Nokea
A 20-year-old client states that the at-home pregnancy test that she took this morning was positive. Which of the following comments by the nurse is appropriate at this time?
- A. Congratulations, you and your family must be so happy.
- B. Have you told the baby’s father yet?
- C. How do you feel about the results?
- D. Please tell me when your last menstrual period was.
Correct Answer: C
Rationale: It is important to assess the client's emotional response to the pregnancy test result before providing further guidance or congratulations.
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Of what is the normal umbilical cord comprised?
- A. 1 artery carrying blood to the fetus and 1 vein carrying blood away from the fetus
- B. 1 artery carrying blood to the fetus and 2 veins carrying blood away from the fetus
- C. 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus
- D. 2 arteries carrying blood to the fetus and 2 veins carrying blood away from the fetus
Correct Answer: C
Rationale: The umbilical cord is comprised of 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus.
A woman in labor begins to experience a sudden increase in vaginal bleeding and the fetal heart rate decelerates. What is the likely cause of these symptoms?
- A. Placenta previa
- B. Placental abruption
- C. Uterine rupture
- D. Cervical laceration
Correct Answer: B
Rationale: The correct answer is B: Placental abruption. Placental abruption is the premature separation of the placenta from the uterine wall, leading to vaginal bleeding and fetal distress. The sudden increase in bleeding and fetal heart rate deceleration are hallmark signs of placental abruption. Placenta previa (choice A) involves bleeding without fetal distress. Uterine rupture (choice C) typically presents with severe abdominal pain and shock. Cervical laceration (choice D) would not cause fetal heart rate deceleration.
What is the purpose of initiating contractions in a contraction stress test (CST)?
- A. Increase placental blood flow.
- B. Identify fetal acceleration patterns.
- C. Determine the degree of fetal activity.
- D. Apply a stressful stimulus to the fetus.
Correct Answer: D
Rationale: The CST assesses fetal response to the stress of uterine contractions to determine if the fetus can tolerate labor.
A nurse is assessing a pregnant patient at 36 weeks gestation who complains of pain in the lower abdomen and back. The nurse finds no signs of labor. Which of the following interventions should the nurse implement?
- A. Encourage the patient to rest and monitor for any changes in symptoms.
- B. Administer pain medication and schedule an appointment with the doctor.
- C. Perform a pelvic exam to determine the cause of the pain.
- D. Instruct the patient to remain in bed for the rest of the day.
Correct Answer: A
Rationale: The correct answer is A: Encourage the patient to rest and monitor for any changes in symptoms. At 36 weeks gestation, the patient might be experiencing Braxton Hicks contractions or round ligament pain, which are common in late pregnancy. Encouraging rest allows for potential relief of discomfort. Monitoring for any changes in symptoms is essential to rule out preterm labor. Option B is incorrect as administering pain medication without identifying the cause may mask symptoms of preterm labor. Option C is incorrect as performing a pelvic exam could potentially cause harm if the patient is experiencing preterm labor. Option D is incorrect as prolonged bed rest is not recommended in pregnancy and may not alleviate the pain or address the underlying cause.
The nurse is caring for a pregnant client who is a vegan. Which of the following foods should the nurse suggest the client consume as substitutes for restricted foods?
- A. Tofu, legumes, broccoli.
- B. Corn, yams, green beans.
- C. Potatoes, parsnips, turnips.
- D. Cheese, yogurt, fish.
Correct Answer: A
Rationale: Tofu, legumes, and broccoli provide essential nutrients like protein, iron, and calcium that are often lacking in a vegan diet. Corn, yams, and green beans offer carbohydrates and vitamins but lack sufficient protein sources. Potatoes, parsnips, and turnips are starchy vegetables with limited nutritional variety. Cheese, yogurt, and fish are non-vegan options.