immune globulin (HBIG) to be given every 12 hours for 3 days. The HBIG is typically given as a single dose.

Choice B reason:
This is the correct choice. Newborns whose mothers are positive for the hepatitis B surface antigen should receive both HBIG and the first dose of the hepatitis B vaccine within 12 hours of birth. The HBIG provides immediate protection against hepatitis B infection, and the vaccine begins the process of building long-term immunity.

Choice C reason:
This choice is incorrect because delaying the administration of HBIG and the hepatitis B vaccine until 1 week after birth would leave the newborn vulnerable to hepatitis B infection. The recommended schedule is to administer these within 12 hours of birth.

Choice D reason:
This choice is incorrect because the hepatitis B vaccine is not given monthly. The typical schedule for the hepatitis B vaccine is the first dose at birth, the second dose at 1-2 months of age, and the third dose at 6 months of age. Additionally, the vaccine is not administered based on the newborn's hepatitis B surface antigen status.