Nokea
A baby is born addicted to crack cocaine. Which of the following signs/symptoms would the nurse expect to see?
- A. Hyperreflexia.
- B. Anorexia.
- C. Constipation.
- D. Hypokalemia.
Correct Answer: A
Rationale: Neonates born addicted to crack cocaine often exhibit hyperreflexia, irritability, and other signs of withdrawal.
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A client with diabetes mellitus is at 37 weeks gestation. She has had weekly NSTs for the last 3 weeks, and the results have been reactive. This week, the NST was nonreactive after 40 minutes. The nurse anticipates which of the following will be performed for the client based on these results?
- A. Scheduled for an immediate ultrasound
- B. Scheduled for a biophysical profile
- C. Admitted to the hospital for induction of labor
- D. Scheduled for a follow-up appointment for NST in 2 days
Correct Answer: B
Rationale: The correct answer is B: Scheduled for a biophysical profile. At 37 weeks gestation, a nonreactive NST after 40 minutes indicates a need for further evaluation with a biophysical profile to assess fetal well-being comprehensively. This test includes NST along with ultrasound evaluation of amniotic fluid volume, fetal tone, fetal breathing movements, and gross body movements. Biophysical profile provides a more detailed assessment of fetal status compared to NST alone.
Choice A is incorrect because an immediate ultrasound is not the next step after a nonreactive NST. Choice C is incorrect because hospital admission for labor induction is premature based on one nonreactive NST result. Choice D is incorrect because waiting for 2 days for a follow-up NST is not recommended due to the urgency of assessing fetal well-being promptly.
The nurse is counseling a woman who has been diagnosed with mild osteoporosis. Which of the following should be included in the counseling session?
- A. Begin a regimen of walking each day.
- B. Refrain from drinking chocolate milk.
- C. Increase her daily intake of red meat.
- D. Only wear shoes with rubber soles.
Correct Answer: A
Rationale: Weight-bearing exercises like walking can help strengthen bones and reduce the risk of fractures in individuals with osteoporosis.
A client complaining of frequency, urgency, and burning on urination is seen by her health care practitioner. Which of the following factors in the client's history places her at risk for these complaints?
- A. The client urinates immediately after every sexual encounter.
- B. The client uses the diaphragm as a family planning method.
- C. The client wipes from front to back after every toileting.
- D. The client changes her peripads every two hours during her menses.
Correct Answer: B
Rationale: The use of a diaphragm can increase the risk of urinary tract infections due to pressure on the urethra.
Without doing a vaginal examination, a nurse concludes that a primigravida, who has received no medications during her labor, is in transition. Which of the following signs/symptoms would lead a nurse to that conclusion?
- A. The woman fell asleep during a contraction.
- B. The woman yelled at her partner and vomited.
- C. The woman laughed at something on the television.
- D. The woman began pushing with each contraction.
Correct Answer: B
Rationale: Yelling and vomiting are common signs of the transition phase of labor, characterized by intense contractions and emotional distress.
A woman, who is in pain from a diagnosis of mastitis, has abruptly weaned her baby to a bottle. Her actions place the woman at high risk for which of the following?
- A. Mammary rupture.
- B. Postpartum psychosis.
- C. Supernumerary nipples.
- D. Breast abscess.
Correct Answer: D
Rationale: Abrupt weaning can lead to milk stasis, increasing the risk of a breast abscess due to bacterial infection.