Nokea
A nurse is caring for a postpartum person who is experiencing a boggy uterus. What is the priority intervention?
- A. perform uterine massage
- B. encourage early ambulation
- C. assist with positioning
- D. perform a pelvic exam
Correct Answer: A
Rationale: The correct answer is A: perform uterine massage. This is the priority intervention for a boggy uterus to prevent postpartum hemorrhage by promoting uterine contraction and reducing bleeding. Uterine massage helps the uterus to firm up and expel clots. Early ambulation (B) and positioning (C) can support recovery but do not directly address the boggy uterus. Performing a pelvic exam (D) is not necessary for managing a boggy uterus and may even exacerbate bleeding.
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What is the embryonic membrane that contains fingerlike projections on its surface, which attach to the uterine wall?
- A. Amnion
- B. Yolk sac
- C. Chorion
- D. Decidua basalis
Correct Answer: C
Rationale: The chorion is a thick membrane with fingerlike projections (villi) on its outermost surface.
The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks’ gestation. What sample will be collected for the initial screening process?
- A. Urine
- B. Blood
- C. Saliva
- D. Amniotic fluid
Correct Answer: B
Rationale: AFP screening is done using a blood sample, which is less invasive than an amniocentesis.
Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following?
- A. Avoid eating greasy foods.
- B. Drink orange juice before rising.
- C. Consume 1 teaspoon of nutmeg each morning.
- D. Eat 3 large meals plus a bedtime snack.
Correct Answer: A
Rationale: Greasy foods can exacerbate nausea and vomiting. Small, frequent meals are recommended, and saltine crackers before rising can help alleviate symptoms. Orange juice and nutmeg are not recommended.
A woman missed her menstrual period 1 week ago and has come to the doctor’s office for a pregnancy test. Which placental hormone is measured in pregnancy tests?
- A. Progesterone
- B. Estrogen
- C. Human chorionic gonadotropin
- D. Human placental lactogen
Correct Answer: C
Rationale: Human chorionic gonadotropin is the basis for most pregnancy tests. It is detectable in maternal blood as soon as implantation occurs, usually 7 to 9 days after fertilization.
A pregnant patient at 24 weeks gestation reports pain in the lower abdomen and back. What is the nurse's first priority action?
- A. Administer pain relief as prescribed and provide comfort measures.
- B. Assess the patient for signs of preterm labor, including regular contractions.
- C. Recommend the patient rest and apply heat to the affected area.
- D. Instruct the patient to lie flat on her back and monitor the symptoms.
Correct Answer: B
Rationale: The correct answer is B: Assess the patient for signs of preterm labor, including regular contractions. At 24 weeks gestation, lower abdominal and back pain can indicate preterm labor, a serious complication. The nurse's first priority should be to assess for signs such as regular contractions, vaginal bleeding, pelvic pressure, or changes in vaginal discharge. Prompt identification of preterm labor allows for timely interventions to prevent preterm birth and its associated risks. Administering pain relief (choice A) without assessing for preterm labor can delay necessary interventions. Recommending rest and heat application (choice C) may not address the underlying cause of the pain. Instructing the patient to lie flat on her back (choice D) may worsen symptoms and is not recommended in pregnancy.