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A client at 8 weeks of gestation with iron deficiency anemia is prescribed iron supplements. Which beverage should the nurse reinforce the client to take the supplements with for better absorption?
- A. Ice water
- B. Low-fat or whole milk
- C. Tea or coffee
- D. Orange juice
Correct Answer: D
Rationale: The correct answer is D: Orange juice. Vitamin C enhances iron absorption by converting non-heme iron to a more absorbable form. The acidity in orange juice aids in this process. Ice water (choice A) does not contain any nutrients to enhance iron absorption. Low-fat or whole milk (choice B) contains calcium, which can inhibit iron absorption. Tea or coffee (choice C) contains tannins that can also inhibit iron absorption. In summary, orange juice is the best choice due to its vitamin C content that helps improve iron absorption.
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A client who is at 22 weeks of gestation reports concern about the blotchy hyperpigmentation on her forehead. Which of the following actions should the nurse take?
- A. Tell the client to follow up with a dermatologist.
- B. Explain to the client this is an expected occurrence.
- C. Instruct the client to increase her intake of vitamin D.
- D. Inform the client she might have an allergy to her skin care products.
Correct Answer: B
Rationale: The correct answer is B. The blotchy hyperpigmentation on the client's forehead is likely melasma, a common occurrence during pregnancy. This is due to hormonal changes causing increased melanin production. The nurse should educate the client that this is an expected occurrence during pregnancy and reassure her that it is usually temporary and will fade postpartum.
Choice A (Tell the client to follow up with a dermatologist) is incorrect because dermatological consultation is not typically necessary for melasma during pregnancy.
Choice C (Instruct the client to increase her intake of vitamin D) is incorrect because vitamin D deficiency is not typically associated with blotchy hyperpigmentation on the forehead during pregnancy.
Choice D (Inform the client she might have an allergy to her skin care products) is incorrect because melasma is not caused by allergies to skincare products.
A client who is at 24 weeks of gestation and reports daily mild headaches is being cared for by a nurse. Which of the following instructions should the nurse include in the plan of care?
- A. Administer ibuprofen 400 mg twice daily.
- B. Recommend that the client perform conscious relaxation techniques daily.
- C. Give the client ginseng tea with each meal.
- D. Instruct the client to soak in a bath with a water temperature of 105°F for 15 minutes daily.
Correct Answer: B
Rationale: The correct answer is B: Recommend that the client perform conscious relaxation techniques daily. Headaches during pregnancy can be common due to hormonal changes and increased blood volume. The nurse should recommend non-pharmacological interventions like relaxation techniques to manage headaches safely without medication. Conscious relaxation techniques can help reduce stress and tension, potentially alleviating headaches. Ibuprofen (choice A) is not recommended during pregnancy due to potential harm to the fetus. Ginseng tea (choice C) is not safe for pregnant women as it may lead to complications. Soaking in a hot bath (choice D) with a water temperature of 105°F can raise the body temperature, which is not advised during pregnancy as it may harm the baby.
A client is reinforcing discharge teaching with a client who has premature rupture of membranes at 26 weeks of gestation. Which of the following instructions should the client include?
- A. Use a condom with sexual intercourse
- B. Avoid bubble bath solution when taking a tub bath
- C. Wipe from front to back when performing perineal hygiene
- D. Keep a daily record of fetal kick counts
Correct Answer: D
Rationale: The correct answer is D: Keep a daily record of fetal kick counts. This is important for monitoring fetal well-being, especially in cases of premature rupture of membranes. By counting fetal kicks daily, the client can assess fetal movements and report any changes promptly to healthcare providers. This helps in early detection of fetal distress or problems.
A: Using a condom with sexual intercourse is not relevant to the situation of premature rupture of membranes.
B: Avoiding bubble bath solution is important for preventing vaginal infections but not directly related to monitoring fetal well-being.
C: Wiping from front to back during perineal hygiene is a general hygiene practice and not specific to the situation of premature rupture of membranes.
During active labor, a nurse notes tachycardia on the external fetal monitor tracing. Which of the following conditions should the nurse identify as a potential cause of the heart rate?
- A. Maternal fever
- B. Fetal heart failure
- C. Maternal hypoglycemia
- D. Fetal head compression
Correct Answer: A
Rationale: The correct answer is A: Maternal fever. Maternal fever can lead to tachycardia in the fetus due to the transfer of maternal antibodies, cytokines, and other inflammatory mediators across the placenta, affecting fetal heart rate. Maternal fever can indicate infection, which can cause fetal distress. The other choices are incorrect because:
B: Fetal heart failure typically presents with bradycardia, not tachycardia.
C: Maternal hypoglycemia can affect the fetus but is more likely to cause fetal bradycardia than tachycardia.
D: Fetal head compression can result in decelerations but not necessarily tachycardia.
A caregiver is learning about newborn safety. Which of the following statements by a parent indicates an understanding of the teaching?
- A. I will dress my baby in flame-retardant clothing.
- B. I will ensure a bib on my baby at night to keep her clothing dry.
- C. I will warm my baby's formula using the lowest setting in the microwave.
- D. I will cover the crib mattress with plastic to prevent staining.
Correct Answer: A
Rationale: The correct answer is A because dressing the baby in flame-retardant clothing is a safety measure to reduce the risk of burns. Flame-retardant clothing can help protect the baby in case of accidental exposure to fire or heat sources.
Choice B is incorrect because putting a bib on the baby at night can pose a suffocation hazard. Choice C is incorrect because warming formula in the microwave can create hot spots that may burn the baby's mouth. Choice D is incorrect because covering the crib mattress with plastic can increase the risk of suffocation and overheating for the baby.