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A nurse is providing teaching about terbutaline to a client who is experiencing preterm labor. Which of the following statement by client indicates an understanding of the teaching?
- A. "The medication could cause me to experience heart palpitation"
- B. "This medication could cause me to experience blurred vision"
- C. "This medication could cause me to experience ringing in my ears"
- D. "This medication could cause me to experience frequent "¦"
Correct Answer: A
Rationale: The correct answer is A. The statement "The medication could cause me to experience heart palpitations" indicates understanding because terbutaline, a beta-agonist used to stop preterm labor, can indeed cause heart palpitations as a common side effect due to its impact on the cardiovascular system. This shows the client has grasped a potential side effect of the medication.
The other choices are incorrect:
B: "This medication could cause me to experience blurred vision" - Blurred vision is not a common side effect of terbutaline.
C: "This medication could cause me to experience ringing in my ears" - Ringing in the ears is not a common side effect of terbutaline.
D: "This medication could cause me to experience frequent " - Incomplete statement, not indicating understanding of a specific side effect.
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The nurse would classify a newborn delivered at 39 weeks' gestation, weighing 2400 g ( 5.0 lbs) as being:
- A. Preterm and immature
- B. Small-for-gestational age
- C. Average-for-gestational age
- D. Average-for-gestational age but pre-term
Correct Answer: B
Rationale: The correct answer is B: Small-for-gestational age. A newborn delivered at 39 weeks' gestation and weighing 2400g is considered small-for-gestational age because the weight is below the 10th percentile for the gestational age. This indicates intrauterine growth restriction. Preterm and immature (choice A) would not apply as the baby was delivered at term. Average-for-gestational age (choice C) would not be accurate as the baby's weight is below the normal range for that gestational age. Choice D is also incorrect as the baby is not within the average weight range for the gestational age.
A 23-year-old female patient is considering intrauterine device (IUD) contraception. What is the most important information to assess before placement?
- A. Is there any family history of heart disease?
- B. Are you allergic to any metals?
- C. Have you had any previous IUDs inserted?
- D. Do you have a history of hypertension?
Correct Answer: B
Rationale: The correct answer is B: Are you allergic to any metals? This is crucial because some IUDs contain metals like copper, which can trigger allergic reactions in individuals with metal allergies. It is important to assess for metal allergies to prevent potential adverse reactions.
Incorrect Choices:
A: Family history of heart disease is not directly relevant to IUD placement.
C: Previous IUD insertions are important for clinical history but do not impact the initial assessment for a new insertion.
D: History of hypertension is important for overall health assessment but does not directly affect IUD placement.
The nurse is teaching a client about foods rich in folic acid during pregnancy. Which food should the nurse recommend?
- A. Citrus fruits.
- B. Lean meats.
- C. Dairy products.
- D. Whole grains.
Correct Answer: A
Rationale: The correct answer is A, citrus fruits. Folic acid is important for fetal development and helps prevent birth defects. Citrus fruits like oranges, grapefruits, and lemons are rich sources of folic acid. They provide the necessary nutrients for a healthy pregnancy. Lean meats (B) are good sources of protein but not specifically high in folic acid. Dairy products (C) are important for calcium but do not contain significant amounts of folic acid. Whole grains (D) are beneficial for fiber and nutrients, but they are not the best source of folic acid compared to citrus fruits.
Preexisting medical conditions like diabetes, hypertension, and autoimmune diseases can impact pregnancy outcomes. What education can the nurse provide?
- A. Your medical condition always gets worse during pregnancy.
- B. Nutrition changes cannot help with fertility.
- C. Maintaining glucose control can increase chances of conceiving.
- D. Autoimmune diseases only affect pregnancy, not infertility.
Correct Answer: C
Rationale: The correct answer is C: Maintaining glucose control can increase chances of conceiving. This is because uncontrolled diabetes can lead to complications during pregnancy, affecting both the mother and the baby. By educating the patient on the importance of managing their glucose levels, the nurse can help improve fertility outcomes.
A: Your medical condition always gets worse during pregnancy - Incorrect. Medical conditions may not always worsen during pregnancy, and managing them properly can lead to positive outcomes.
B: Nutrition changes cannot help with fertility - Incorrect. Nutrition plays a crucial role in fertility, and making appropriate dietary changes can improve the chances of conception.
D: Autoimmune diseases only affect pregnancy, not infertility - Incorrect. Autoimmune diseases can impact fertility as well as pregnancy outcomes, so it is important to address these conditions when trying to conceive.
The nurse is assessing a client in labor with ruptured membranes. What finding indicates the need for immediate intervention?
- A. Temperature of 100.6°F.
- B. Clear amniotic fluid.
- C. Green, foul-smelling fluid.
- D. Client reports contractions every 5 minutes.
Correct Answer: C
Rationale: The correct answer is C: Green, foul-smelling fluid. This indicates meconium-stained amniotic fluid, which can be a sign of fetal distress and possible meconium aspiration. Immediate intervention is needed to prevent potential complications for the baby.
A: Temperature of 100.6°F could indicate maternal infection but does not require immediate intervention unless other signs are present.
B: Clear amniotic fluid is a normal finding.
D: Contractions every 5 minutes may indicate active labor, but it is not an immediate concern unless coupled with other signs of distress.