A nurse on a postpartum unit is assisting with the care of four clients. The nurse should identify that which of the following clients should receive Rh (D. immune globulin?
An Rh-negative client who has an Rh-negative newborn
An Rh-negative client who has an Rh-positive newborn
An Rh-positive client who has an Rh-positive newborn
An Rh-positive client who has an Rh-negative newborn
The Correct Answer is B
A. If both the mother and the newborn are Rh-negative, there is no need for Rh (D. immune globulin.
B. An Rh-negative mother carrying an Rh-positive baby is at risk for Rh incompatibility. She should receive Rh (D. immune globulin to prevent sensitization.
C. If both the mother and the newborn are Rh-positive, there is no need for Rh (D. immune globulin.
D. If the mother is Rh-positive and the newborn is Rh-negative, there is no need for Rh (D. immune globulin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
A. Excessive lanugo:
This is incorrect. Excessive lanugo is more commonly seen in preterm newborns. Post-term newborns, such as those born at 43 weeks of gestation, typically have little to no lanugo due to its shedding during late gestation.
B. Hypotonia:
This is incorrect. Hypotonia (reduced muscle tone) is not a characteristic finding in post-term newborns. Post-term infants generally exhibit normal or increased muscle tone, unless there is an underlying condition or birth complication.
C. Absent vernix:
This is correct. Vernix caseosa, a protective substance that coats the skin in utero, is typically absent or minimal in post-term newborns because it is reabsorbed in the amniotic fluid as gestation progresses beyond term.
D. Dry, cracked skin:
This is correct. Post-term newborns often have dry, peeling, or cracked skin due to prolonged exposure to amniotic fluid. The lack of vernix exacerbates this condition, leading to skin that appears weathered or desquamated.
E. Long, hard nails:
This is correct. Post-term newborns frequently have long, hard nails that may extend beyond the fingertips. This is a result of extended fetal development time in utero
Correct Answer is D
Explanation
A. Uterine atony
Uterine atony refers to the lack of muscle tone in the uterus after delivery, leading to excessive bleeding. This is not typically associated with abruptio placentae, which involves the premature separation of the placenta from the uterine wall during pregnancy, typically presenting with different symptoms such as painful contractions and bleeding.
B. Polyhydramnios
Polyhydramnios refers to an excessive amount of amniotic fluid during pregnancy and is not a characteristic of abruptio placentae. Polyhydramnios can be associated with various conditions but is not directly linked to placental abruption.
C. Painless vaginal bleeding
Painless vaginal bleeding is more characteristic of placenta previa, a condition where the placenta is abnormally positioned over the cervix. Abruptio placentae, on the other hand, typically presents with painful vaginal bleeding due to the detachment of the placenta from the uterine wall.
D. Board-like abdomen
A board-like abdomen is a classic sign of abruptio placentae, indicating significant uterine muscle contraction and possible internal hemorrhage. The sudden separation of the placenta can cause blood to accumulate behind the placenta, leading to a rigid, "board-like" feeling of the abdomen, which is a hallmark symptom of this condition.
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