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A nurse is reinforcing teaching with a client about common discomforts during the first trimester of pregnancy. Which of the following discomforts should the nurse include in the teaching?
- A. Urination urgency and frequency
- B. Tingling in the fingers
- C. Round ligament pain
- D. Perineal discomfort and pressure
Correct Answer: A
Rationale: Increased urgency and frequency of urination are common discomforts during the first trimester of pregnancy. This occurs due to hormonal changes and the growing uterus pressing on the bladder, which reduces its capacity.
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A nurse is assisting with the care of a client who is in labor and has an epidural infusion for pain management. The client's blood pressure is 80/40 mm Hg.
Which of the following actions should the nurse take?
- A. Assist the client to empty her bladder.
- B. Place the client in knee chest position
- C. Administer methylergonovine IM
- D. Give a bolus of lactated Ringer's
Correct Answer: D
Rationale: The client's blood pressure is low (80/40 mm Hg), indicating hypotension, a common side effect of epidural anesthesia during labor. Administering a bolus of intravenous fluids, such as lactated Ringer's solution, is the initial intervention to increase intravascular volume, improving blood pressure and perfusion to vital organs.
A nurse is reinforcing teaching with a client who is at 10 weeks of gestation regarding the purposes of laboratory tests.
Which of the following statements by the client indicates an understanding of the teaching?
- A. White blood cell count is an indicator of anemia.
- B. Urine specific gravity identifies my risk for pregnancy induced hypertension
- C. Platelet count identifies if I am at risk for bleeding
- D. Sedimentation rate checks for signs of cancer
Correct Answer: C
Rationale: Platelet count identifies bleeding risk by assessing clotting ability, a key concern in pregnancy, showing the client understands the test's purpose accurately.
A nurse is caring for a client who is pregnant and has a vaginal culture that is positive for chlamydia.
Which of the following medications should the nurse plan to administer?
- A. Acyclovir
- B. Metronidazole
- C. Tetracycline
- D. Amoxicillin
Correct Answer: D
Rationale: Amoxicillin is a safe and effective antibiotic for treating chlamydia in pregnant women, avoiding tetracyclines which are contraindicated due to fetal risks.
A nurse is reinforcing teaching about preventing mastitis with a client who is breastfeeding.
Which of the following instructions should the nurse include?
- A. Wear an underwire bra between feedings.
- B. You should use a breast pump if you plan to return to work.
- C. Wash your nipples with soap and water daily.
- D. Cover your breasts immediately after feedings.
Correct Answer: B
Rationale: Using a breast pump prevents engorgement when returning to work, reducing mastitis risk by maintaining milk flow and supply.
A nurse is assisting in planning care for a newborn who is experiencing neonatal abstinence syndrome.
Which of the following actions should the nurse recommend?
- A. Avoid swaddling the newborn
- B. Minimize holding the newborn
- C. Decrease environmental noise.
- D. Avoid using a pacifier.
Correct Answer: C
Rationale: Decreasing environmental noise reduces stress and overstimulation in newborns with neonatal abstinence syndrome, who are hypersensitive, aiding comfort and stability.