Nokea
A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. When is the best time for the nurse to schedule the patient’s ultrasound?
- A. Immediately
- B. In 2 weeks
- C. In 4 weeks
- D. In 6 weeks
Correct Answer: A
Rationale: An ultrasound at around 5-6 weeks after the last menstrual period is the most accurate time to determine gestational age.
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A pregnant patient at 26 weeks gestation reports frequent headaches and blurred vision. What should the nurse do first?
- A. Encourage the patient to take over-the-counter pain medication for relief.
- B. Monitor the patient's blood pressure and check for signs of preeclampsia.
- C. Advise the patient to rest and stay hydrated to alleviate symptoms.
- D. Schedule a follow-up appointment for further evaluation in a few days.
Correct Answer: B
Rationale: The correct answer is B: Monitor the patient's blood pressure and check for signs of preeclampsia. At 26 weeks gestation, headaches and blurred vision could be symptoms of preeclampsia, a serious condition in pregnancy. Monitoring blood pressure is crucial as high blood pressure is a key indicator. Preeclampsia can lead to severe complications for both the mother and baby if left untreated. Encouraging over-the-counter pain medication (Choice A) may mask symptoms without addressing the underlying cause. Rest and hydration (Choice C) are important, but immediate evaluation for preeclampsia is necessary. Scheduling a follow-up appointment (Choice D) delays potential diagnosis and treatment.
A woman in labor begins to experience a sudden increase in vaginal bleeding and the fetal heart rate decelerates. What is the likely cause of these symptoms?
- A. Placenta previa
- B. Placental abruption
- C. Uterine rupture
- D. Cervical laceration
Correct Answer: B
Rationale: The correct answer is B: Placental abruption. Placental abruption is the premature separation of the placenta from the uterine wall, leading to vaginal bleeding and fetal distress. The sudden increase in bleeding and fetal heart rate deceleration are hallmark signs of placental abruption. Placenta previa (choice A) involves bleeding without fetal distress. Uterine rupture (choice C) typically presents with severe abdominal pain and shock. Cervical laceration (choice D) would not cause fetal heart rate deceleration.
The nurse is caring for a pregnant client who is a vegan. Which of the following foods should the nurse suggest the client consume as substitutes for restricted foods?
- A. Tofu, legumes, broccoli.
- B. Corn, yams, green beans.
- C. Potatoes, parsnips, turnips.
- D. Cheese, yogurt, fish.
Correct Answer: A
Rationale: Tofu, legumes, and broccoli provide essential nutrients like protein, iron, and calcium that are often lacking in a vegan diet. Corn, yams, and green beans offer carbohydrates and vitamins but lack sufficient protein sources. Potatoes, parsnips, and turnips are starchy vegetables with limited nutritional variety. Cheese, yogurt, and fish are non-vegan options.
A client is 15 weeks pregnant. She calls the obstetric office to request a medication for a headache. The nurse answers the telephone. Which of the following is the nurse’s best response?
- A. Because the organ systems in the baby are developing right now, it is risky to take medicine.
- B. You can take any of the over-the-counter medications because they are all safe in pregnancy.
- C. The physician will prescribe a category 'X' medication for you.
- D. You can take acetaminophen because it is a category 'B' medicine.
Correct Answer: D
Rationale: Acetaminophen is a category 'B' medication, which is considered safe during pregnancy. Other over-the-counter medications may not be safe, and category 'X' medications are contraindicated.
The woman's partner is lightly stroking her abdomen as an alternative to medication for pain relief in labor. What is this known as?
- A. Counterpressure
- B. Effieurage
- C. Guided imagery
- D. Biofeedback
Correct Answer: A
Rationale: The correct answer is A: Counterpressure. This technique involves applying pressure to specific areas to alleviate pain during labor. In this scenario, the partner is using light strokes on the woman's abdomen to provide pain relief. Counterpressure helps release endorphins, which are natural painkillers, and distracts the brain from focusing on the pain sensations. Effleurage (B) is a gentle stroking technique used for relaxation, not specifically for pain relief. Guided imagery (C) involves visualizing calming scenes to reduce stress, not directly addressing pain. Biofeedback (D) is a method of monitoring and controlling physiological responses, not a hands-on pain relief technique like counterpressure.