Nokea
The nurse is monitoring a laboring client with oxytocin infusion. What finding requires immediate intervention?
- A. Contractions lasting 60 seconds.
- B. Contractions every 2 minutes.
- C. Fetal heart rate of 100 beats/minute.
- D. Client reports back pain.
Correct Answer: C
Rationale: A fetal heart rate of 100 bpm indicates bradycardia, requiring immediate intervention to ensure fetal well-being.
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The nurse knows that contraindication of the induction of labor includes:
- A. Placenta previa
- B. Diabetes mellitus
- C. PROM
- D. Isoimmunization
Correct Answer: A
Rationale: Placenta previa is a contraindication for the induction of labor because the placenta partially or completely covers the cervix. Inducing labor in this situation can lead to complications such as excessive bleeding and compromised blood flow to the baby. Therefore, it is important to avoid inducing labor in cases of placenta previa to ensure the safety of both the mother and the baby.
Mother in late middle age who is certain she is not pregnant tells
the nurse during an office visit she has urinary problems as well as
sensation of bearing down and of something in the vagina. The nurse
should realize that the client is most likely suffering from:
- A. Uterine prolapse
- B. Cystocele/rectocele
- C. Urinary tract infection (UTI)
- D. Endometriosis
Correct Answer: B
Rationale: A cystocele/rectocele occurs when the supportive tissue between a woman's bladder and vaginal wall weakens, allowing the bladder to bulge into the vagina. This can lead to urinary problems such as difficulty emptying the bladder completely, frequent urination, and urinary incontinence. The fact that the mother is in late middle age and certain she is not pregnant, combined with her urinary problems, suggests that she may be experiencing symptoms of a cystocele/rectocele. It is important for the nurse to further assess the client's symptoms and provide appropriate education and treatment options.
Which health concern is most likely to be an issue for the older mother?
- A. Nutrition and diet planning
- B. Exercise and fitness
- C. Having enough rest and sleep
- D. Effective contraceptive methods
Correct Answer: A
Rationale: As women age, their nutritional needs may change, and they may require more specific nutrients to support their health. Older mothers may be more susceptible to health concerns related to inadequate nutrition and diet planning, such as osteoporosis or heart disease. Proper nutrition is essential for both the mother's well-being and the health of her child. Therefore, nutrition and diet planning are more likely to be an issue for an older mother compared to exercise, rest, or contraceptive methods, especially during pregnancy and postpartum periods.
A client is experiencing uterine atony after delivery. What is the nurse's first action?
- A. Massage the fundus until firm.
- B. Increase IV fluid rate.
- C. Notify the healthcare provider.
- D. Administer prescribed oxytocin.
Correct Answer: A
Rationale: Fundal massage stimulates uterine contraction and is the initial response to uterine atony to prevent hemorrhage.
A nurse educator is teaching a class to nursing developing cervical cancer. Which client is at students about the incidence of sexually transmitted highest risk? infections (STIs) and their impact on public health.
- A. Client with a Pap test and an HPV screen positive Which is the most commonly reported STI in the for type 12 United States?
- B. Client who is 40 years old and stopped smoking
- C. Syphilis
- D. Gonorrhea
Correct Answer: A
Rationale: Human papillomavirus (HPV) is the most commonly reported sexually transmitted infection (STI) in the United States. HPV infection, especially high-risk types such as HPV-16, is strongly associated with cervical cancer. Therefore, a client who is positive for HPV type 16 on an HPV screen is at the highest risk for developing cervical cancer among the given choices. The nurse educator would need to emphasize the importance of regular screening, follow-up, and prevention strategies for this client to reduce the risk of cervical cancer development.