Nokea
A gravid woman who recently emigrated from mainland China is being seen at her first prenatal visit. She was never vaccinated in her home country. An injection to prevent which of the following communicable diseases should be administered to the woman during her pregnancy?
- A. Influenza.
- B. Mumps.
- C. Rubella.
- D. Varicella.
Correct Answer: A
Rationale: Influenza vaccination is safe and recommended during pregnancy to protect both the mother and fetus. Vaccines for Mumps, Rubella, and Varicella are live attenuated vaccines and are contraindicated during pregnancy.
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Which statements about amniotic fluid are correct? Select all that apply.
- A. Provides fetal nutrition
- B. Cushions the fetus from injury
- C. Enables the fetus to grow
- D. Enables the fetus to practice swallowing
Correct Answer: D
Rationale: Amniotic fluid cushions the fetus, enables growth, maintains a stable thermal environment, and allows the fetus to practice swallowing.
The nurse notes each of the following findings in a 10-week gestation client. Which of the findings would enable the nurse to tell the client that she is positively pregnant?
- A. Fetal heart rate via Doppler.
- B. Positive pregnancy test.
- C. Positive Chadwick’s sign.
- D. Montgomery gland enlargements.
Correct Answer: A
Rationale: A fetal heart rate detected via Doppler is a positive sign of pregnancy. A positive pregnancy test, Chadwick’s sign, and Montgomery gland enlargements are probable signs but not definitive.
A patient at the obstetric office has just learned she is pregnant with dizygotic twins. What facts will the nurse include when educating this patient? (Select all that apply.)
- A. Dizygotic twins are the same sex.
- B. Dizygotic twins share a placenta.
- C. Dizygotic pregnancies tend to repeat in families.
- D. Dizygotic twins have separate chorions.
Correct Answer: C
Rationale: Dizygotic twins tend to repeat in families and have separate chorions. They can be the same sex or different sexes and have their own placenta. The incidence of dizygotic twins increases with maternal age rather than decreases.
During the first stage of labor, what is the primary goal of nursing care in the early phase?
- A. Administer pain medication.
- B. Monitor fetal heart rate continuously.
- C. Promote relaxation and provide comfort measures.
- D. Prepare for imminent delivery.
Correct Answer: C
Rationale: The correct answer is C because during the early phase of labor, the primary goal of nursing care is to promote relaxation and provide comfort measures to help the mother cope with contractions and manage pain. This helps create a calm and supportive environment, enhancing the progress of labor. Administering pain medication (A) may be necessary later, not necessarily in the early phase. Monitoring fetal heart rate continuously (B) is important but not the primary goal in the early phase. Preparing for imminent delivery (D) is premature in the early phase, as labor can be lengthy.
A postpartum person is breastfeeding her newborn. What is the most appropriate action if the person is experiencing nipple pain?
- A. apply lanolin cream
- B. administer pain relief
- C. monitor the baby's latch
- D. provide distraction techniques
Correct Answer: B
Rationale: The correct answer is B: administer pain relief. Nipple pain during breastfeeding can be caused by various factors such as improper latch, engorgement, or infection. Administering pain relief can help alleviate the discomfort temporarily while addressing the root cause. Applying lanolin cream (choice A) may help with moisturizing the nipples but won't address the underlying issue causing the pain. Monitoring the baby's latch (choice C) is important for long-term prevention but may not provide immediate relief. Providing distraction techniques (choice D) is not addressing the physical pain and may not be effective in resolving the issue. Administering pain relief is the most appropriate immediate action to help the postpartum person manage the discomfort while addressing the cause of the pain.