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A patient in labor is requesting an epidural but has a history of a previous back surgery. What is the most important assessment before proceeding with the epidural?
- A. History of spinal surgery or deformity
- B. Fetal heart rate
- C. Perform a vaginal exam to assess for fetal position
- D. Administer Pitocin
Correct Answer: C
Rationale: The correct answer is C: Perform a vaginal exam to assess for fetal position. This is important because the position of the fetus can affect the safety and efficacy of administering an epidural in a patient with a history of back surgery. If the fetus is in a breech position or in any other position that could complicate the epidural placement, alternative pain management options may need to be considered.
A: History of spinal surgery or deformity is important but assessing the fetal position takes precedence in this scenario.
B: Fetal heart rate monitoring is essential during labor but not the most important assessment before proceeding with the epidural in this case.
D: Administering Pitocin is unrelated to the assessment needed before proceeding with the epidural.
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A pregnant patient is concerned about the safety of using over-the-counter medications for her cold symptoms. Which of the following responses is most appropriate for the nurse?
- A. It is always safe to use OTC medications during pregnancy.
- B. You should avoid using any medications during pregnancy unless prescribed by your healthcare provider.
- C. OTC medications for cold symptoms are safe during any trimester of pregnancy.
- D. Use herbal remedies instead of OTC medications to avoid harm to the baby.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. During pregnancy, it is crucial to minimize medication use to prevent potential harm to the fetus.
2. Many OTC medications have not been extensively studied for safety in pregnancy.
3. Healthcare providers can recommend safe and effective treatment options tailored to the individual.
4. Avoiding unnecessary medication reduces the risk of adverse effects on the developing baby.
Summary:
A: Incorrect. Not all OTC medications are safe during pregnancy, and blanket statements can be harmful.
C: Incorrect. Safety of OTC medications can vary by trimester, so blanket statements are not appropriate.
D: Incorrect. Herbal remedies can also pose risks during pregnancy, and individualized guidance is necessary.
A nurse is caring for a laboring person and is monitoring for signs of fetal distress. Which finding is the most concerning in this situation?
- A. Late decelerations
- B. Bradycardia
- C. Tachycardia
- D. Variable decelerations
Correct Answer: A
Rationale: The correct answer is A: Late decelerations. Late decelerations indicate uteroplacental insufficiency, which can lead to fetal hypoxia and distress. This is the most concerning finding as it indicates a problem with oxygen delivery to the fetus. Bradycardia (B) and Tachycardia (C) can also be concerning, but late decelerations are more specific to fetal distress. Variable decelerations (D) are caused by cord compression and are concerning but not as indicative of fetal distress as late decelerations.
A 40-week pregnant woman is admitted to the labor and delivery unit and is in active labor. Her cervix is 8 cm dilated, and she is experiencing strong contractions. What is the next priority action?
- A. Administer an epidural block
- B. Perform a vaginal examination to assess fetal descent
- C. Assess the fetal heart rate
- D. Prepare for delivery
Correct Answer: C
Rationale: The correct answer is C: Assess the fetal heart rate. This is the next priority action because monitoring the fetal heart rate is crucial to ensure the well-being of the baby during labor. It helps in identifying any signs of fetal distress and guides the healthcare provider in making timely interventions to prevent complications. Administering an epidural block (choice A) can be considered later once the fetal well-being is ensured. Performing a vaginal examination (choice B) may not be necessary at this moment as the woman is already in active labor and has progressed to 8 cm dilation. Preparing for delivery (choice D) should only be done after assessing the fetal well-being to ensure a safe delivery.
A pregnant patient at 30 weeks gestation is complaining of severe heartburn. What should the nurse recommend?
- A. Lie down after meals to improve digestion.
- B. Drink a large amount of water after eating.
- C. Eat smaller meals more frequently and avoid lying down after meals.
- D. Take antacids regularly to relieve heartburn.
Correct Answer: C
Rationale: The correct answer is C: Eat smaller meals more frequently and avoid lying down after meals. This is the best recommendation for the pregnant patient experiencing severe heartburn at 30 weeks gestation. Eating smaller meals more frequently can help reduce the amount of stomach acid produced, thus decreasing the likelihood of heartburn. Avoiding lying down after meals can prevent stomach acid from flowing back into the esophagus, further reducing heartburn symptoms.
Rationale for why other choices are incorrect:
A: Lying down after meals can worsen heartburn by allowing stomach acid to flow back into the esophagus.
B: Drinking a large amount of water after eating may worsen heartburn by increasing stomach pressure and pushing stomach acid back up.
D: Taking antacids regularly may provide temporary relief but is not addressing the root cause of the heartburn and may not be safe for long-term use during pregnancy.
A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. When is the best time for the nurse to schedule the patient’s ultrasound?
- A. Immediately
- B. In 2 weeks
- C. In 4 weeks
- D. In 6 weeks
Correct Answer: A
Rationale: An ultrasound at around 5-6 weeks after the last menstrual period is the most accurate time to determine gestational age.