Nokea
A 36-week gestation gravid lies flat on her back.
- A. Hypertension.
- B. Dizziness.
- C. Rales.
- D. Chloasma.
Correct Answer: B
Rationale: Lying flat on the back can compress the inferior vena cava, leading to reduced blood flow and dizziness. Chloasma, rales, and hypertension are unrelated to this position.
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A nurse is assessing a postpartum person for signs of deep vein thrombosis (DVT). What is the most common sign of DVT in the postpartum period?
- A. Swelling and redness of the calf
- B. Pain in the lower leg
- C. Heat intolerance
- D. Cold intolerance
Correct Answer: A
Rationale: The correct answer is A: Swelling and redness of the calf. Postpartum women are at a higher risk for DVT due to hormonal changes and immobility. Swelling and redness in the calf indicate possible DVT as blood clots can cause inflammation and blockage in the veins. Pain in the lower leg (B) is a common symptom but not the most specific for DVT. Heat intolerance (C) and cold intolerance (D) are not typically associated with DVT and are unrelated symptoms in this context.
Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following?
- A. Avoid eating greasy foods.
- B. Drink orange juice before rising.
- C. Consume 1 teaspoon of nutmeg each morning.
- D. Eat 3 large meals plus a bedtime snack.
Correct Answer: A
Rationale: Greasy foods can exacerbate nausea and vomiting. Small, frequent meals are recommended, and saltine crackers before rising can help alleviate symptoms. Orange juice and nutmeg are not recommended.
A nurse is monitoring a laboring person who is receiving oxytocin for labor induction. What is the priority assessment during oxytocin infusion?
- A. monitor fetal heart rate
- B. assess maternal vital signs
- C. assess uterine tone
- D. monitor for signs of uterine hyperstimulation
Correct Answer: C
Rationale: The correct answer is C: assess uterine tone. This is the priority assessment during oxytocin infusion because oxytocin can cause uterine hyperstimulation, leading to fetal distress. By assessing uterine tone regularly, the nurse can detect any signs of hyperstimulation early and take appropriate action to prevent complications. Monitoring fetal heart rate (A) is important but assessing uterine tone takes precedence as it directly impacts fetal well-being. Maternal vital signs (B) are important but are not as directly related to the safety of the fetus during oxytocin infusion. Monitoring for signs of uterine hyperstimulation (D) is essential, but assessing uterine tone is the proactive approach to detect hyperstimulation before it escalates.
A nurse is preparing to administer a postpartum tetanus shot. What is the most important action before administering the shot?
- A. verify the person's immunization status
- B. assess the person's blood pressure
- C. assess for uterine atony
- D. prepare for a cesarean section
Correct Answer: C
Rationale: Rationale:
C is correct because assessing for uterine atony is crucial before administering a postpartum tetanus shot to ensure no postpartum hemorrhage risk. Uterine atony can lead to excessive bleeding, which can be exacerbated by the tetanus shot.
Summary:
A - Verifying immunization status is important but not the most immediate action.
B - Assessing blood pressure is important but not directly related to the risk of postpartum hemorrhage.
D - Preparing for a cesarean section is not necessary for administering a postpartum tetanus shot.
A woman, 6 weeks pregnant, is having a vaginal examination. Which of the following would the practitioner expect to find?
- A. Thin cervical muscle.
- B. An enlarged ovary.
- C. Thick cervical mucus.
- D. Pale pink vaginal wall.
Correct Answer: B
Rationale: An enlarged ovary is a common finding in early pregnancy due to the corpus luteum. Thin cervical muscle, thick cervical mucus, and a pale pink vaginal wall are not typical findings at this stage.