Nokea
A nurse is providing care to a client in labor. A pelvic exam reveals a vertex presentation with the presenting part tilted toward the left side of the mother's pelvis and directed toward the anterior portion of the pelvis. When developing this client's plan of care, which intervention would the nurse include?
- A. implementing measures for a vaginal birth
- B. preparing the client for a cesarean birth
- C. assisting with artificial rupture of the membranes
- D. instituting continuous internal fetal monitoring
Correct Answer: A
Rationale: The fetal presentation and position is left occiput anterior position or LOA, which is the most common and most favorable fetal position for birth. LOA along with right occiput anterior position are optimal positions for vaginal birth. Therefore the nurse should implement measures for a vaginal birth. This fetal presentation is not an indication for cesarean birth. Nor is there need for artificially rupturing the membranes. Continuous internal fetal monitoring would be warranted if the woman or fetus was considered to be high risk.
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The nurse is reviewing the monitoring strip of a woman in labor who is experiencing a contraction. The nurse notes the time the contraction takes from its onset to reach its highest intensity. The nurse interprets this time as which phase?
- A. increment
- B. acme
- C. peak
- D. decrement
Correct Answer: A
Rationale: The correct answer is A because the time from the onset of a contraction to its highest intensity corresponds to the increment phase, which is the buildup of the contraction. The acme is the peak intensity, and the decrement is the relaxation phase.
A patient asks why folic acid is recommended before conception. What should the nurse explain?
- A. It improves egg quality for fertilization.
- B. It prevents neural tube defects in the developing fetus.
- C. It reduces the risk of multiple pregnancies.
- D. It enhances hormone levels during ovulation.
Correct Answer: B
Rationale: The correct answer is B because folic acid is known to prevent neural tube defects like spina bifida in the developing fetus. This is crucial in the early stages of pregnancy when the neural tube is forming. Other choices are incorrect because folic acid does not directly impact egg quality, the risk of multiple pregnancies, or hormone levels during ovulation. Overall, the primary rationale for recommending folic acid before conception is to ensure the proper development of the baby's neural tube.
What is the significance of progesterone supplementation in fertility treatments?
- A. It triggers ovulation during the treatment cycle.
- B. It maintains the uterine lining to support implantation and early pregnancy.
- C. It reduces hormonal fluctuations in male partners.
- D. It eliminates the need for ovarian stimulation.
Correct Answer: B
Rationale: The correct answer is B because progesterone supplementation helps maintain the uterine lining, which is crucial for implantation and early pregnancy success. Progesterone prepares the endometrium for embryo implantation by thickening the uterine lining and promoting blood flow. This ensures a supportive environment for the developing embryo. The other choices are incorrect as progesterone does not directly trigger ovulation (A), reduce hormonal fluctuations in male partners (C), or eliminate the need for ovarian stimulation (D) in fertility treatments.
Karen, a 28-year-old female patient, has a hysterosalpingogram ordered but not scheduled. What should the nurse tell the patient?
- A. When your next menses starts, call the office to schedule your procedure.
- B. You may experience uterine cramping during the procedure.
- C. Radiation exposure will be avoided through the use of ultrasound imaging.
- D. The purpose of the test is to evaluate the inside of your uterus and your fallopian tubes.
Correct Answer: A
Rationale: Rationale for Correct Answer (A):
- A is correct because the nurse should instruct the patient to call the office when her next menstrual cycle starts to schedule the hysterosalpingogram. This is essential as the test needs to be performed during a specific phase of the menstrual cycle for accurate results.
Summary of Incorrect Choices:
- B: While uterine cramping may be a possible side effect of the procedure, this information is not the most crucial to communicate to the patient at this time.
- C: While it is important to address concerns about radiation exposure, the use of ultrasound imaging doesn't eliminate the need for the patient to schedule the procedure at the appropriate time in her menstrual cycle.
- D: While this choice provides some information about the purpose of the test, it does not address the immediate action the patient needs to take to schedule the procedure correctly.
What is the role of a saline sonohysterogram in evaluating infertility?
- A. To visualize the uterine cavity and detect abnormalities.
- B. To measure hormone levels in the bloodstream.
- C. To assess ovarian reserve directly.
- D. To monitor embryo development after IVF.
Correct Answer: A
Rationale: The correct answer is A because a saline sonohysterogram is specifically used to visualize the uterine cavity and detect abnormalities such as polyps, fibroids, or adhesions that may be causing infertility. It helps identify structural issues that may interfere with implantation or pregnancy.
Choice B is incorrect because a saline sonohysterogram does not measure hormone levels in the bloodstream. Choice C is also incorrect as it does not directly assess ovarian reserve, which is typically evaluated through blood tests like AMH and FSH levels. Choice D is incorrect as a saline sonohysterogram is not used to monitor embryo development after IVF, but rather to assess the uterine cavity before the procedure.