Nokea
A client in the first stage of labor reports severe lower back pain. What intervention is most effective?
- A. Administer an epidural block.
- B. Encourage frequent position changes.
- C. Apply a heating pad to the back.
- D. Perform a sterile vaginal exam.
Correct Answer: B
Rationale: Frequent position changes, especially to hands-and-knees or leaning forward, can relieve back pain caused by fetal position.
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Which intervention is most appropriate for a mother with mastitis?
- A. Advise the mother to stop breastfeeding temporarily
- B. Encourage continued breastfeeding
- C. Apply cold compresses to the affected breast
- D. Refer the mother to a lactation consultant
Correct Answer: B
Rationale: Continuing breastfeeding helps resolve mastitis by clearing milk ducts.
A nurse is caring for a client who is in labor and requests nonpharmacological pain management. Which of the following nursing actions promotes client comfort?
- A. Assisting the client into squatting position
- B. Having the client lie in a supine position
- C. Applying fundal pressure during contractions
- D. Encouraging the client to void every 6 hr.
Correct Answer: A
Rationale: Assisting the client into a squatting position can help relieve pain and discomfort during labor. Squatting can open up the pelvis, allowing the baby to descend and progress through the birth canal more effectively. This position can also help with gravity-assisted delivery, decreasing the pressure on the mother's back and helping to reduce labor pains. Encouraging various positions during labor can provide comfort and promote optimal positioning for delivery.
The nurse assesses a patient for medical eligibility for contraceptive use. What is the meaning of an MEC score of 1?
- A. There is no restriction for the use of the contraceptive method.
- B. There is an unacceptable health risk if the contraceptive method is used.
- C. There is a risk that outweighs the advantages of the contraceptive method.
- D. There is an advantage of using a contraceptive method that outweighs any risk.
Correct Answer: A
Rationale: In the context of medical eligibility for contraceptive use, an MEC (Medical Eligibility Criteria) score of 1 indicates that there are no restrictions for using the particular contraceptive method. A score of 1 suggests that the advantages of using the contraceptive method outweigh any potential risks, making it a safe and recommended choice for the patient. Therefore, a patient with an MEC score of 1 can use the contraceptive method without any concerns regarding health risks or restrictions.
The nurse is monitoring a client receiving oxytocin for labor induction. What finding requires the nurse to stop the infusion?
- A. Contractions every 2 minutes.
- B. Fetal heart rate of 100 beats/minute.
- C. Maternal blood pressure of 120/80 mmHg.
- D. Client reports mild back pain.
Correct Answer: B
Rationale: A fetal heart rate of 100 bpm indicates bradycardia and requires immediate discontinuation of oxytocin.
The nurse is caring for a client with preeclampsia. What is the most important assessment?
- A. Daily weight.
- B. Urine protein levels.
- C. Fetal heart rate.
- D. Blood pressure.
Correct Answer: D
Rationale: Blood pressure monitoring is critical to prevent complications such as eclampsia and placental issues in preeclampsia.