Nokea
A 33-year-old client at 9 weeks gestation tells the nurse that while she has 'cut down,' she still has at least one alcoholic drink every evening before bedtime. What intervention should the nurse implement?
- A. Notify child protective services of the client's illicit drug use and probable child endangerment
- B. Praise the client for her actions and offer to discuss ways to decrease consumption even more
- C. Insist that the client stop all alcohol use and draw a blood alcohol level at each prenatal visit
- D. Discuss the risks of alcohol use and encourage complete abstinence
Correct Answer: D
Rationale: Complete abstinence (D) is recommended to prevent fetal alcohol spectrum disorders.
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A patient at 8 weeks' gestation complains to the nurse, 'I feel sick almost every morning. And I throw up at least two or three times a week.' What is the nurse's best guidance for this patient?
- A. Do you like cheese?'
- B. Try eating four meals a day instead of three meals a day.'
- C. Try eating peanut butter on whole wheat bread right before going to bed.'
- D. If you can eat enough throughout the day, you don't have to worry about being sick.'
Correct Answer: C
Rationale: The correct answer is C: 'Try eating peanut butter on whole wheat bread right before going to bed.' This recommendation is based on the fact that consuming a small snack high in protein and complex carbohydrates before going to bed can help stabilize blood sugar levels and reduce morning sickness symptoms in pregnant women. Peanut butter provides protein and whole wheat bread provides complex carbohydrates, which can help alleviate nausea and vomiting.
Choice A is incorrect because asking about cheese does not address the patient's symptoms or provide any practical guidance for managing morning sickness.
Choice B is incorrect because increasing the number of meals may not necessarily alleviate morning sickness and could potentially exacerbate symptoms.
Choice D is incorrect because suggesting that eating enough throughout the day will prevent sickness oversimplifies the issue and does not offer targeted advice for managing morning sickness.
A pregnant client with mitral stenosis Class III is prescribed complete bedrest. The client asks the nurse, 'Why must I stay in bed all the time?' Which response is best for the nurse to provide this client?
- A. Complete bedrest decreases oxygen needs and demands on the heart muscle tissue.
- B. You have a small opening in your heart and complete bedrest will help it get bigger.
- C. We want your baby to be healthy, and this is the only way we can make sure that will happen.
- D. Labor is difficult, and you need to save your energy so you will be strong enough then.
Correct Answer: A
Rationale: Complete bedrest decreases oxygen needs and demands on the heart muscle tissue, which is crucial for clients with mitral stenosis.
An obviously pregnant woman walks into the hospital's emergency department entrance shouting. 'Help me! Help me! My baby is coming! I'm so afraid!' The nurse determines if delivery is indeed imminent, what action is most important for the nurse to take?
- A. Determine the gestational age of fetus
- B. Assess the amount and color of the amniotic fluid
- C. Obtain peripheral IV access and begin administration of IV fluids
- D. Provide clear concise instructions in a calm, deliberate manner
Correct Answer: D
Rationale: Providing clear instructions (D) helps manage the situation calmly and effectively.
A hospital has achieved Magnet status. Which indicators would be consistent with this type of certification?
- A. There is stratification of communication in a directed manner between nursing staff and administration.
- B. There is increased job satisfaction of nurses, with a lower staff turnover rate.
- C. Physicians are certified in their respective specialty areas.
- D. All nurses have baccalaureate degrees and certification in their clinical specialty area.
Correct Answer: B
Rationale: Magnet status hospitals demonstrate higher nurse job satisfaction and lower turnover rates, along with improved quality of care.
In consideration of the historic evolution of maternity care, which treatment options were used over the past century?
- A. During the nineteenth century, women of privilege were delivered by midwives in a hospital setting.
- B. Granny midwives received their training through a period of apprenticeship.
- C. The recognition of improved obstetric outcomes was related to increased usage of hygienic practices.
- D. A shift to hospital-based births occurred as a result of medical equipment designed to facilitate birth.
Correct Answer: A
Rationale: Training of granny midwives by apprenticeship, improved health outcomes due to hygiene, and the advent of medical equipment facilitating birth were key developments.