A nurse is reinforcing postpartum discharge teaching to a client who had no immunity to varicella and was given the varicella vaccine.
Which of the following statements by the client indicates understanding?

I need a second vaccination at my postpartum visit.

I will need to use contraception for 3 months before considering pregnancy.

I was given the vaccine because my baby is O-positive.

I will be tested in 3 months to see if I have developed immunity.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The client needs a second varicella vaccination at her postpartum visit to ensure full immunity. The initial dose provides partial immunity, and the second dose completes the vaccination series.

Choice B rationale

The client needs to use contraception for 1 month, not 3 months, before considering pregnancy after receiving the varicella vaccine. This is to prevent potential harm to a developing fetus.

Choice C rationale

The varicella vaccine is not given based on the baby’s blood type. It is administered to protect the client from varicella infection.

Choice D rationale

There is no need for testing to see if the client has developed immunity after receiving the varicella vaccine. The second dose is given to ensure full immunity. .

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Correct Answer is C

Explanation

Choice A rationale

While sharing personal experiences can sometimes be comforting, it may not always be appropriate or helpful in a professional setting. The focus should be on the patient’s needs and feelings.

Choice B rationale

Calling for a chaplain can be supportive, but it is important to first offer the parents the opportunity to hold their baby and spend time with them, which can be an important part of the grieving process.

Choice C rationale

Allowing the parents to hold their baby for as long as they want provides them with the opportunity to say goodbye and can be a crucial part of the grieving process. It helps them to acknowledge their loss and begin to process their emotions.

Choice D rationale

Telling the parents that the loss is for the best is not supportive and can be hurtful. It is important to validate their feelings and provide compassionate care during this difficult time. .

A. At 1 cm above the umbilicus. B. One fingerbreadth above the symphysis pubis. C. To the right of the umbilicus. D. Three fingerbreadths above the umbilicus.

Correct Answer is A

Explanation

Choice A rationale

At 1 cm above the umbilicus is the expected position of the uterine fundus 12 hours postpartum. After delivery, the fundus is typically at the level of the umbilicus and then descends approximately 1 cm per day. At 12 hours postpartum, it is normal for the fundus to be slightly above the umbilicus.

Choice B rationale

One fingerbreadth above the symphysis pubis is not the expected position of the fundus 12 hours postpartum. This position is more typical several days postpartum as the uterus continues to involute and return to its pre-pregnancy size.

Choice C rationale

To the right of the umbilicus is not a normal finding and may indicate a full bladder, which can displace the uterus. The nurse should assist the client to void and then reassess the fundal position.

Choice D rationale

Three fingerbreadths above the umbilicus is not expected 12 hours postpartum. This position may indicate uterine atony or subinvolution, which requires further assessment and intervention.

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A nurse is reinforcing postpartum discharge teaching to a client who had no immunity to varicella and was given the varicella vaccine.Which of the following statements by the client indicates understanding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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A nurse is reinforcing postpartum discharge teaching to a client who had no immunity to varicella and was given the varicella vaccine.
Which of the following statements by the client indicates understanding?