Nokea
A nurse is assessing a newborn who was born vaginally with vacuum extractor assistance ... that crosses the suture line. The nurse should identify the swellings as which of the following....?
- A. Nevus flammeus
- B. Caput uccedaneum
- C. Cephalohematoma
- D. Erythema toxicum
Correct Answer: C
Rationale: Cephalohematoma is a collection of blood between the skull and its periosteum that occurs due to rupture of blood vessels during birth trauma. It is typically found on one side of the head and does not cross the suture line. In contrast, caput succedaneum is a diffuse swelling that occurs on the newborn's scalp and can cross the suture lines. Nevus flammeus is a vascular birthmark that appears as a pink or red patch on the skin, unrelated to trauma. Erythema toxicum is a benign rash that appears as red spots or patches with a white or yellow papule in the center, also unrelated to trauma.
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An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting?
- A. Ferning capacity
- B. Basal body temperature
- C. Colposcopy
- D. Hysterotomy
Correct Answer: A
Rationale: Ferning capacity refers to the ability of cervical mucus to form a fern-like pattern under a microscope when it is close to ovulation. This pattern indicates the presence of estrogen, which is essential for supporting sperm motility. By assessing ferning capacity, the infertility specialist can determine if the woman's cervical mucus contains enough estrogen to facilitate the movement of sperm for successful fertilization. This test helps in evaluating the quality of cervical mucus and its role in the fertility process. The other options (Basal body temperature, Colposcopy, Hysterotomy) are not directly related to assessing estrogen levels in cervical mucus for sperm motility.
What is the primary nursing action for a newborn experiencing signs of hypoglycemia?
- A. Administer glucose water via a bottle
- B. Feed the newborn breastmilk or formula
- C. Monitor glucose levels and reassess in 30 minutes
- D. Start an IV glucose drip
Correct Answer: B
Rationale: Feeding with breastmilk or formula is the most effective intervention for neonatal hypoglycemia.
The nurse is teaching a client with a midline episiotomy about perineal care after vaginal birth. Which statement from the client indicates she
- B. I will use the perineal bottle without touching perineum each time going to the bathroom
- C. I will gently pat perineal dry rather than wipe
- D. I will only use the perineal bottle after bowel movements
Correct Answer: C
Rationale: This statement indicates a correct understanding of perineal care after a midline episiotomy. After vaginal birth, it is important to avoid wiping the perineal area to prevent irritation and infection. Instead, gently patting the area dry is recommended to promote healing and prevent discomfort. This approach helps to minimize trauma to the sensitive tissues of the perineum and reduces the risk of introducing bacteria from wiping.
A family member stands at the nurse station and requests help for their partner. What response should the nurse give to the family member?
- A. Are you the husband?
- B. Who is your wife?
- C. What can I do to help you and your partner?
- D. Are you part of the trans couple in room 214?
Correct Answer: C
Rationale: A neutral and inclusive response ensures the family member feels respected and supported.
Which will indicate a concealed hemorrhage in an abruptio placenta?
- A. Hard board-like abdomen
- B. Decreased fundal height
- C. Bradycardia
- D. Decreased abdominal pain
Correct Answer: A
Rationale: A concealed hemorrhage in abruptio placentae, also known as a concealed retroplacental hematoma, can cause rapid, significant bleeding behind the placenta with limited visible external bleeding. This internal bleeding can lead to significant blood loss and can cause the uterus to become tense and firm, resulting in a hard board-like abdomen upon palpation. This clinical sign is a key indicator of a concealed hemorrhage in abruptio placentae and should prompt immediate medical attention to prevent maternal and fetal complications. The other choices, such as decreased fundal height, bradycardia, and decreased abdominal pain, are not typically associated with a concealed hemorrhage in abruptio placentae.