Nokea
A patient calls the clinic Monday morning. She had condomless sex Friday night and is interested in emergency contraception. What should the nurse tell this patient?
- A. Emergency contraception pills are very effective for medically induced abortions early in pregnancy.
- B. If she is not midcycle when she had sex, she does not need emergency contraception.
- C. It is too late for her to use emergency contraceptive pills, but she can come in for placement of a copper IUD.
- D. She can use emergency contraceptive pills, even if she has had other condomless sex since the Friday night event.
Correct Answer: D
Rationale: The correct advice for the patient in this scenario is to inform her that she can still use emergency contraceptive pills, even if she has had other condomless sex since the Friday night event. Emergency contraceptive pills are most effective when taken as soon as possible after unprotected sex, but they can still be used within a certain window of time depending on the type of pill used. It is important to inform the patient that she can take emergency contraception in this situation to reduce the risk of an unintended pregnancy.
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A nurse is caring for a client who is receiving oxytocin for induction of labor and notes late decelerations of the fetal heart rate on the monitor Tracing. Which of the following action should the nurse take?
- A. Decrease maintenance IV solution infusion rate.
- B. Place the client in lateral position.
- C. Administer misoprostol 25 mcg vaginally D
- D. Administer oxygen via face mask at 2 L/min
Correct Answer: B
Rationale: Late decelerations of the fetal heart rate can indicate uteroplacental insufficiency, which may be a result of decreased oxygen supply to the fetus. Placing the client in a lateral position can help enhance uteroplacental perfusion by relieving pressure on the vena cava and improving maternal blood flow to the placenta. This position change can help improve fetal oxygenation and decrease the occurrence of late decelerations. Other actions such as administering oxygen and assessing for other contributing factors should also be done, but placing the client in a lateral position is the most appropriate immediate intervention in this scenario.
How can a nurse support a mother planning to formula-feed her newborn?
- A. Discourage frequent feeding to avoid overfeeding
- B. Recommend holding the baby during feeding
- C. Provide information about formula preparation
- D. Advise limiting formula feeding to once daily
Correct Answer: C
Rationale: Providing accurate information about formula preparation ensures safe and adequate feeding.
What does the nurse know about the definition of a family?
- A. Families are made up of couples with biological children.
- B. Families are created through marriage or birth.
- C. Families can be blended but are not called families.
- D. Families are made of kinships defined by the family.
Correct Answer: D
Rationale: Families are diverse and defined by the individuals involved, not limited to traditional structures.
A nurse is assessing a newborn who is 48 hours old and is experiencing opioid withdrawals. Which of the following findings should the nurse expect?
- A. Hypotonicity
- B. Moderate tremors of the extremities
- C. Axillary temperature 36.1°C (96.9 F)
- D. Excessive sleeping
Correct Answer: B
Rationale: Neonatal opioid withdrawal syndrome, also known as neonatal abstinence syndrome (NAS), can occur in newborns who were exposed to opioids in utero. Symptoms of NAS can include tremors, irritability, high-pitched crying, poor feeding, vomiting, diarrhea, sweating, and sneezing. The severity of symptoms can vary depending on the type of opioid exposure, dosage, and duration of exposure. In this case, the nurse should expect to see moderate tremors of the extremities in the newborn experiencing opioid withdrawals at 48 hours old. It is important for the nurse to monitor and manage the newborn's withdrawal symptoms closely to ensure their safety and well-being.
Whose theoretical model describes how clinical judgment evolves with experience?
- A. Benner
- B. Tanner
- C. Lasater
- D. Nightingale
Correct Answer: A
Rationale: Patricia Benner developed the theoretical model known as the Novice to Expert Theory, which describes how clinical judgment evolves with experience. According to this theory, individuals progress through five levels of proficiency in a skill: novice, advanced beginner, competent, proficient, and expert. Benner's model emphasizes the importance of experiential learning and highlights how nurses develop expertise over time through practical experience and reflection.