Nokea
A 34-week pregnant woman presents with a non-reactive nonstress test (NST). What should the nurse do next?
- A. Administer a tocolytic agent
- B. Perform a biophysical profile (BPP)
- C. Monitor the fetal heart rate for 30 minutes
- D. Monitor fetal heart rate
Correct Answer: B
Rationale: The correct answer is B: Perform a biophysical profile (BPP). A non-reactive NST indicates fetal distress, so a BPP is necessary to assess the overall well-being of the fetus. BPP evaluates fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume, and NST results. Administering a tocolytic agent (A) is not indicated as the issue is fetal distress, not preterm labor. Monitoring the fetal heart rate for 30 minutes (C) may delay necessary intervention if fetal distress is present. Monitoring fetal heart rate (D) alone does not provide a comprehensive assessment of fetal well-being.
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What advice should the nurse give regarding herbal supplements during pregnancy?
- A. Herbals are safe because they're natural
- B. Licorice and cat’s claw are safe
- C. The FDA has approved herbals for pregnancy
- D. Discuss everything with a healthcare provider
Correct Answer: D
Rationale: Herbal supplements may pose risks during pregnancy, and their safety is not well-established. Consulting a healthcare provider is essential.
Which of the following skin changes should the nurse highlight for a pregnant woman’s health care practitioner?
- A. Linea nigra.
- B. Melasma.
- C. Petechiae.
- D. Spider nevi.
Correct Answer: C
Rationale: Petechiae (small hemorrhages under the skin) could indicate underlying medical conditions such as thrombocytopenia or coagulopathy, warranting further investigation. Linea nigra and melasma are common benign changes, while spider nevi are usually harmless but less urgent.
A patient with a history of hypertension is admitted to the labor and delivery unit. Which of the following is most important to monitor for during labor?
- A. Hypotension
- B. Precipitous delivery
- C. Preeclampsia
- D. Increased bleeding risk
Correct Answer: C
Rationale: The correct answer is C: Preeclampsia. Preeclampsia is a serious condition characterized by high blood pressure and protein in the urine, which can lead to complications for both the mother and baby during labor. Monitoring for signs of preeclampsia is crucial to ensure timely intervention and prevent adverse outcomes.
A: Hypotension is not typically a major concern in a patient with a history of hypertension during labor.
B: Precipitous delivery refers to an unusually fast labor, which can be managed but is not the most important issue to monitor for in this case.
D: Increased bleeding risk may be a concern, but preeclampsia poses a more immediate threat to the patient's health and requires closer monitoring.
A nurse is educating a postpartum person about newborn care. Which of the following should be included in the teaching about umbilical cord care?
- A. keep the cord dry and clean
- B. apply a sterile dressing to the cord
- C. use alcohol or iodine to clean the cord
- D. apply a sterile dressing to the umbilicus
Correct Answer: A
Rationale: The correct answer is A: keep the cord dry and clean. This is because keeping the umbilical cord dry and clean helps prevent infection and promotes healing. Applying a sterile dressing (B) is unnecessary and may trap moisture, leading to infection. Using alcohol or iodine (C) is outdated and can delay cord separation. Applying a sterile dressing to the umbilicus (D) is not recommended as it can interfere with air circulation and healing. In summary, choice A is correct as it aligns with current best practices for umbilical cord care.
The nurse is assessing a pregnant patient who is 30 weeks gestation and is concerned about the possibility of gestational diabetes. Which of the following symptoms should the nurse educate the patient to report?
- A. Increased thirst and frequent urination
- B. Sudden weight loss and increased energy
- C. Extreme fatigue and headaches
- D. Decreased fetal movement and nausea
Correct Answer: A
Rationale: The correct answer is A: Increased thirst and frequent urination. This is because these symptoms are indicative of hyperglycemia, which is common in gestational diabetes. Increased thirst occurs due to the body trying to flush out excess sugar through urine, leading to frequent urination. This should be reported to the healthcare provider for further evaluation and management.
Other choices are incorrect:
B: Sudden weight loss and increased energy are not typical symptoms of gestational diabetes. Weight loss can occur in uncontrolled diabetes, but it is not a common symptom in gestational diabetes.
C: Extreme fatigue and headaches can be non-specific symptoms and are not necessarily related to gestational diabetes.
D: Decreased fetal movement and nausea are more commonly associated with other complications in pregnancy, such as placental insufficiency or preeclampsia, rather than gestational diabetes.