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A nurse should monitor a client who is postpartum from a forceps delivery for which of the following complications?
- A. Placental abruption.
- B. Seizure.
- C. Idiopathic thrombocytopenia.
- D. Infection.
Correct Answer: D
Rationale: Forceps delivery increases the risk of trauma and infection due to potential tissue damage.
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The nurse is caring for a pregnant client who was sent to the hospital for a biophysical profile. She is 37 weeks gestation with her second child, has gestational diabetes, and complains of decreased fetal movement for the last 24 hours. Which action should the nurse take first?
- A. Perform vital signs
- B. Call physician
- C. Perform glucose
- D. Place on fetal monitor
Correct Answer: D
Rationale: The correct answer is D: Place on fetal monitor. This action is crucial to assess the fetal well-being and monitor the baby's heart rate and movements. It helps in determining if the baby is in distress and requires immediate intervention. Performing vital signs (A) is important but not the priority in this situation. Calling the physician (B) can be done after the initial assessment on the fetal monitor. Performing glucose (C) is not the priority when the main concern is the well-being of the baby.
Which of the patient health behaviors in the first trimester would the nurse identify as a risk factor in pregnancy?
- A. Sexual intercourse two or three times weekly
- B. Moderate exercise for 30 minutes daily
- C. Working 40 hours a week as a secretary in a travel agency
- D. Relaxing in a hot tub for 30 minutes a day, several days a week
Correct Answer: D
Rationale: The correct answer is D because relaxing in a hot tub for 30 minutes a day, several days a week can increase the body temperature, which is harmful during the first trimester and can lead to birth defects. Choice A is not a risk factor as it promotes a healthy sexual relationship. Choice B is beneficial as moderate exercise is recommended during pregnancy. Choice C is not necessarily a risk factor unless it involves exposure to harmful substances or excessive stress.
The nurse is caring for a 45-year-old client who is scheduled to have a chorionic villus sampling. Which information is most important for the nurse to obtain from the client before the procedure?
- A. NPO status
- B. Blood type and Rh
- C. Weeks of gestation
- D. Maternal bleeding disorders
Correct Answer: D
Rationale: The correct answer is D: Maternal bleeding disorders. This information is crucial before a chorionic villus sampling to assess the risk of excessive bleeding during the procedure due to potential clotting issues. Maternal bleeding disorders can increase the risk of complications during the procedure.
A: NPO status is not as critical for this procedure as it does not typically require fasting.
B: Blood type and Rh are important for other purposes but not specifically needed before a chorionic villus sampling.
C: Weeks of gestation is important for determining the timing of the procedure but does not directly impact the safety or success of the procedure.
Which suggestion is most helpful for the pregnant patient who is experiencing heartburn?
- A. Drink plenty of fluids at bedtime.
- B. Eat only three meals a day so the stomach is empty between meals.
- C. Drink coffee or orange juice immediately on arising in the morning.
- D. Use Tums or Rolaids to obtain relief, as directed by the health care provider.
Correct Answer: D
Rationale: The correct answer is D because Tums or Rolaids are safe antacids commonly recommended for heartburn during pregnancy. They help neutralize stomach acid and provide relief. Choice A is incorrect as drinking fluids before bedtime can aggravate heartburn. Choice B is incorrect because it's important to eat small, frequent meals to prevent heartburn. Choice C is incorrect as coffee and orange juice can trigger heartburn due to their acidity. Overall, using antacids under healthcare provider guidance is the best option for managing heartburn during pregnancy.
A nurse has provided a young woman with preconception counseling. Which of the statements by the woman indicates that the teaching was successful? Select all that apply.
- A. “As soon as I think I may be pregnant, I should stop drinking alcohol.”
- B. “It is important for me to see my medical doctor for a complete physical.”
- C. “I should make sure that my daily multivitamin contains folic acid.”
- D. “When I go to my dentist for a checkup I should state that I may be pregnant.”
Correct Answer: A
Rationale: All the statements indicate successful preconception counseling, covering topics such as alcohol cessation, medical checkups, folic acid intake, dental care, and dietary precautions.