Nokea
A nurse is teaching a client who is at 10 weeks of gestation about nutrition during pregnancy. Which of the following statements by the client indicates an understanding of the teaching?
- A. "I should increase my protein intake to 60 grams each day."
- B. "I should drink 2 liters of water each day."
- C. "I should increase my overall daily caloric intake by 300 calories."
- D. "I should take 600 micrograms of folic acid each day."
Correct Answer: A
Rationale: The correct answer is A because protein is essential for fetal development and increasing protein intake to 60 grams per day is recommended during pregnancy for optimal growth. Adequate protein intake helps in the formation of new tissues and cells.
Choice B is incorrect because while staying hydrated is important during pregnancy, the specific amount of 2 liters per day is not a standard recommendation and may vary depending on individual needs.
Choice C is incorrect as increasing overall daily caloric intake by 300 calories is a general guideline, not specific to the client's gestational age.
Choice D is incorrect as while folic acid is crucial during pregnancy to prevent birth defects, the recommended daily intake is usually 400-800 micrograms, so 600 micrograms is within the range but not the best answer.
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A nurse is caring for a client who is at 38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring?
- A. Determine progression of dilatation and effacement.
- B. Perform Leopold maneuvers.
- C. Complete a sterile speculum exam.
- D. Prepare a Nitrazine paper test.
Correct Answer: B
Rationale: Performing Leopold maneuvers helps the nurse determine the fetal position and presentation, which is essential for accurate placement of the external transducer.
A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan?
- A. Feed the newborn 1 oz of water every 4 hr.
- B. Apply lotion to the newborn's skin three times per day.
- C. Remove all clothing from the newborn except the diaper.
- D. Discontinue therapy if the newborn develops a rash.
Correct Answer: C
Rationale: The correct answer is C: Remove all clothing from the newborn except the diaper. During phototherapy, the newborn's skin needs to be exposed to the light to effectively treat hyperbilirubinemia. Removing all clothing allows maximum skin exposure. Option A is incorrect as water does not help with phototherapy. Option B is incorrect as lotion can interfere with the effectiveness of the therapy. Option D is incorrect as a rash is a common side effect of phototherapy and discontinuing it would hinder treatment.
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.
A nurse is caring for a client who is in labor and receiving oxytocin. Which of the following findings indicates that the nurse should increase the rate of infusion?
- A. Contractions every 5 min that last 30 seconds
- B. Montevideo units consistently 300 mm Hg
- C. Urine output of 20 mL/hr
- D. FHR pattern with absent variability
Correct Answer: A
Rationale: Contractions every 5 minutes lasting 30 seconds are inadequate for labor progression, indicating the need to increase oxytocin infusion to strengthen contractions.
Which of the following is a potential barrier to evidence-based practice in maternal and newborn healthcare?
- A. Lack of access to up-to-date research
- B. Resistance to change
- C. Limited resources
- D. All of the above
Correct Answer: D
Rationale: All the options listed (lack of access to research resistance to change and limited resources) are common barriers to implementing evidence-based practice in healthcare settings. These factors can hinder the adoption of new practices and the improvement of care quality.