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A nurse is caring for a laboring person who is in the first stage of labor. What is the priority assessment to perform during this stage?
- A. monitor vital signs
- B. perform a vaginal exam
- C. perform a cervical check
- D. monitor the fetal heart rate
Correct Answer: A
Rationale: The correct answer is A: monitor vital signs. During the first stage of labor, it is crucial to monitor the laboring person's vital signs to assess for any signs of distress or complications. This includes monitoring blood pressure, pulse rate, respiratory rate, and temperature. By closely monitoring vital signs, the nurse can identify any potential issues early on and take appropriate actions to ensure the safety and well-being of both the laboring person and the baby. Performing a vaginal exam (B) or cervical check (C) may be necessary later in labor but is not the priority assessment during the first stage. Monitoring the fetal heart rate (D) is also important but not the priority over monitoring the laboring person's vital signs.
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A nurse is educating a postpartum person about newborn care. What is the best way to prevent diaper rash?
- A. frequent diaper changes
- B. use of a barrier cream
- C. apply petroleum jelly to the skin
- D. change diapers frequently
Correct Answer: C
Rationale: The correct answer is C: apply petroleum jelly to the skin. Petroleum jelly acts as a barrier, protecting the baby's skin from moisture and irritants in the diaper. It helps maintain the skin's natural moisture and prevents diaper rash.
Rationale:
1. Petroleum jelly creates a protective barrier on the skin, preventing direct contact with moisture and irritants.
2. It helps to keep the skin moisturized, reducing the risk of irritation.
3. Petroleum jelly is safe and gentle on the baby's skin.
4. It is particularly effective for preventing diaper rash compared to other options.
Summary:
A: Frequent diaper changes are important but may not provide enough protection against moisture and irritants.
B: Barrier creams can be effective, but petroleum jelly is a more commonly recommended option.
D: Changing diapers frequently is essential, but applying petroleum jelly as an additional protective measure is more effective in preventing diaper rash.
A nurse is providing prenatal education to a pregnant patient. Which of the following statements indicates a need for further teaching about maternal weight gain during pregnancy?
- A. I should aim to gain about 25 to 35 pounds during my pregnancy.
- B. I should eat for two during pregnancy.
- C. I can exercise as long as I stay within my doctor's recommendations.
- D. Gaining too much weight during pregnancy can increase my risk of complications.
Correct Answer: B
Rationale: The correct answer is B because the statement "I should eat for two during pregnancy" is incorrect. The rationale is that during pregnancy, a woman does not need to eat for two individuals. Instead, she needs to consume additional calories to support the growth and development of the fetus. Eating for two could lead to excessive weight gain and potential complications. The other choices indicate correct understanding and knowledge about maternal weight gain during pregnancy. A suggests the recommended weight gain range, C acknowledges the importance of exercising within doctor's limits, and D highlights the risks of gaining too much weight during pregnancy.
A nurse is caring for a pregnant patient who is 24 weeks gestation and has been diagnosed with anemia. What should the nurse teach the patient about managing this condition?
- A. Increase iron-rich foods and take iron supplements as prescribed.
- B. Rest frequently and avoid physical activity to prevent exhaustion.
- C. Limit intake of dairy products to prevent iron deficiency.
- D. Incorporate more vitamin D-rich foods into the diet to help the body absorb iron.
Correct Answer: A
Rationale: The correct answer is A because increasing iron-rich foods and taking iron supplements as prescribed is the standard treatment for managing anemia during pregnancy. Iron is essential for red blood cell production, which is crucial for both the mother and the developing fetus. Resting frequently (choice B) may help with fatigue but does not address the root cause of anemia. Limiting dairy intake (choice C) is not necessary and may lead to other nutritional deficiencies. Incorporating vitamin D-rich foods (choice D) can be beneficial for overall health but does not specifically address the management of anemia.
The school nurse is counseling a group of adolescent girls. What does the nurse explain about sperm ejaculated near the cervix?
- A. They are destroyed by the acidic pH of the vagina.
- B. They survive up to 5 days and can cause pregnancy.
- C. They lose their motility in about 12 hours after intercourse.
- D. They are usually pushed out of the vagina by the muscular action of the vaginal wall.
Correct Answer: B
Rationale: Sperm ejaculated near the cervix can survive up to 5 days and cause pregnancy even before ovulation.
Why is pregnancy planning important for women of childbearing age?
- A. Much organogenesis occurs before the missed period
- B. Insurance preapproval is required
- C. No more than 3 pregnancies are recommended
- D. Pregnancies less than 2 years apart stress the cardiovascular system
Correct Answer: A
Rationale: Organogenesis occurs early in pregnancy, often before a missed period, making early intervention critical for fetal health.