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A nurse is planning care for a client who is 1 hr postpartum and has peripartum cardiomyopathy. Which of the following actions should the nurse plan to take?
- A. Obtain a prescription for misoprostol.
- B. Assess blood pressure twice daily.
- C. Restrict daily oral fluid intake.
- D. Administer an IV bolus of lactated Ringer's.
Correct Answer: B
Rationale: The correct answer is B: Assess blood pressure twice daily. In peripartum cardiomyopathy, monitoring blood pressure is crucial to detect any signs of worsening cardiac function or complications. Regular assessment can help identify hypertension or hypotension, which are common in this condition. Misoprostol (A) is not indicated for peripartum cardiomyopathy. Restricting oral fluid intake (C) can be harmful as adequate hydration is important postpartum. Administering an IV bolus of lactated Ringer's (D) may not be necessary unless specifically ordered by the healthcare provider based on the client's condition.
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A nurse is preparing to administer an IM injection to a newborn. Which of the following sites should the nurse select?
- A. Vastus lateralis
- B. Dorsogluteal
- C. Deltoid
- D. Rectus femoris
Correct Answer: A
Rationale: The correct answer is A: Vastus lateralis. For newborns, the vastus lateralis muscle is the preferred site for intramuscular injections due to its larger muscle mass and reduced risk of injury to nerves and blood vessels. It is located on the thigh, making it easily accessible and safe for administration. The deltoid muscle (choice C) is not recommended for newborns due to insufficient muscle mass. The dorsogluteal site (choice B) is not recommended for infants due to the proximity to the sciatic nerve. The rectus femoris (choice D) is not typically used for IM injections in newborns.
Which of the following is a potential complication of a placental abruption?
- A. Preterm labor
- B. Fetal distress
- C. Polyhydramnios
- D. All of the above
Correct Answer: B
Rationale: The correct answer is B: Fetal distress. Placental abruption is the premature separation of the placenta from the uterus, leading to decreased oxygen and nutrients to the fetus, causing fetal distress. Preterm labor (choice A) can occur due to placental abruption, but it is not a direct complication. Polyhydramnios (choice C) is excessive amniotic fluid, which is not typically associated with placental abruption. Choice D is incorrect as preterm labor and polyhydramnios are not direct complications. Fetal distress is the most immediate and concerning complication of placental abruption due to the compromised blood flow to the fetus.
What is the function of the placenta during pregnancy?
- A. To transport oxygen and nutrients from the mother to the fetus
- B. To remove waste products from the fetus
- C. To regulate fetal temperature
- D. All of the above
Correct Answer: D
Rationale: The placenta serves multiple functions, including transporting oxygen and nutrients, removing waste products, and helping regulate fetal temperature.
Which of the following is a potential complication of placenta previa?
- A. Preterm labor
- B. Fetal growth restriction
- C. Placental abruption
- D. All of the above
Correct Answer: C
Rationale: Placenta previa can lead to placental abruption, a serious condition where the placenta detaches from the uterine wall prematurely.
A nurse is assessing a newborn who is 16 hr old. Which of the following findings should the nurse report to the provider?
- A. Substernal retractions
- B. Acrocyanosis
- C. Overlapping suture lines
- D. Head circumference 33 cm (13 in)
Correct Answer: A
Rationale: The correct answer is A: Substernal retractions. Substernal retractions in a newborn indicate respiratory distress and can be a sign of underlying respiratory issues such as respiratory distress syndrome. The nurse should report this finding to the provider immediately for further evaluation and intervention to ensure the newborn's respiratory status is stable. Acrocyanosis (choice B) is a common finding in newborns and is not typically concerning. Overlapping suture lines (choice C) can be a normal variation in newborn skull anatomy. The head circumference of 33 cm (13 in) (choice D) is within the normal range for a newborn and would not require immediate reporting.