Nokea
A 20-year-old gravida 1 para 0 presents to the prenatal clinic with a chief complaint that she feels like she is pregnant. Which are presumptive signs of pregnancy? Select all that apply.
- A. Linea nigra
- B. Breast tenderness
- C. Leukorrhea
- D. Chadwick’s sign
Correct Answer: A
Rationale: The correct answer is A: Linea nigra. Linea nigra is a presumptive sign of pregnancy, which refers to a dark line that appears on the abdomen. This sign is caused by hormonal changes during pregnancy. Breast tenderness (B) and leukorrhea (C) are actually probable signs of pregnancy, not presumptive signs. Chadwick's sign (D) is also a probable sign, not a presumptive sign. Presumptive signs are subjective symptoms reported by the patient and are not definitive indicators of pregnancy.
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When a pattern of variable decelerations occur, the nurse should immediately
- A. administer O at 8 to 10 L/minut
- B. place a wedge under the right hip.
- C. increase the IV fluids to 150 mL/hour.
- D. position patient in a knee-chest position.
Correct Answer: D
Rationale: The correct answer is D because positioning the patient in a knee-chest position helps to relieve pressure on the vena cava, improving blood flow to the placenta and fetus. This can help alleviate variable decelerations. Choice A is incorrect because administering oxygen at 8 to 10 L/min would not directly address the cause of variable decelerations. Choice B is incorrect as placing a wedge under the right hip is typically used for supine hypotension syndrome. Choice C is incorrect because increasing IV fluids may not directly address the issue of variable decelerations.
When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?
- A. Early decelerations
- B. Variable decelerations
- C. Nonperiodic accelerations
- D. Increase in baseline variability
Correct Answer: B
Rationale: The correct answer is B: Variable decelerations. When the mother's membranes rupture during active labor, variable decelerations should be observed in the fetal heart rate. This is because the rupture of membranes can lead to umbilical cord compression, causing variable decelerations in the fetal heart rate pattern. Variable decelerations are characterized by abrupt and visually apparent decreases in heart rate variability.
A: Early decelerations are usually associated with head compression during contractions and are benign.
C: Nonperiodic accelerations are not a typical pattern seen in response to ruptured membranes during labor.
D: An increase in baseline variability is a positive sign and does not specifically indicate the occurrence of variable decelerations related to umbilical cord compression.
A primigravida patient asks the nurse to explain the term quickening. Which statement by the nurse is correct?
- A. It is intermittent uterine contractions caused by the increase in hormones, especially estrogen.
- B. It is the absence of menses and is one of the earliest symptoms a woman reports when she is pregnant.
- C. It is when the mother can first feel the movements of the fetus.
- D. It is an increase in vaginal discharge caused by the increase in estrogen.
Correct Answer: C
Rationale: The correct answer is C because quickening refers to the first time a mother feels fetal movements, usually around 18-20 weeks gestation. This marks the beginning of fetal movements that the mother can perceive.
A is incorrect because intermittent uterine contractions are not referred to as quickening.
B is incorrect as it describes amenorrhea, not quickening.
D is incorrect as an increase in vaginal discharge is not the definition of quickening.
What is a complication of uterine rupture?
- A. DIC
- B. nuchal cord
- C. polyhydramnios
- D. oligohydramnios
Correct Answer: A
Rationale: The correct answer is A: DIC (Disseminated Intravascular Coagulation). Uterine rupture can lead to severe bleeding, causing DIC. This is because the release of blood into the abdomen triggers the body's clotting system, resulting in the consumption of clotting factors and platelets. This can lead to widespread clotting in small blood vessels and ultimately result in bleeding disorders.
Summary:
- B: Nuchal cord is when the umbilical cord is wrapped around the baby's neck, not directly related to uterine rupture.
- C: Polyhydramnios is excessive amniotic fluid, not a direct complication of uterine rupture.
- D: Oligohydramnios is decreased amniotic fluid, not a direct complication of uterine rupture.
Observation of a fetal heart rate pattern indicates an increase in heart rate from the prior baseline rate of 152 bpm. Which physiologic mechanisms would account for this situation?
- A. Inhibition of epinephrine
- B. Inhibition of norepinephrine
- C. Stimulation of the vagus nerve
- D. Sympathetic stimulation
Correct Answer: D
Rationale: The correct answer is D: Sympathetic stimulation. Sympathetic stimulation increases heart rate by releasing norepinephrine, which acts on beta-adrenergic receptors in the heart. This leads to an increase in heart rate. Choices A and B are incorrect because inhibition of epinephrine or norepinephrine would not cause an increase in heart rate. Choice C is incorrect because stimulation of the vagus nerve would actually decrease heart rate by releasing acetylcholine, which acts on muscarinic receptors in the heart.