Nokea
A client has just received synthetic prostaglandins for the induction of labor. The nurse plans to monitor the client for which of the following side effects?
- A. Nausea and uterine tetany.
- B. Hypertension and vaginal bleeding.
- C. Urinary retention and severe headache.
- D. Bradycardia and hypothermia.
Correct Answer: A
Rationale: Synthetic prostaglandins can cause nausea and uterine tetany, which are common side effects. The nurse should monitor for these and other potential complications.
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Which of the following features would the nurse expect to be absent in an 8-week-gestation embryo?
- A. Four-chambered heart.
- B. Fingers and toes.
- C. Fully formed genitalia.
- D. Facial features.
Correct Answer: C
Rationale: At 8 weeks, the embryo’s genitalia are not fully formed, though other features like the heart and facial structures are developing.
When should the nurse begin discharge planning?
- A. When the patient is ready
- B. Close to the time of discharge
- C. Upon admission to the hospital
- D. After an order is written/prescribed
Correct Answer: C
Rationale: Discharge planning begins the moment a patient is admitted to a health care facility.
What does a birth plan help the parents accomplish?
- A. Avoidance of an episiotomy
- B. Determining the outcome of the birth
- C. Assuming complete control of the situation
- D. Taking an active part in planning the birth experience
Correct Answer: D
Rationale: The correct answer is D because a birth plan allows parents to actively participate in planning their birth experience by outlining their preferences and wishes. It helps them communicate their desires to healthcare providers and ensures their preferences are considered during labor and delivery. Choice A is incorrect as avoiding an episiotomy is a specific medical procedure, not the primary purpose of a birth plan. Choice B is incorrect as determining the outcome of birth is not within the control of parents. Choice C is incorrect as assuming complete control of the situation may not be realistic or safe during childbirth.
A breastfeeding client, 6 days postdelivery, calls the postpartum unit stating, “I think I am engorged. My breasts are very hard and hot and they really hurt.” Which of the following questions should the nurse ask at this time?
- A. “Have you taken a warm shower this morning?”
- B. “Do you have an electric breast pump?”
- C. “How much did you have to drink yesterday?”
- D. “When was the last time you fed the baby?”
Correct Answer: D
Rationale: Asking when the client last fed the baby helps determine if engorgement is due to infrequent feeding, which is a common cause of breast engorgement.
The nurse's role in diagnostic testing is to provide which of the following?
- A. Advice to the couple
- B. Information about the tests
- C. Reassurance about fetal safety
- D. Assistance with decision making
Correct Answer: B
Rationale: The correct answer is B: Information about the tests. The nurse's role in diagnostic testing is to educate the couple about the purpose, procedure, risks, and benefits of the tests. This empowers them to make informed decisions. Providing advice (A) may be beyond the nurse's scope. Reassurance about fetal safety (C) is important but not the primary role. While the nurse may assist with decision-making (D), the key focus should be on providing comprehensive information.