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A patient in her fifth month of pregnancy asks the nurse, 'How many more calories should I be eating daily?' What is the correct response by the nurse?
- A. 180 more calories a day
- B. 340 more calories a day
- C. 452 more calories a day
- D. 500 more calories a day
Correct Answer: B
Rationale: The correct response is B: 340 more calories a day. During the second trimester, an additional 340 calories per day is recommended for pregnant women. This ensures proper nutrition for both the mother and the developing fetus. Option A (180 more calories) may not provide enough energy for the needs of pregnancy. Options C (452 more calories) and D (500 more calories) are excessive and could lead to unnecessary weight gain, which may pose risks during pregnancy. Option B strikes a balanced approach to support the increased energy demands of pregnancy without being excessive.
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The nurses assessing a 38-week gestation newborn infant immediately following a vaginal birth. Which assessment finding best indication that the infant is transitioning well to extrauterine life?
- A. Heart rate 220 beats/minute
- B. Cries vigorously when stimulated
- C. A positive Babinski reflex
- D. Flexion of all four extremities
Correct Answer: B
Rationale: Vigorous crying (B) indicates effective transition to extrauterine life.
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.
A medical-surgical nurse is asked to float to a women's health unit to care for patients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and the nurse is familiar with caring for postoperative patients. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment?
- A. The staff nurse has the responsibility of accepting any assignment that is made while working for a healthcare facility.
- B. Because the unit is short-staffed, the staff nurse should accept the assignment to provide care.
- C. The staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment.
- D. The nursing supervisor should emphasize that this assignment requires care of a surgical patient for which the staff nurse is adequately trained.
Correct Answer: C
Rationale: The Nurse Practice Act allows nurses to refuse assignments involving practices opposed to their religious, cultural, ethical, or moral values.
A multigravida client arrives at the labor and delivery unit and tells the nurse that her bag of water has broken. The nurse identifies the presence of meconium fluid on the perineum and determines the fetal heart rate is between 140 to 150 beats/minute. What action should the nurse implement next?
- A. Complete a sterile vaginal exam
- B. Take maternal temperature every 2 hours
- C. Prepare for an immediate cesarean birth
- D. Obtain sterile suction equipment
Correct Answer: A
Rationale: A vaginal exam (A) should be performed after the rupture of membranes to determine the presence of a prolapsed cord.
The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?
- A. Insert an internal fetal monitor
- B. Assess for cervical changes q1h
- C. Monitor bleeding from IV sites
- D. Perform Leopold's maneuvers
Correct Answer: C
Rationale: Monitoring bleeding from peripheral sites (C) is the priority intervention. This client is presenting with signs of placental abruption. Disseminated intravascular coagulation (DIC) is a complication of placental abruption, characterized by abnormal bleeding.