A nurse is teaching routine prenatal care to a group of clients who are pregnant.
Which of the following statements by a client indicates an understanding of the teaching?
I will be able to hear my baby's heartbeat when I am 6 weeks pregnant.
I will have monthly prenatal visits for the first 28 weeks of pregnancy.
I will have a complete blood count performed at each prenatal visit.
I will have a blood test to check for neural tube defects when I am 32 weeks pregnant
The Correct Answer is B
Choice A rationale
The fetal heartbeat is typically detectable by Doppler around 10-12 weeks, not as early as 6 weeks.
Choice B rationale
Monthly prenatal visits up to 28 weeks are standard practice for monitoring pregnancy.
Choice C rationale
A complete blood count is not performed at every prenatal visit but at specific intervals.
Choice D rationale
The blood test for neural tube defects, such as AFP, is usually done around 16-18 weeks, not 32 weeks.
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Correct Answer is A
Explanation
Choice A rationale
An indwelling urinary catheter can increase the risk of falls because it may cause discomfort and restricted mobility, leading the client to move awkwardly or lose balance.
Choice B rationale
While a second-degree perineal laceration might cause pain and limited mobility, it doesn't usually contribute as significantly to fall risk as an indwelling catheter.
Choice C rationale
Saturating a perineal pad every 5 to 6 hours may indicate heavy postpartum bleeding, but it isn't directly related to fall risk. The concern here would be more about monitoring for hemorrhage rather than falls.
Choice D rationale
Breast engorgement causes discomfort and pain but doesn't directly affect a client's mobility or balance, making it less likely to increase fall risk.
Correct Answer is D
Explanation
Choice A rationale
Only one dose of rubella immunization is necessary post-delivery, no need for a second dose in 2 weeks.
Choice B rationale
Prevention of pregnancy is recommended for at least 1 month (not 4 months) after receiving the rubella vaccine to avoid possible teratogenic effects.
Choice C rationale
An additional rubella immunization is not recommended during pregnancy as the live vaccine is contraindicated during gestation.
Choice D rationale
Rubella vaccine is safe for breastfeeding mothers, as it does not affect the safety of breast milk.