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A client at 40-weeks gestation is admitted to the labor and delivery unit in active labor. The client's cervix is dilated 8 cm, 100% effaced, and the fetus is at +1 station. The client begins to push forcefully with contractions. What action should the nurse take?
- A. Encourage the client to pant-blow during contractions.
- B. Assist the client to push with contractions.
- C. Prepare for an immediate delivery.
- D. Notify the healthcare provider.
Correct Answer: A
Rationale: Pant-blow breathing helps prevent premature pushing before full dilation, reducing the risk of cervical edema.
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A client at 39-weeks gestation is admitted to the labor and delivery unit in active labor. The client's cervix is dilated 6 cm, 90% effaced, and the fetus is at 0 station. The client's membranes rupture spontaneously, and the fluid is clear. What action should the nurse take next?
- A. Monitor the fetal heart rate pattern.
- B. Perform a vaginal examination.
- C. Encourage the client to ambulate.
- D. Administer pain medication.
Correct Answer: A
Rationale: Monitoring the fetal heart rate pattern after membrane rupture is essential to detect any changes in fetal status.
A pregnant patient has lactose intolerance. Which recommendation will the nurse provide to best help the patient meet dietary needs for calcium?
- A. Add foods such as nuts, dried fruit, and broccoli to the diet.
- B. Consume dairy products but take an over-the-counter anti-gas product.
- C. Increase the intake of dark leafy vegetables, such as spinach and chard.
- D. Use powdered milk instead of liquid forms of milk.
Correct Answer: A
Rationale: The correct answer is A: Add foods such as nuts, dried fruit, and broccoli to the diet. This recommendation is best because these foods are good sources of calcium and are also lactose-free, which is important for a pregnant patient with lactose intolerance. Nuts and dried fruits are rich in calcium, while broccoli is a good vegetable source of calcium.
Choice B is incorrect because consuming dairy products can exacerbate symptoms of lactose intolerance, even with an anti-gas product. Choice C is incorrect because while dark leafy vegetables are good sources of calcium, they may not provide enough for a pregnant patient's needs. Choice D is incorrect because powdered milk still contains lactose and may not be well-tolerated by someone with lactose intolerance.
A primigravida at 39-weeks gestation is admitted to the labor and delivery unit in active labor. She is given an epidural anesthetic. Her blood pressure drops to 90/50 mm Hg, and the fetal heart rate shows late decelerations. What is the most likely cause of these findings?
- A. Maternal hypotension.
- B. Uteroplacental insufficiency.
- C. Fetal distress.
- D. Amniotic fluid embolism.
Correct Answer: A
Rationale: Maternal hypotension following epidural anesthesia can lead to decreased placental perfusion, causing late decelerations in the fetal heart rate.
Expectant parents ask a prenatal nurse educator, 'Which setting for childbirth limits the amount of parent-infant interaction?'
- A. Birth center
- B. Home birth
- C. Traditional hospital birth
- D. Labor, birth, and recovery room
Correct Answer: C
Rationale: In traditional hospital settings, the mother may see the infant for only short feeding periods, and the infant is cared for in a separate nursery.
The nurse identifies crepitus when examining the chest of a newborn who was delivered vaginally. Which further assessment should the nurse perform?
- A. Elicit positive scarf sign on the affected side
- B. Observe for an asymmetrical Moro (startle) reflex
- C. Watch for swelling of fingers on the affected side
- D. Note paralysis of affected extremity and muscles
Correct Answer: B
Rationale: The most common neonatal birth trauma due to vaginal delivery is fracture of the clavicle. Although an infant may be asymptomatic, a fracture clavicle should be suspected is an infant has limited use of the affected arm malposition of the arm, an asymmetric Moro reflex (B), crepitus over the clavicle, focal swelling or tenderness, or cries when the arm is moved.