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The nurse is monitoring a client with suspected placental abruption. What is a key assessment finding?
- A. Painless vaginal bleeding.
- B. Hard, rigid abdomen with severe pain.
- C. Clear amniotic fluid.
- D. Regular uterine contractions.
Correct Answer: B
Rationale: A hard, rigid abdomen and severe pain are classic signs of placental abruption, requiring urgent intervention.
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A client reports experiencing painless contractions at 32 weeks' gestation. What should the nurse explain?
- A. These are Braxton Hicks contractions and are normal.
- B. This is a sign of preterm labor.
- C. This indicates cervical dilation.
- D. This requires immediate hospitalization.
Correct Answer: A
Rationale: Braxton Hicks contractions are common in the third trimester and typically do not signify labor.
A client in the first trimester reports nausea. What dietary recommendation should the nurse make?
- A. Eat dry crackers before getting out of bed.
- B. Avoid eating throughout the day.
- C. Increase intake of spicy foods.
- D. Consume large, infrequent meals.
Correct Answer: A
Rationale: Dry crackers before rising can help manage nausea by stabilizing blood sugar and reducing gastric discomfort.
A patient is taking oral contraceptives and asks whether they will still be effective if she has diarrhea. What should the nurse respond?
- A. Oral contraceptives will still work if taken with food.
- B. Oral contraceptives may be less effective during diarrhea due to absorption issues.
- C. Oral contraceptives need to be stopped for 7 days when experiencing diarrhea.
- D. Oral contraceptives will be more effective during diarrhea due to faster metabolism.
Correct Answer: B
Rationale: Diarrhea can reduce the absorption of oral contraceptives, potentially making them less effective. Choice A is incorrect because food does not always affect oral contraceptive absorption. Choice C is incorrect because there is no need to stop the contraceptives, but additional methods may be recommended during diarrhea. Choice D is incorrect because diarrhea does not increase the effectiveness of oral contraceptives.
Three hours after birth, a newborn of a mother with diabetes becomes jittery, has weak, high- pitched cry , and exhibits irregular respirations. The nurse recognizes that these signs are often associated with:
- A. Hypovolemia
- B. Hypocalcemia
- C. Hypoglycemia
- D. Hyperglycemia
Correct Answer: C
Rationale: The signs described in the scenario - jitteriness, weak high-pitched cry, irregular respirations - are indicative of hypoglycemia in a newborn. Babies born to mothers with diabetes are at risk for hypoglycemia due to their exposure to high blood sugar levels in utero. After birth, when the baby is separated from the mother's blood supply, their own insulin production may lead to a sudden drop in blood glucose levels.
A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following information should the nurse include?
- A. Focusing on controlling body functions
- B. "Synchronized breathing will be required during hypnosis"
- C. "Hypnosis can be beneficial in you practiced it during the prenatal period"
- D. "Hypnosis does not work for controlling pain associated with labor".
Correct Answer: C
Rationale: The correct information that the nurse should include is that "Hypnosis can be beneficial if you practiced it during the prenatal period." This statement is true because hypnosis is a tool that can help individuals manage pain and stress through focused attention and suggestion. By practicing hypnosis techniques during the prenatal period, the individual can become more familiar and comfortable with the practice, making it more effective during labor. It is important to establish a routine and practice hypnosis consistently to maximize its benefits during labor.