The nurse when assessing the client's perineum found erythematous lesions on the vulva that looks like herpes. The nurse anticipates the patient's treatment regimen to include which of the following:

Penicillin G intravenously

Acyclovir orally

Betamethasone for late preterm labor

Ceftriaxone (Rocephin)

Answer and Explanation

The Correct Answer is B

A. Penicillin G is an antibiotic used to treat bacterial infections, particularly those caused by streptococci and certain other bacteria. It is not effective against viruses like herpes simplex virus (HSV).

B. Acyclovir is an antiviral medication commonly used to treat infections caused by HSV, including genital herpes. It is effective in reducing the severity of symptoms, speeding up healing of lesions, and preventing recurrent outbreaks. Oral acyclovir is a standard treatment for genital herpes.

C. Betamethasone is a corticosteroid used to accelerate fetal lung maturity in cases of preterm labor between 24 and 34 weeks of gestation. It is not indicated for the treatment of herpes simplex virus infections.

D. Ceftriaxone is a broad-spectrum antibiotic used to treat bacterial infections. It is not effective against viral infections such as herpes simplex virus.

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Correct Answer is A

Explanation

A. During breastfeeding, it's important for the newborn to take not only the nipple but also a portion of the surrounding areola into their mouth. Placing both the nipple and some of the areola ensures that the baby can latch deeply onto the breast. A deep latch helps the baby effectively extract milk, stimulates milk flow, and reduces the risk of nipple pain or damage.

B. Newborns do have innate reflexes that help them find and latch onto the breast but their latch can still benefit from proper positioning and guidance from the mother. Encouraging the mother to understand how to position the nipple and areola correctly can enhance the breastfeeding experience for both the mother and baby.

C. It may not be necessary to emphasize placing breast tissue beyond the areola into the baby's mouth. The key focus should be on ensuring that the nipple and a significant portion of the areola are taken into the baby's mouth to achieve a deep latch.

D. Even though a newborn's mouth is small, effective breastfeeding depends on achieving a deep latch, which involves taking both the nipple and some of the areola into the mouth. Encouraging the mother to aim for only part of the nipple could lead to shallow latch, ineffective milk transfer, and potential nipple soreness.

A. Blood pressure 80/56 mm Hg<br> B. The client reports perfuse itching. C. Temperature 38.2°C (100.8°F) D. The client reports weakness of the lower extremities.

Correct Answer is A

Explanation

A. Hypotension is a common side effect of epidural opioid analgesia due to sympathetic blockade. This can lead to decreased placental perfusion and fetal distress. Therefore, a low blood pressure reading such as 80/56 mm Hg is a priority finding that requires immediate nursing intervention. The nurse should assess for signs of hypotension (e.g., dizziness, pallor, decreased urine output) and implement measures to improve blood pressure

B. Pruritus (itching) is a common side effect of opioid analgesia due to its effect on histamine release. While uncomfortable for the client, it is generally not life-threatening or an immediate priority unless it becomes severe and affects the client's ability to breathe or is accompanied by other symptoms such as rash or difficulty swallowing.

C. A temperature elevation (fever) can indicate infection, which is important to monitor during labor. However, a single temperature reading of 38.2°C (100.8°F) alone may not be immediately alarming, especially if the client is not exhibiting other signs of infection such as chills, increased uterine tenderness, or foul-smelling vaginal discharge. It should be further assessed, but it is not typically the highest priority compared to hypotension.

D. Motor weakness in the lower extremities can occur with epidural analgesia due to the effects of local anesthetics or opioids on nerve function. While it should be addressed, especially to prevent falls or injury to the client, it is not as immediately concerning as hypotension, which can compromise maternal and fetal well-being.

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The nurse when assessing the client's perineum found erythematous lesions on the vulva that looks like herpes. The nurse anticipates the patient's treatment regimen to include which of the following:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting a client who is postpartum with her first breastfeeding experience. When the client asks how much of the nipple she should put into the newborn's mouth, which of the following responses should the nurse make?

Correct Answer is A

Explanation

A nurse is caring for a client who is receiving opioid epidural analgesia during labor. Which of the following findings is the nurse's priority?

Correct Answer is A

Explanation

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