Nokea
A nurse is assessing a client who is 1 hr postpartum following a vaginal birth. The nurse notes that the client has excessive vaginal bleeding. Which of the following actions should the nurse take first?
- A. Massage the client's fundus.
- B. Administer oxytocin to the client.
- C. Empty the client’s bladder.
- D. Provide oxygen to the client via nonrebreather face mask.
Correct Answer: A
Rationale: The correct action is to massage the client's fundus first. This helps to stimulate uterine contractions and control excessive bleeding, preventing postpartum hemorrhage. Massaging the fundus promotes the expulsion of clots and helps the uterus contract, decreasing the risk of further bleeding. Administering oxytocin (choice B) can be done after fundal massage to enhance uterine contractions. Emptying the client's bladder (choice C) can also aid in reducing uterine atony but is not the priority in this situation. Providing oxygen (choice D) is not directly related to controlling postpartum bleeding.
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What is the recommended method of screening for gestational diabetes during pregnancy?
- A. Fasting blood glucose test
- B. Random blood glucose test
- C. Oral glucose tolerance test (OGTT)
- D. HbA1c test
Correct Answer: C
Rationale: The oral glucose tolerance test (OGTT) is the standard method for screening gestational diabetes during pregnancy.
A nurse is caring for a client who is in active labor and notes the FHR baseline has been 100/min for the past 15 min. The nurse should identify which of the following conditions as a possible cause of fetal bradycardia?
- A. Maternal hypoglycemia
- B. Chorioamnionitis
- C. Fetal anemia
- D. Maternal fever
Correct Answer: C
Rationale: Fetal anemia can lead to bradycardia due to reduced oxygen delivery to the fetal heart.
Which hormone is responsible for stimulating the growth and development of the ovarian follicles?
- A. Estrogen
- B. Progesterone
- C. Follicle-stimulating hormone (FSH)
- D. Luteinizing hormone (LH)
Correct Answer: C
Rationale: The correct answer is C: Follicle-stimulating hormone (FSH). FSH stimulates the growth and development of ovarian follicles by promoting the production of estrogen in the ovaries. It helps in the maturation of the follicles and ultimately leads to ovulation. Estrogen (A) and Progesterone (B) are hormones produced by the ovaries but do not directly stimulate the growth of ovarian follicles. Luteinizing hormone (LH) (D) is responsible for triggering ovulation and the formation of the corpus luteum, not for the growth and development of ovarian follicles.
A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicates an understanding of the teaching?
- A. "I will eat foods that taste good instead of balancing my meals."
- B. "I will avoid having a snack before I go to bed each night."
- C. "I will have a cup of hot tea with each meal."
- D. "I will eliminate products that contain dairy from my diet."
Correct Answer: D
Rationale: The correct answer is D: "I will eliminate products that contain dairy from my diet." This is because hyperemesis gravidarum is a condition characterized by severe nausea and vomiting during pregnancy. Dairy products can be harder to digest and may exacerbate nausea. By eliminating dairy, the client can reduce the likelihood of triggering nausea and vomiting.
A: "I will eat foods that taste good instead of balancing my meals." - This statement does not address the dietary changes needed for hyperemesis gravidarum.
B: "I will avoid having a snack before I go to bed each night." - While avoiding snacks before bedtime can be a good practice for some, it does not specifically address the dietary needs of hyperemesis gravidarum.
C: "I will have a cup of hot tea with each meal." - Hot tea may not necessarily help with managing hyperemesis gravidarum symptoms and does not address the need for dietary modifications.
A nurse is caring for a client immediately following the delivery of a stillborn fetus. Which of the following actions should the nurse take?
- A. Limit the amount of time the fetus is in the client’s room.
- B. Provide the client with photos of the fetus.
- C. Instruct the client that an autopsy should be performed within 24 hr.
- D. Inform the client that the law requires them to name the fetus.
Correct Answer: B
Rationale: The correct answer is B: Provide the client with photos of the fetus. This action allows the client to have tangible memories of their stillborn baby, aiding in the grieving process and facilitating closure. It is important for the client to have something to remember their child by, as it validates the existence of the baby and acknowledges the client's loss. It also promotes a sense of connection and remembrance. Providing photos can be a compassionate gesture that supports the client emotionally during this difficult time.
Choice A is incorrect because limiting the time the fetus is in the room may not consider the client's emotional needs. Choice C is incorrect as it may add unnecessary stress to the client. Choice D is incorrect as there is no legal requirement to name a stillborn fetus.