Nokea
A client at 32 weeks' gestation is experiencing preterm labor. What is the primary goal of tocolytic therapy?
- A. To prevent fetal hypoxia.
- B. To delay delivery and improve fetal lung maturity.
- C. To reduce maternal blood pressure.
- D. To increase uteroplacental blood flow.
Correct Answer: B
Rationale: Tocolytics are used to delay preterm delivery, allowing time for fetal lung maturity with corticosteroid administration.
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A newborn's birth was prolonged because the shoulders were very wide. The nurse performing the assessment would be particularly observant for a problem with the:
- A. Moro reflex
- B. Plantar reflex
- C. Babinski reflex
- D. Stepping reflex
Correct Answer: B
Rationale: Shoulder dystocia can affect the plantar reflex.
A 2-week-old neonate is admitted to the hospital with a diagnosis of possible sepsis. The neonate weighs 3.2 kg, The health care provider prescribes the following orders for the neonate and signs the order sheet. Which order would the nurse question? Progress Notes: 12/01/22- 10am
- A. Acetaminophen (Tylenol) 10mg/kg per rectum every 4-6 hours prn for pain
- B. Ampicillin 200mg/kg IV every 6 hours in D5.45 NSSIV @ 125ml/hr.
- C. Mom may breastfeed ad lib
- D. Draw blood cultures x 3 in A.M.
Correct Answer: B
Rationale: Ampicillin dosage exceeds recommended levels for neonates.
A nurse is assessing a client who is at 31 weeks of gestation. Which of the following findings show potential prenatal complication?
- A. Periodic tingling of fingers
- B. Absence of clonus
- C. Leg cramps
- D. Blurred vision
Correct Answer: D
Rationale: Blurred vision is a potential prenatal complication during the third trimester of pregnancy and can be a sign of conditions such as preeclampsia or gestational diabetes. It is important for the nurse to further assess this finding and consult with the healthcare provider to ensure appropriate management and monitoring of the client's condition. Periodic tingling of fingers, absence of clonus, and leg cramps are common discomforts during pregnancy and do not typically indicate a prenatal complication.
A newborn has a respiratory rate of 80 breaths/min, nasal flaring with sternal retractions, a heart rate of 120 beats/min, temperature of 36C and a persisting oxygen saturation of <87%. The nurse interprets these findings as:
- A. Cardiac distress
- B. Respiratory Alkalosis
- C. Bronchial pneumonia
- D. Respiratory Distress
Correct Answer: D
Rationale: These signs indicate respiratory distress.
Before giving a client oral combination contraceptives, which side effects should the nurse tell the patient to be aware of? Select all that apply.
- A. Irregular bleeding
- B. Thick vaginal discharge
- C. Nausea
- D. Breast tenderness
Correct Answer: B
Rationale: Common side effects of oral combination contraceptives include irregular bleeding, nausea, and breast tenderness. Choice B, thick vaginal discharge, is not typically associated with oral contraceptives.