A pregnant client receives Rho(D) immune globulin after an amniocentesis. The day following the procedure the client calls the nurse to report a temperature of 99.8° F (37.67°C). Which action should the nurse implement?

Instruct the client to maintain bed rest for 24 hours.

Encourage the client to increase her intake of oral fluids

Schedule a visit with the healthcare provider today

Verify the administered Rho(D) immune globulin's compatibility

Answer and Explanation

The Correct Answer is C

A. Instruct the client to maintain bed rest for 24 hours:
There is no clear indication for bed rest based solely on a slightly elevated temperature. Bed rest is not a standard recommendation for this situation.

B. Encourage the client to increase her intake of oral fluids:
Increasing fluid intake is a general recommendation for mild elevations in temperature. Adequate hydration can support the body's natural response to infection or inflammation.

C. Schedule a visit with the healthcare provider today:
This option is a prudent choice. A temperature elevation after a medical procedure may indicate an infection, and it's appropriate to schedule a visit with the healthcare provider for further evaluation.

D. Verify the administered Rho(D) immune globulin's compatibility:
While verifying the compatibility of the administered medication is important, it is not the primary concern when a client reports an elevated temperature. In this context, addressing the temperature and potential infection takes precedence.

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Correct Answer is B

Explanation

A. Bleeding tendencies:
Bleeding tendencies are not typically a priority immediately after birth unless there is a specific indication. Newborns are not at immediate risk for bleeding unless there are underlying conditions.

B. Heat loss:
Heat loss is a significant concern for newborns. Maintaining an adequate temperature is crucial to prevent hypothermia, which can lead to complications.

C. Hypoglycemia:
While monitoring blood glucose is important in the newborn, it may not be the most immediate concern within the first minutes after delivery. Stabilizing the newborn's temperature and initiating breathing are usually higher priorities.

D. Fluid balance:
Fluid balance is essential, but the initial focus is often on establishing respirations and maintaining temperature. Fluids may be administered as needed based on the clinical assessment.

A. Provide information about the high risk nature of her pregnancy B. Explain the benefits of a five-year post-transplant waiting period C. Gently remind the client that anti-rejection drugs cause sterility D. Determine if the client is considering options for adopting a child

Correct Answer is B

Explanation

A. Provide information about the high-risk nature of her pregnancy:

While it is true that pregnancies after organ transplantation are considered high-risk due to potential complications, the initial recommendation often involves waiting for a specified period.

B. Explain the benefits of a five-year post-transplant waiting period

After a liver transplant, healthcare providers typically recommend waiting for a certain period before attempting pregnancy. This waiting period allows the individual's health to stabilize, and it ensures that the transplanted organ is functioning optimally. Pregnancy, being a physiological stressor, can pose additional challenges to individuals with transplants. Waiting for a few years post-transplant is a precautionary measure to minimize potential risks.

C. Gently remind the client that anti-rejection drugs cause sterility:

This statement is not accurate. Anti-rejection drugs can affect fertility, but they do not cause sterility. The discussion should focus on the potential risks and safety considerations for pregnancy after a liver transplant.

D. Determine if the client is considering options for adopting a child:

While adoption might be an option, the primary intervention should involve discussing the waiting period and potential risks associated with pregnancy after a liver transplant.

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A pregnant client receives Rho(D) immune globulin after an amniocentesis. The day following the procedure the client calls the nurse to report a temperature of 99.8° F (37.67°C). Which action should the nurse implement?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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