The nurse is assessing a client with suspected gestational hypertension. What finding supports this diagnosis?
- A. Blood pressure of 150/90 mmHg.
- B. Proteinuria of +2.
- C. Fetal heart rate of 140 beats/minute.
- D. Mild edema in the lower extremities.
Correct Answer: A
Rationale: Gestational hypertension is diagnosed with a blood pressure of 140/90 mmHg or higher without proteinuria.
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The nurse is monitoring a client receiving oxytocin for labor induction. What finding requires the nurse to take immediate action?
- A. Contractions lasting 90 seconds.
- B. Contractions every 2–3 minutes.
- C. Fetal heart rate of 180 beats/minute.
- D. Client reports mild nausea.
Correct Answer: C
Rationale: A fetal heart rate of 180 bpm indicates tachycardia, which may suggest fetal distress requiring immediate intervention.
Be- tions before finding one that works.
- A. Once you take the prescribed medication, you plan on teaching this client? will be cured of the infection.
- B. Breastfeeding
- C. Even though you don't experience symptoms,
- D. Postpartum depression you can still spread the infection.
Correct Answer: C
Rationale: Option C is the most appropriate statement to make to the client because it addresses the reality of sexually transmitted infections (STIs). Many STIs can be transmitted even when the infected individual is not experiencing any symptoms. This is an important point to communicate to prevent the spread of the infection to other sexual partners. It emphasizes the need for practicing safe sex measures and getting tested regularly, regardless of the presence of symptoms. It is important for the client to understand that they can still be a carrier of the infection even if they are not displaying any noticeable symptoms.
The nurse is conducting a prenatal class on the female reproductive system. When a client asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the best response?
- A. It promotes the fertilized ovum's chances of survival.
- B. It promotes the fertilized ovum's exposure to estrogen and progesterone.
- C. It promotes the fertilized ovum's normal implantation in the top portion of the uterus.
- D. It promotes the fertilized ovum's exposure to luteinizing hormone and follicle-stimulating hormone.
Correct Answer: C
Rationale: The delay ensures the ovum reaches the uterus at the right developmental stage for proper implantation in the upper uterine segment.
The patient asks the nurse when her Nexplanon can be inserted. How does the nurse respond?
- A. after the delivery of your placenta
- B. only during your period
- C. while you are in labor
- D. during the delivery
Correct Answer: A
Rationale: The nurse would respond with option A, "after the delivery of your placenta." Nexplanon is a hormonal contraceptive implant that is typically inserted in the upper arm subdermally. It is recommended to wait until after the delivery of the placenta to reduce the risk of causing any harm to the fetus during pregnancy or labor. Inserting Nexplanon during labor or delivery is not recommended due to the potential risks involved.
The nurse assesses a patient for medical eligibility for contraceptive use. What is the meaning of an MEC score of 2?
- A. There is no restriction for the use of the contraceptive method.
- B. There is an unacceptable health risk if the contraceptive method is used.
- C. There is a risk that outweighs the advantages of the contraceptive method.
- D. There is an advantage of using a contraceptive method that outweighs any risk.
Correct Answer: B
Rationale: An MEC score of 2 indicates that there is an unacceptable health risk if the contraceptive method is used. This means that the potential health risks associated with using this particular contraceptive method outweigh the benefits. Therefore, the nurse should advise against using this method for contraception due to the elevated health risks involved. It is essential for healthcare providers to meticulously assess the medical eligibility of a patient before recommending any contraceptive method to ensure the safety and well-being of the individual.