Nokea
Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage?
- A. 10th and 12th weeks of gestation
- B. 18th and 22nd weeks of gestation
- C. 24th and 28th weeks of gestation
- D. 36th and 40th weeks of gestation
Correct Answer: C
Rationale: The correct answer is C (24th and 28th weeks of gestation) because during the second and third trimesters of pregnancy, insulin needs typically increase due to hormonal changes causing insulin resistance. This is when the placenta produces hormones that interfere with insulin, leading to higher blood sugar levels. Choices A, B, and D are incorrect because they do not align with the typical pattern of insulin dosage adjustments during pregnancy for clients with type 1 diabetes.
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A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient's magnesium level is 7.6 mg/dL. What is the nurse's priority action?
- A. Stop the infusion of magnesium.
- B. Assess the patient's respiratory rate.
- C. Assess the patient's deep tendon reflexes.
- D. Notify the health care provider of the magnesium level.
Correct Answer: B
Rationale: The correct answer is B: Assess the patient's respiratory rate. A magnesium level of 7.6 mg/dL is above the therapeutic range (4-7 mg/dL) and can lead to magnesium toxicity. Respiratory depression is a common early sign of magnesium toxicity. Assessing the patient's respiratory rate is the priority to monitor for this potentially life-threatening complication. Stopping the infusion of magnesium (Choice A) is not the immediate priority as the patient's respiratory status needs to be assessed first. Assessing deep tendon reflexes (Choice C) is important for magnesium toxicity but not as urgent as assessing respiratory rate. Notifying the health care provider (Choice D) can be done after assessing the patient's respiratory rate.
A patient at 10 weeks' gestation informs the nurse they are having vaginal bleeding and cramping. After completing a speculum examination, the health-care provider (HCP) informs the patient their cervix is open. What does the nurse anticipate the HCP will inform the patient they are experiencing?
- A. complete abortion
- B. incomplete abortion
- C. inevitable abortion
- D. spontaneous abortion
Correct Answer: C
Rationale: The correct answer is C: inevitable abortion. At 10 weeks' gestation, an open cervix with vaginal bleeding and cramping indicates an inevitable abortion, where the miscarriage is unavoidable and the process is ongoing. The open cervix suggests that the pregnancy is not viable and will not continue. The other options are incorrect because: A. Complete abortion refers to the expulsion of all products of conception, B. Incomplete abortion involves partial expulsion of products of conception, and D. Spontaneous abortion is a general term for any non-induced abortion.
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
- A. Determining cervical dilation and effacement
- B. Monitoring FHR and maternal vital signs
- C. Observing vaginal bleeding or leakage of amniotic fluid
- D. Determining frequency, duration, and intensity of contractions
Correct Answer: A
Rationale: The correct answer is A: Determining cervical dilation and effacement. This assessment is contraindicated for a patient with suspected placenta previa because it can lead to further disruption of the placenta and potentially cause severe bleeding. Monitoring FHR and vital signs (B) is important for assessing fetal well-being and maternal status. Observing vaginal bleeding or amniotic fluid leakage (C) is crucial in identifying complications. Determining the frequency, duration, and intensity of contractions (D) is essential for monitoring labor progression but is not appropriate for a patient with suspected placenta previa due to the risk of placental disruption.
What should the nurse recognize as evidence that the patient is recovering from preeclampsia?
- A. 1+ protein in urine
- B. 2+ pitting edema in lower extremities
- C. Urine output >100 mL/hour
- D. Deep tendon reflexes +2
Correct Answer: C
Rationale: The correct answer is C: Urine output >100 mL/hour. This signifies improved kidney function, a key indicator of recovery in preeclampsia. Increased urine output indicates better kidney perfusion and reduced risk of complications like renal failure. A: 1+ protein in urine suggests ongoing kidney damage. B: 2+ pitting edema in lower extremities indicates fluid retention, a common symptom of preeclampsia. D: Deep tendon reflexes +2 are not specific to preeclampsia recovery, although hyperreflexia can be seen in severe cases.
As the triage nurse in the emergency room, you are reviewing results for the high-risk obstetric patient who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer–Betke test is positive. Based on this information, you anticipate that
- A. immediate birth is required.
- B. the patient should be transferred to the critical care unit for closer observation.
- C. RhoGAM should be administered.
- D. a tetanus shot should be administered.
Correct Answer: A
Rationale: The correct answer is A: immediate birth is required. The positive Kleihauer–Betke test indicates fetal-maternal hemorrhage, where fetal blood enters the maternal circulation. This can lead to fetal-maternal transfusion, causing fetal anemia. Immediate birth is necessary to assess and manage potential fetal distress, such as anemia and hypoxia, due to the trauma from the MVA.
Choices B, C, and D are incorrect:
B: Transferring to critical care unit is not the immediate priority. The focus should be on addressing the fetal distress.
C: RhoGAM is given to Rh-negative mothers to prevent Rh sensitization, but it is not directly related to the positive Kleihauer–Betke test result.
D: Tetanus shot administration is important for tetanus prevention, but it is not the priority in this case where immediate birth is required due to fetal-maternal hemorrhage.