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A nurse is caring for a pregnant patient who is at 32 weeks gestation and reports frequent headaches and nausea. What should the nurse do first?
- A. Monitor the patient's blood pressure and assess for signs of preeclampsia.
- B. Administer anti-nausea medication and provide comfort measures.
- C. Encourage the patient to rest and drink fluids.
- D. Schedule a follow-up appointment for further evaluation.
Correct Answer: A
Rationale: The correct answer is A: Monitor the patient's blood pressure and assess for signs of preeclampsia. At 32 weeks gestation, headaches and nausea could be symptoms of preeclampsia, a serious condition in pregnancy. Monitoring blood pressure is crucial as preeclampsia is characterized by high blood pressure. Assessing for signs of preeclampsia, such as proteinuria or visual disturbances, is essential for timely intervention. Administering anti-nausea medication or encouraging rest without addressing the possibility of preeclampsia could delay necessary treatment. Scheduling a follow-up appointment without immediate assessment could also put the patient at risk if preeclampsia is present.
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A nurse is providing prenatal education to a patient who is 22 weeks gestation. Which of the following topics should be emphasized at this stage of pregnancy?
- A. Signs and symptoms of preterm labor
- B. Signs of gestational diabetes
- C. Breastfeeding education
- D. Postpartum care
Correct Answer: A
Rationale: The correct answer is A: Signs and symptoms of preterm labor. At 22 weeks gestation, it is crucial to educate the patient about potential signs of preterm labor to help prevent premature birth and ensure the well-being of the baby. Symptoms such as regular contractions, abdominal cramping, backache, and vaginal bleeding should be discussed. This topic is time-sensitive and requires immediate action if observed.
Summary of other choices:
B: Signs of gestational diabetes - While important, monitoring for gestational diabetes typically occurs later in pregnancy, usually around 24-28 weeks.
C: Breastfeeding education - Important, but not as time-sensitive as preterm labor education.
D: Postpartum care - Relevant but more appropriate for later stages of pregnancy or after birth, not specifically at 22 weeks gestation.
What are late FHR decelerations caused by?
- A. Altered cerebral blood flow
- B. Umbilical cord compression
- C. Uteroplacental insufficiency
- D. Meconium fluid
Correct Answer: C
Rationale: The correct answer is C: Uteroplacental insufficiency. Late FHR decelerations are caused by decreased blood flow and oxygen delivery to the fetus due to impaired uteroplacental circulation. This can result from conditions like placental abruption or placental insufficiency. Altered cerebral blood flow (A) is more related to early decelerations. Umbilical cord compression (B) typically causes variable decelerations. Meconium fluid (D) can lead to fetal distress but is not the primary cause of late decelerations.
What is the primary purpose of performing an episiotomy during delivery?
- A. to reduce the risk of perineal trauma
- B. to promote faster delivery
- C. to facilitate fetal descent
- D. to provide immediate fetal oxygenation
Correct Answer: A
Rationale: The primary purpose of performing an episiotomy during delivery is to reduce the risk of perineal trauma. Episiotomy is a surgical incision made in the perineum to widen the vaginal opening during childbirth, which can help prevent severe tearing of the perineal tissue. This procedure is performed to provide controlled and precise incision, reducing the likelihood of extensive tears that may lead to complications such as infection or prolonged healing time. It is not done to promote faster delivery, facilitate fetal descent, or provide immediate fetal oxygenation. These choices do not accurately reflect the main goal of episiotomy, which is to minimize perineal trauma.
How should the nurse respond to a concern about alcohol exposure during conception?
- A. Inform the doctor
- B. Reassure it's unlikely the baby was affected
- C. Suggest abortion
- D. Recommend ultrasound
Correct Answer: B
Rationale: Occasional alcohol exposure around conception is unlikely to cause significant harm, though ongoing abstinence is advised.
Transvaginal ultrasonography is often performed during the first trimester. What conditions may require this test? (Select all that apply.)
- A. Multifetal gestation
- B. Bicornuate uterus
- C. Presence and location of pregnancy
- D. Amniotic fluid volume
Correct Answer: C
Rationale: Transvaginal ultrasound is used to confirm fetal viability, assess multiple gestations, and check for uterine abnormalities.