Nokea
A nurse is working with an active labor patient who is in preterm labor and has been designated as high risk. The patient is very apprehensive and asks the nurse, 'Is everything going to be all right?' The nurse replies, 'Yes, everything will be okay.' Following delivery via an emergency cesarean birth, the newborn undergoes resuscitation and does not survive. The patient is distraught over the outcome and blames the nurse for telling her that everything would be okay. Which ethical principle did the nurse violate?
- A. Autonomy
- B. Fidelity
- C. Beneficence
- D. Accountability
Correct Answer: B
Rationale: Fidelity involves keeping promises and being truthful; the nurse violated this principle by making an unrealistic promise.
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Which effect is a common response to both smoking and cocaine use in the pregnant patient?
- A. Vasoconstriction
- B. Increased appetite
- C. Increased metabolism
- D. Changes in insulin metabolism
Correct Answer: A
Rationale: The correct answer is A: Vasoconstriction. Both smoking and cocaine use can lead to vasoconstriction, which is the narrowing of blood vessels. In pregnant patients, this can reduce blood flow to the fetus, leading to potential complications. Increased appetite (B) and increased metabolism (C) are not common responses to both smoking and cocaine use. Changes in insulin metabolism (D) are more commonly associated with conditions like gestational diabetes rather than as a common response to smoking and cocaine use during pregnancy.
Changes in the diet of the pregnant patient who has phenylketonuria would include
- A. adding foods high in vitamin C.
- B. eliminating drinks containing aspartame.
- C. restricting protein intake to <20 g a day.
- D. increasing caloric intake to at least 1800 cal/day.
Correct Answer: B
Rationale: The correct answer is B: eliminating drinks containing aspartame. Patients with phenylketonuria lack the enzyme to metabolize phenylalanine, found in aspartame. Avoiding aspartame-containing products is crucial to prevent phenylalanine buildup. Choice A is incorrect as vitamin C is not directly related to phenylketonuria. Choice C is incorrect as protein restriction is necessary, but the recommended intake is individualized and not a fixed amount. Choice D is incorrect as caloric intake is important, but the focus should be on managing phenylalanine levels.
A woman who had a miscarriage 6 months ago becomes pregnant. Which instruction is most important is most important for the nurse to provide this client?
- A. Elevate lower legs while resting
- B. Increase caloric intake by 200 to 300 calories per day
- C. Increase water intake to 8 full glasses per day
- D. Take prescribed multivitamin and mineral supplements
Correct Answer: D
Rationale: A client who has had a spontaneous abortion or stillbirth in the last 1.5 years should take multivitamin and mineral supplements (D) and maintain a balanced diet because the previous pregnancy may have left her nutritionally depleted.
A client at 40-weeks gestation is admitted to the labor and delivery unit in active labor. The client's cervix is dilated 8 cm, 100% effaced, and the fetus is at +1 station. The client begins to push forcefully with contractions. What action should the nurse take?
- A. Encourage the client to pant-blow during contractions.
- B. Assist the client to push with contractions.
- C. Prepare for an immediate delivery.
- D. Notify the healthcare provider.
Correct Answer: A
Rationale: Pant-blow breathing helps prevent premature pushing before full dilation, reducing the risk of cervical edema.
A 42-week gestational client is receiving an intravenous infusion of oxytocin (Pitocin) to augment early labor. The nurse should discontinue the oxytocin infusion for which pattern of contractions?
- A. Transition labor with contractions every 2 minutes, lasting 90 seconds each
- B. Early labor with contractions every 5 minutes, lasting 40 seconds each
- C. Active labor with contractions every 31 minutes, lasting 60 seconds each
- D. Active labor with contractions every 2 to 3 minutes, lasting 70 to 80 seconds each
Correct Answer: A
Rationale: Contractions pattern (A) describes hyperstimulation and an inadequate resting time between contractions to allow for placental perfusion. The oxytocin infusion should be discontinued.