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A nurse is reviewing the medical record of a newly admitted client who is at 32 weeks of gestation. Which of the following conditions is an indication for fetal assessment using electronic fetal monitoring?
- A. Oligohydramnios.
- B. Hyperemesis gravidarum.
- C. Leukorrhea.
- D. Periodic tingling of the fingers.
Correct Answer: A
Rationale: Oligohydramnios, or low amniotic fluid, is an indication for electronic fetal monitoring as it can be associated with fetal distress and other complications.
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A nurse is providing teaching about immunizations to a client who is pregnant. Which of the following statements should the nurse include in the teaching?
- A. The immunization for varicella should be given at least 1 month prior to delivery.
- B. You can receive the rubella immunization during the third trimester of pregnancy.
- C. The hepatitis B immunization should not be obtained until after you finish breastfeeding.
- D. You can receive the immunization for influenza at any time during your pregnancy.
Correct Answer: D
Rationale: The influenza vaccine is safe and recommended during pregnancy to protect both the mother and the baby. Varicella and rubella vaccines are contraindicated during pregnancy.
A nurse is preparing to administer oxytocin to a client who is postpartum. Which of the following findings is an indication for the administration of the medication? (Select all that apply.)
- A. Flaccid uterus
- B. Cervical laceration
- C. Excess vaginal bleeding
- D. Increased afterbirth cramping
Correct Answer: A,C
Rationale: The correct answers are A and C. A flaccid uterus indicates poor uterine tone, which can lead to postpartum hemorrhage. Oxytocin is given to enhance uterine contractions and tone, helping prevent excessive bleeding. Excess vaginal bleeding is also an indication for oxytocin administration as it can help control bleeding by promoting uterine contractions. Choices B, D, and other options are incorrect as they do not directly relate to the need for oxytocin administration in this scenario. Cervical laceration and increased afterbirth cramping may require other interventions, but they do not specifically indicate the need for oxytocin administration to address postpartum bleeding.
Which of the following is a professional standard for nursing practice in maternal and newborn healthcare?
- A. Collaboration with interdisciplinary team members
- B. Advocacy for patients and families
- C. Incorporation of evidence-based practice
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D, all of the above. Collaboration with interdisciplinary team members is crucial in providing holistic care in maternal and newborn healthcare. Advocacy for patients and families ensures their rights and preferences are respected. Incorporation of evidence-based practice ensures that nursing care is based on the best available research and clinical expertise. Therefore, selecting all of the above options is essential to uphold professional standards in nursing practice in maternal and newborn healthcare.
A nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
- A. Identify the attitude of the head.
- B. Palpate the fundus to identify the fetal part.
- C. Determine the location of the fetal back.
- D. Palpate for the fetal part presenting at the inlet.
Correct Answer: B, C, D, A
Rationale: Leopold maneuvers should be performed in the following sequence: palpate the fundus, determine the location of the fetal back, palpate for the fetal part presenting at the inlet, and identify the attitude of the head.
What is the recommended method of pain relief for a woman who has a vaginal tear or episiotomy after delivery?
- A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
- B. Acetaminophen
- C. Ice packs
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce inflammation and pain. Acetaminophen is a pain reliever that can be used in conjunction with NSAIDs for added relief. Ice packs can help reduce swelling and numb the area. Using all three methods together can provide a comprehensive approach to pain relief, targeting different aspects of discomfort such as inflammation, pain, and swelling. This combination can effectively manage pain and promote healing in cases of vaginal tear or episiotomy. Other choices are incorrect because using only one method may not address all aspects of pain and discomfort associated with the condition.