Nokea
A nurse is caring for a client who has preeclampsia and is receiving a continuous infusion of magnesium sulfate IV. Which of the following actions should the nurse take?
- A. Restrict hourly fluid intake to 150 mL/hr.
- B. Have calcium gluconate readily available.
- C. Assess deep tendon reflexes every 6 hr.
- D. Monitor intake and output every 4 hr.
Correct Answer: B
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity and should be readily available in case the client shows signs of toxicity, such as respiratory depression or loss of deep tendon reflexes.
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What is the recommended method of administering the second dose of hepatitis B vaccine to a newborn?
- A. Intramuscular injection
- B. Oral administration
- C. Topical application
- D. Subcutaneous injection
Correct Answer: A
Rationale: Intramuscular injection is the recommended method for administering the second dose of the hepatitis B vaccine to a newborn, as it ensures proper absorption and effectiveness.
Which of the following is a potential complication of gestational diabetes?
- A. Polyhydramnios
- B. Preterm labor
- C. Neonatal hypoglycemia
- D. All of the above
Correct Answer: D
Rationale: Gestational diabetes can lead to polyhydramnios, preterm labor, and neonatal hypoglycemia.
A nurse is caring for a client who is at 38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring?
- A. Determine progression of dilatation and effacement.
- B. Perform Leopold maneuvers.
- C. Complete a sterile speculum exam.
- D. Prepare a Nitrazine paper test.
Correct Answer: B
Rationale: Performing Leopold maneuvers helps the nurse determine the fetal position and presentation, which is essential for accurate placement of the external transducer.
A nurse is caring for a client who is in active labor with a fetus in the occipitoposterior position. The nurse assists the client into a hands-and-knees position. Which of the following questions should the nurse ask to evaluate the effectiveness of this intervention?
- A. Does that lessen your suprapubic pain?
- B. Are you feeling relief from your pelvic pressure?
- C. Do your contractions feel further apart?
- D. Has your back labor improved?
Correct Answer: D
Rationale: The correct answer is D: "Has your back labor improved?" This question is appropriate because the occipitoposterior position often leads to back labor due to the baby's position pressing on the mother's spine. By asking if the back labor has improved, the nurse can assess the effectiveness of the hands-and-knees position in helping relieve pressure on the mother's back.
Choice A: "Does that lessen your suprapubic pain?" is incorrect because the hands-and-knees position is more effective for back pain relief, not suprapubic pain.
Choice B: "Are you feeling relief from your pelvic pressure?" is incorrect because the hands-and-knees position is more effective for addressing back pain, not pelvic pressure.
Choice C: "Do your contractions feel further apart?" is incorrect as the position change is unlikely to affect the timing of contractions significantly.
In summary, the correct question (Choice D) directly addresses the main issue associated with occipitoposterior
Which of the following is a potential ethical issue related to neonatal organ donation?
- A. Informed consent
- B. Allocation of resources
- C. End-of-life decision making
- D. All of the above
Correct Answer: A
Rationale: Informed consent is a key ethical issue in neonatal organ donation.