A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care?

Instruct the client to stop taking the antiretroviral medications at 32 weeks of gestation.

Use a fetal scalp electrode during labor and delivery.

Bathe the newborn before initiating skin-to-skin contact.

Administer a pneumococcal immunization to the newborn within 4 hr following

Answer and Explanation

The Correct Answer is C

The purpose of bathing the newborn before initiating skin-to-skin contact is to decrease the risk of transmission of the virus from the mother to the newborn. Instructing the client to stop taking the antiretroviral medications at 32 weeks of gestation is incorrect as these medications should be taken throughout pregnancy to decrease the risk of transmission to the fetus.

Using a fetal scalp electrode during labor and delivery is also not an appropriate action as it increases the risk of transmission of the virus to the newborn. Administering a pneumococcal immunization to the newborn within 4 hours following birth is not specific to HIV positive newborns and is not related to preventing transmission of the virus.

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Correct Answer is C

Explanation

The nurse should include in the teaching that clients who use a diaphragm for birth control should have an annual examination to assess its fit and effectiveness. The nurse should also educate clients on the proper use and care of the diaphragm.

Spermicide should be used no more than 30 minutes prior to sexual intercourse, not 3 hours prior.

Emergency contraception does not provide ongoing protection against pregnancy, so clients will need to use another form of birth control immediately after taking the medication.

Fertility can return quickly after the removal of an IUD, usually within a few weeks to a month.

A. Administer 70% nitrous oxide mixed with oxygen. B. Ambulate the client in the hallway. C. Apply counterpressure to the sacral area. D. Have the client sit in a tub of warm water. E. Perform Leopold maneuvers

Correct Answer is ["A","C","D"]

Explanation

Administering 70% nitrous oxide mixed with oxygen is a common pain management option for laboring clients.

Applying counterpressure to the sacral area can help alleviate back pain during labor. Sitting in a tub of warm water, also known as hydrotherapy, can help reduce pain and promote relaxation during labor.

Ambulating the client may not be feasible or safe during the latent phase of labor when contractions are less frequent and intense.

Performing Leopold maneuvers, which involve palpating the mother's abdomen to determine the position of the fetus, does not directly address pain management.

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A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is conducting a class for a group of clients about birth control. Which of the following information should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain. Which of the following nursing interventions are appropriate to reduce pain? (Select all that apply.)

Correct Answer is ["A","C","D"]

Explanation

A nurse is providing discharge teaching to a postpartum client about caring for her 5-day-old male newborn at home. Which of the following statements should the nurse make to the client?

A nurse in a newborn nursery is receiving a change-of-shift report for four newborns. Which of the following newborns should the nurse assess first?

A nurse is caring for a client who received epidural analgesia during labor and is 4 hr postpartum. Which of the following client reports should the nurse address first?

A nurse is preparing to perform a fundal massage for a postpartum client who is experiencing uterine atony. In which order should the nurse plan to perform the following actions? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

A nurse is providing teaching to a client who is 2 days postpartum and wants to continue using her diaphragm for contraception. Which of the following instructions should the nurse include?

The nurse manager on the labor and delivery unit is teaching a group of newly licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching?

A nurse is providing teaching about the expected effects of magnesium sulfate to a client who is at 28 weeks of gestation and has preeclampsia. Which of the following responses by the nurse is appropriate?

A nurse is caring for a client who is at 30 weeks of gestation and receiving magnesium sulfate for preeclampsia. The nurse should recognize which of the following manifestations as an adverse reaction to the medication?