Nokea
A client at 40 weeks of gestation is experiencing contractions every 3 to 5 minutes, becoming stronger. A vaginal exam by the registered nurse reveals the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client requests pain medication. Which of the following actions should the nurse prepare to take? (Select all that apply)
- A. Provide ice chips.
- B. Insert an indwelling urinary catheter.
- C. Administer opioid analgesic medication.
- D. Provide ice chips.
Correct Answer: C
Rationale: The correct action is to administer opioid analgesic medication (Choice C). At 40 weeks gestation with contractions every 3-5 minutes, 3 cm dilated, 80% effaced, and -1 station, the client is in active labor. Pain medication is appropriate to manage discomfort during labor. Opioid analgesics can help reduce pain intensity while still allowing the client to remain alert and participate in labor. Ice chips (Choice A and D) are not directly related to pain management in labor. Inserting a urinary catheter (Choice B) is not indicated unless there are specific concerns about bladder distention.
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A client in a prenatal clinic is receiving education from a nurse and mentions, 'I don't like milk.' Which of the following foods should the nurse recommend as a good source of calcium?
- A. Dark green leafy vegetables
- B. Deep red or orange vegetables
- C. White bread and rice
- D. Meat, poultry, and fish
Correct Answer: A
Rationale: The correct answer is A: Dark green leafy vegetables. Dark green leafy vegetables like kale, spinach, and broccoli are excellent sources of calcium. They provide a good alternative to dairy for those who don't like milk. These vegetables are rich in calcium, which is essential for bone health, especially during pregnancy. They also offer other nutrients like vitamin K and magnesium that support calcium absorption.
Summary:
B: Deep red or orange vegetables - While these vegetables are nutritious, they are not significant sources of calcium.
C: White bread and rice - These foods do not provide a significant amount of calcium.
D: Meat, poultry, and fish - While these foods are rich in protein and other nutrients, they are not primary sources of calcium.
A client in active labor at 39 weeks of gestation is receiving continuous IV oxytocin and has early decelerations in the FHR on the monitor tracing. What action should the nurse take?
- A. Discontinue the oxytocin infusion.
- B. Continue monitoring the client.
- C. Request that the provider assess the client.
- D. Increase the infusion rate of the maintenance IV fluid.
Correct Answer: B
Rationale: The correct action for the nurse to take when a client in active labor at 39 weeks of gestation has early decelerations in the FHR on the monitor tracing is to continue monitoring the client. Early decelerations are typically benign and are associated with head compression during contractions, which is a normal response to labor. There is no need to discontinue the oxytocin infusion as early decelerations do not indicate fetal distress. Requesting the provider to assess the client may not be necessary at this point unless other concerning signs are present. Increasing the infusion rate of the maintenance IV fluid is not indicated as it would not address the early decelerations. Therefore, the best course of action is to continue monitoring the client for any changes in the FHR pattern.
During preterm labor, a client is scheduled for an amniocentesis. The nurse should review which of the following tests to assess fetal lung maturity?
- A. Alpha-fetoprotein (AFP)
- B. Lecithin/sphingomyelin (L/S) ratio
- C. Kleihauer-Betke test
- D. Indirect Coombs' test
Correct Answer: B
Rationale: The correct answer is B: Lecithin/sphingomyelin (L/S) ratio. This test is used to assess fetal lung maturity by determining the ratio of two substances present in amniotic fluid. An L/S ratio of 2:1 or higher indicates mature fetal lungs, reducing the risk of respiratory distress syndrome in preterm infants.
A: Alpha-fetoprotein (AFP) is used to screen for neural tube defects, not fetal lung maturity.
C: Kleihauer-Betke test is used to detect fetal-maternal hemorrhage.
D: Indirect Coombs' test is used to detect antibodies in maternal blood that may attack fetal red blood cells, not assess fetal lung maturity.
In summary, the L/S ratio test is the most appropriate choice to assess fetal lung maturity during preterm labor, as it directly correlates with the development of the fetal lungs.
A client in a family planning clinic requests oral contraceptives. Which of the following findings in the client's history should be recognized as contraindications to oral contraceptives? (Select all that apply.)
- A. Cholecystitis
- B. Hypertension
- C. Migraine headaches
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Cholecystitis, hypertension, and migraine headaches are all contraindications to oral contraceptives. Cholecystitis can be exacerbated by oral contraceptives. Hypertension increases the risk of cardiovascular events with oral contraceptives. Migraine headaches, especially with aura, are associated with an increased risk of stroke when combined with oral contraceptives. Therefore, considering these risks, it is crucial to recognize these findings as contraindications to prescribing oral contraceptives.
A client who is pregnant states that her last menstrual period was April 1st. What is the client's estimated date of delivery?
- A. January 8
- B. January 15
- C. February 8
- D. February 15
Correct Answer: A
Rationale: The estimated date of delivery (EDD) is calculated by adding 280 days to the first day of the last menstrual period (LMP). In this case, April 1st + 280 days = January 8, which is the correct EDD. Choice A is correct. Choices B, C, and D are incorrect because they do not account for the 280-day gestation period from the LMP.