A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

Choice A Reason:

Obtaining a specimen for a Kleihauer-Betke test is incorrect. The Kleihauer-Betke test is used to determine the fetal-maternal hemorrhage in cases of Rh-negative mothers, particularly after delivery. However, in the immediate postpartum period with uterine atony and significant bleeding, the priority is to control bleeding and stabilize the patient's condition. Obtaining a Kleihauer-Betke test can be done later if indicated, but it is not the immediate action for managing uterine atony.

Choice B Reason:

Administering betamethasone IM is incorrect. Betamethasone is a corticosteroid commonly used to promote fetal lung maturity when preterm birth is anticipated. It is not indicated for managing uterine atony or postpartum hemorrhage.

Choice C Reason:

Avoiding performing sterile vaginal examinations is incorrect. Sterile vaginal examinations may be necessary to assess the extent of cervical dilation, evaluate the presence of any retained products of conception, or assist with the placement of interventions such as uterine massage or administration of medications. However, avoiding or minimizing vaginal examinations alone does not address the underlying cause of uterine atony or control postpartum hemorrhage. Therefore, it is not the most appropriate immediate action.

Choice D Reason:

Anticipating a prescription for misoprostol is correct. Uterine atony, characterized by the inability of the uterus to contract effectively after childbirth, is a significant cause of postpartum hemorrhage. Misoprostol, a prostaglandin E1 analogue, is commonly used to manage uterine atony and prevent or control postpartum hemorrhage. It helps to stimulate uterine contractions and reduce bleeding by promoting uterine muscle tone.

Explanation

Choice A Reason:

Providing the newborn with 15 mL glucose water after each feeding does not directly relate to the care of jaundice or phototherapy. While hydration is important, the prescription for phototherapy does not specify the administration of glucose water.

Choice B Reason:

Turning the newborn every 4 hours is a general nursing intervention to prevent pressure ulcers and promote comfort, but it does not specifically address the care needs related to phototherapy for jaundice. While repositioning is important for overall care, it's not the priority action in this situation.

Choice C Reason:

Closing the newborn's eyes before applying eyepatches is correct. In phototherapy, newborns are exposed to special lights that help break down the bilirubin causing jaundice. To protect their eyes from the bright lights, eyepatches are typically applied. Closing the newborn's eyes before applying the eyepatches helps ensure that their eyes are shielded from the light and prevents potential damage or discomfort. The other options are not directly related to the care of a newborn undergoing phototherapy for jaundice.

Choice D Reason:

Applying hydrating lotion to the newborn's skin prior to treatment is correct. While keeping the newborn's skin hydrated is important, applying hydrating lotion prior to phototherapy might interfere with the effectiveness of the treatment. Additionally, there's no specific indication in the scenario provided that suggests the need for hydrating lotion before phototherapy. Therefore, this action is not necessary or recommended