Nokea
A client at 34 weeks' gestation is diagnosed with polyhydramnios. What complication should the nurse monitor for?
- A. Preterm labor.
- B. Placental abruption.
- C. Fetal growth restriction.
- D. Cord prolapse.
Correct Answer: A
Rationale: Polyhydramnios increases the risk of preterm labor due to uterine overdistension.
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The nurse should anticipate the labor pattern for a fetal occiput posterior position to be
- A. Prolonged and more painful
- B. Precipitous
- C. Rapid during transition
- D. Shorter than average during the latent phase
Correct Answer: A
Rationale: The nurse should anticipate the labor pattern for a fetal occiput posterior position to be prolonged and more painful. This is because in occiput posterior position, the baby's head is facing the mother's abdomen instead of her back, which can lead to slower descent and dilation of the cervix. The baby's head may have difficulty rotating to the optimal position for birth, causing longer labor and increased back pain for the mother. Nurses should be prepared to provide additional support and pain management strategies for women experiencing labor with a fetal occiput posterior position.
What is the priority nursing intervention for a newborn with a low Apgar score of 4 at 1 minute?
- A. Place the baby in skin-to-skin contact with the mother
- B. Administer oxygen and stimulate the baby
- C. Delay interventions and reassess in 5 minutes
- D. Begin chest compressions immediately
Correct Answer: B
Rationale: A low Apgar score indicates poor adaptation; oxygen improves function.
The nurse knows that the emancipated minor is considered to have the legal capacity of an adult and may make his or her own health care decisions. Which child would potentially be considered an emancipated minor?
- A. A minor with financial independence who is living with his parents
- B. A minor who is pregnant
- C. A child older than 13 years of age who asks for emancipation
- D. A minor who puts his or her medical decisions in writing
Correct Answer: B
Rationale: Emancipation may be considered in any of the following situations, depending on the state's laws: membership in a branch of the armed services, marriage, court-determined emancipation, financial independence and living apart from parents, college attendance, pregnancy, mother younger than 18 years of age, and a runaway.
A new mother asks the nurse why newborns receive an injection of vit. K after delivery. What will be the best response from the nurse?
- A. Newborns are given vit K to help with the digestion to help them absorb fat soluble vitamins
- B. Newborns are given vit K and erythromycin ointment to help prevent ophthalmia neonatorum
- C. Newborns lack the intestinal flora needed to produce vit K, so it is given to prevent bleeding episodes
- D. This vitamin substitutes for vitamin C and newborns will strengthen their immune system
Correct Answer: C
Rationale: Vitamin K is essential for clotting and prevents hemorrhagic disease.
In teaching parents to use a bulb syringe to suction an infant, the nurse should teach them to:
- A. suction the back of the throat vigorously.
- B. always suction the nose before suctioning the mouth.
- C. use it only once a day.
- D. insert the syringe into the sides of the mouth.
Correct Answer: B
Rationale: Suctioning the nose first prevents pushing secretions further down the throat.