Nokea
A multigravid client in active labor at term is diagnosed with polyhydramnios. The physician has instructed the client about possible neonatal complications related to the polyhydramnios. The nurse determines that the client has understood the instructions when the client states that polyhydramnios is associated with which of the following in the fetus or neonate?
- A. Renal dysfunction.
- B. Intrauterine growth retardation.
- C. Pulmonary hypoplasia.
- D. Gastrointestinal disorders.
Correct Answer: D
Rationale: Polyhydramnios is associated with fetal gastrointestinal disorders (e.g., esophageal atresia) that impair amniotic fluid absorption. Renal dysfunction, growth retardation, or pulmonary hypoplasia are more linked to oligohydramnios.
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During a home visit on the fourth postpartum day, a primiparous client tells the nurse that she has been experiencing breast engorgement. To relieve engorgement, the nurse teaches the client that before nursing her baby, the client should do which of the following?
- A. Apply an ice cube to the nipples.
- B. Rub her nipples gently with lanolin cream.
- C. Express a small amount of breast milk.
- D. Offer the neonate a small amount of formula.
Correct Answer: C
Rationale: Expressing a small amount of milk softens the breast, making it easier for the neonate to latch.
A client asks about the risks of the copper IUD. Which of the following would the nurse include?
- A. It may increase menstrual bleeding and cramping.
- B. It causes permanent infertility.
- C. It requires daily replacement.
- D. It increases the risk of breast cancer.
Correct Answer: A
Rationale: The copper IUD may increase menstrual bleeding and cramping, especially initially. It does not cause permanent infertility, require daily replacement, or increase breast cancer risk.
The physician has ordered prostaglandin gel to be administered vaginally to a newly admitted primigravid client. Which of the following indicate that the client has had a therapeutic response to the medication?
- A. Resting period of 2 minutes between contractions.
- B. Normal patellar and elbow reflexes for the past 2 hours.
- C. Softening of the cervix and beginning effacement.
- D. Leaking of clear amniotic fluid in small amounts.
Correct Answer: C
Rationale: Prostaglandin gel is used for cervical ripening. A therapeutic response is indicated by cervical softening and effacement, preparing the cervix for labor. Resting periods and reflexes are unrelated to the gel's purpose, and leaking amniotic fluid suggests rupture of membranes, not a direct effect of the gel.
Assessment of a primigravid client in active labor who has had no analgesia or anesthesia reveals complete cervical effacement, dilation of 8 cm, and the fetus at 0 station. The nurse should expect the client to exhibit which of the following behaviors during this phase of labor?
- A. Excitement.
- B. Loss of control.
- C. Numbness of the legs.
- D. Feelings of relief.
Correct Answer: B
Rationale: During the transition phase (8–10 cm dilation), primigravid clients without analgesia often experience intense contractions and may feel overwhelmed, leading to a perceived loss of control. Excitement is more common in early labor, numbness of the legs is associated with epidural anesthesia, and feelings of relief typically occur after delivery.
A multigravida in active labor is 7 cm dilated. The fetal heart rate baseline is 130 bpm with moderate variability. The client begins to have variable decelerations to 100 to 110 bpm. What should the nurse do next?
- A. Perform a vaginal examination.
- B. Notify the physician of the decelerations.
- C. Reposition the client and continue to evaluate the tracing.
- D. Administer oxygen via mask at 2 L/minute.
Correct Answer: C
Rationale: Variable decelerations suggest possible cord compression. Repositioning the client (e.g., to a side-lying position) can relieve pressure on the cord, and continued monitoring assesses the effectiveness. Vaginal examination, notification, or oxygen may follow if the issue persists.