Nokea
A client at 15 weeks' gestation is admitted with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 and fundal height is 19 cm. The nurse should prepare to do which of the following?
- A. Transfer the client to the antenatal unit.
- B. Keep the client NPO for 24 hours.
- C. Administer magnesium sulfate.
- D. Obtain an ultrasound.
Correct Answer: D
Rationale: Ultrasound confirms the diagnosis of a hydatidiform mole.
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A nurse is discussing sterilization with a male client. Which of the following statements by the nurse is accurate?
- A. A vasectomy is effective immediately.
- B. A vasectomy requires a follow-up sperm count to confirm sterility.
- C. A vasectomy prevents testosterone production.
- D. A vasectomy is reversible in all cases.
Correct Answer: B
Rationale: A vasectomy requires a follow-up sperm count to confirm sterility, as sperm may remain in the vas deferens initially. It is not effective immediately, does not affect testosterone production, and reversal is not always successful.
A primiparous client is on a regular diet 24 hours postpartum. She is from Guatemala and speaks little English. The client's mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds, based on the understanding about which of the following?
- A. Foods from home are generally discouraged on the postpartum unit.
- B. The mother can bring the daughter any foods that she desires.
- C. This is permissible as long as the foods are nutritious and high in iron.
- D. The client's physician needs to give permission for the foods.
Correct Answer: C
Rationale: Nutritious, iron-rich foods support postpartum recovery and respect cultural preferences.
A 17-year-old client at 33 weeks' gestation diagnosed with mild preeclampsia is prescribed bed rest at home. The nurse instructs the client to contact the health care provider immediately if she experiences which of the following?
- A. Blurred vision.
- B. Ankle edema.
- C. Increased energy levels.
- D. Mild backache.
Correct Answer: A
Rationale: Blurred vision can indicate worsening preeclampsia and requires immediate medical attention.
A nurse is counseling a client about the use of a contraceptive sponge. Which of the following client statements indicates understanding?
- A. The sponge can be inserted just before intercourse.
- B. I will reuse the sponge after rinsing it.
- C. The sponge protects against STIs.
- D. I need to apply additional spermicide after insertion.
Correct Answer: A
Rationale: The contraceptive sponge can be inserted just before intercourse, providing immediate protection. It cannot be reused, does not protect against STIs, and contains spermicide, so additional application is not needed.
A neonate delivered at 30 weeks' gestation and weighing $2,000 \mathrm{~g}$ is admitted to the neonatal intensive care unit. What nursing measure will decrease insensible water loss in a neonate?
- A. Bathing the baby as soon after birth as possible.
- B. Use of eye patches with phototherapy.
- C. Use of humidity in the incubator.
- D. Use of a radiant warmer.
Correct Answer: C
Rationale: Using humidity in the incubator helps maintain a moist environment, reducing insensible water loss through the skin, which is critical for preterm neonates with immature skin barriers.