Nokea
A nurse is caring for a 38-week pregnant patient who is experiencing a decrease in fetal movement. Which of the following should be the nurse's first action?
- A. Encourage the patient to drink a cold beverage and lie down.
- B. Instruct the patient to wait 24 hours and monitor fetal movements.
- C. Order an ultrasound to check the baby's health.
- D. Call the healthcare provider immediately to report the decrease in movement.
Correct Answer: A
Rationale: The correct answer is A: Encourage the patient to drink a cold beverage and lie down. This is the correct action as it promotes fetal movement by stimulating the baby with a change in temperature and position. It is a non-invasive and immediate measure that can be taken by the patient herself.
Choice B is incorrect because waiting 24 hours could delay necessary intervention if the fetus is in distress. Choice C is incorrect as ordering an ultrasound may not be the most immediate or necessary action at this point. Choice D is incorrect as calling the healthcare provider immediately may not be necessary if the issue can be resolved by the patient changing her position and trying to stimulate fetal movement first.
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A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old, at 28 weeks’ gestation; delivered a daughter, now 5 years old, at 39 weeks’ gestation; had a miscarriage 3 years ago, and had a first-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman’s gravidity and parity?
- A. G4 P2121.
- B. G4 P1212.
- C. G5 P1122.
- D. G5 P2211.
Correct Answer: D
Rationale: Gravidity includes all pregnancies (live births, miscarriages, abortions, and current pregnancy). Parity reflects live births. This woman has had 5 pregnancies (2 live births, 1 miscarriage, 1 abortion, and 1 current pregnancy), making her G5 P2211.
A patient in labor is at 6 cm dilation and requests an epidural. What is the most appropriate response from the nurse?
- A. You need to be at least 8 cm dilated for an epidural.
- B. You can have the epidural now since you are in active labor.
- C. The epidural can be administered after the second stage of labor.
- D. An epidural is only administered during the latent phase of labor.
Correct Answer: B
Rationale: The correct answer is B: "You can have the epidural now since you are in active labor." At 6cm dilation, the patient is typically considered to be in active labor, making it an appropriate time to offer an epidural for pain relief. Administering the epidural at this stage can help manage the pain effectively and provide relief during the remainder of labor. Other choices are incorrect because waiting until 8cm dilation (Choice A) may cause unnecessary suffering, administering after the second stage (Choice C) is too late for pain relief, and giving it during the latent phase (Choice D) is not ideal as the patient may not be in active labor yet.
For which patient would an L/S ratio of 2:1 potentially be considered abnormal?
- A. A 38-year-old gravida 2, para 1, who is 38 weeks’ gestation
- B. A 24-year-old gravida 1, para 0, who has diabetes
- C. A 44-year-old gravida 6, para 5, who is at term
- D. An 18-year-old gravida 1, para 0, who is in early labor at term
Correct Answer: B
Rationale: In diabetic pregnancies, an L/S ratio of 2:1 may not reliably indicate lung maturity due to delayed surfactant production.
The nurse is teaching a pregnant patient about preparing for childbirth. Which of the following statements by the patient indicates that further teaching is needed?
- A. I will practice breathing exercises to help manage labor pain.
- B. I should plan to stay in bed during labor to conserve my energy.
- C. I will learn about different labor positions to make the experience more comfortable.
- D. I should discuss pain relief options with my healthcare provider ahead of time.
Correct Answer: B
Rationale: The correct answer is B. Staying in bed during labor is not recommended as it can slow down labor progress and increase discomfort.
Rationale:
1. A: Correct - Breathing exercises help manage pain and promote relaxation during labor.
2. C: Correct - Learning about different labor positions can ease pain and facilitate labor progress.
3. D: Correct - Discussing pain relief options with healthcare provider is important for informed decision-making.
Summary:
Choice B is incorrect as it goes against best practices for labor. The other choices demonstrate understanding of labor preparation and pain management strategies.
The clinic nurse is obtaining a health history on a newly pregnant patient. Which is an indication for fetal diagnostic procedures if present in the health history?
- A. Maternal diabetes
- B. Weight gain of 25 lb
- C. Maternal age older than 30 years
- D. Previous infant weighing more than 3000 g at birth
Correct Answer: A
Rationale: Maternal diabetes is a risk factor in pregnancy due to possible impairment of placental perfusion, necessitating fetal diagnostic procedures.