The labor and delivery nurse reviews a client’s prenatal records and notes that the client had a positive GBS culture at 27 weeks gestation. Based on current guidelines, what is the recommended plan?

Correct Answer: B

Rationale: The correct answer is B: Prepare to administer penicillin prophylactically. This is the recommended plan because current guidelines suggest administering intrapartum prophylaxis with penicillin for GBS-positive pregnant women to prevent neonatal GBS disease. Choice A is incorrect because sending a GBS to the laboratory immediately is unnecessary since the previous positive culture result is already known. Choice C is incorrect because follow-up cultures are not routinely recommended at 38 weeks gestation. Choice D is incorrect because determining if the patient received antibiotics for the positive strep does not address the need for intrapartum prophylaxis specifically with penicillin.

Correct Answer: A

Rationale: The correct answer is A: Assessing lung sounds. This is of highest priority because magnesium sulfate can lead to respiratory depression. Assessing lung sounds helps monitor for signs of respiratory distress, such as decreased breath sounds or crackles. Assessing blood sugar level (B) is important but not as urgent as respiratory status. Encouraging fluid intake (C) is important for hydration but not as critical as respiratory assessment. Assessing for pitting edema (D) is relevant for monitoring fluid retention but not as immediate as assessing lung sounds for respiratory compromise.

Correct Answer: C

Rationale: The correct answer is C: Thiamine. Thiamine deficiency can lead to Wernicke’s encephalopathy in patients with severe hyperemesis gravidarum due to poor nutrient absorption and inadequate dietary intake. This condition can cause neurological symptoms like confusion and ataxia. Folic acid (A) deficiency is common in pregnancy but is not directly related to Wernicke's encephalopathy. Vitamin D (B) deficiency is associated with bone health and immune function, not neurological symptoms. Glucose (D) is important for energy production but is not directly linked to Wernicke's encephalopathy. Checking thiamine levels is crucial to prevent neurological complications in this client.

Correct Answer: D

Rationale: The correct answer is D: Abdominal cramping and lower back pain. These symptoms are typical of preterm labor due to the contractions of the uterus. Lower back pain is a common sign of labor, and abdominal cramping is indicative of uterine contractions. Severe pain in the lower quadrant (A) is more consistent with issues like appendicitis. Severe pain and hard abdomen (B) may indicate a more serious condition like placental abruption. Painless vaginal bleeding (C) is more characteristic of conditions like placenta previa. Therefore, choice D is the most appropriate in the context of suspected preterm labor.

Correct Answer: C

Rationale: The correct answer is C: Being an adolescent. Adolescents are at higher risk for hyperemesis gravidarum due to hormonal changes and inadequate nutritional intake. Adolescents often experience rapid growth and increased nutritional demands, leading to a higher susceptibility to conditions like hyperemesis gravidarum. High levels of hCG (A) are common in pregnancy and can contribute to nausea and vomiting but are not the primary cause of hyperemesis gravidarum. High blood pressure (B) is not directly related to hyperemesis gravidarum. Being underweight (D) may exacerbate the condition but is not the primary factor causing hyperemesis gravidarum in this case.