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A patient with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the patient gain during the pregnancy?
- A. 20 lb
- B. 25 lb
- C. 28 lb
- D. 40 lb
Correct Answer: A
Rationale: The correct answer is A (20 lb). During pregnancy, the recommended weight gain for a woman with a BMI of 30-39.9 is 11-20 pounds. This range helps reduce the risk of complications associated with excessive weight gain. Option B (25 lb) exceeds this recommended range, while options C (28 lb) and D (40 lb) are even further beyond the healthy weight gain guidelines for a BMI of 32. Thus, advising the patient to gain a maximum of 20 pounds is the most appropriate recommendation to ensure a healthy pregnancy outcome.
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A client at 38-weeks gestation is admitted to the labor and delivery unit with mild contractions every 5 minutes. The client's cervix is dilated 2 cm, 50% effaced, and the fetus is at 0 station. The client's membranes rupture spontaneously, and the fluid is clear. What action should the nurse take next?
- A. Monitor the fetal heart rate pattern.
- B. Perform a vaginal examination.
- C. Encourage the client to ambulate.
- D. Administer pain medication.
Correct Answer: A
Rationale: Monitoring the fetal heart rate pattern after membrane rupture is essential to detect any changes in fetal status.
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 term multigravida, who is receiving oxytocin for labor augmentation is requesting pain medication. Review of the client's record indication that she was medicated 30 minutes ago with butorphanol (Stadol) 2 mg and promethazine (Phenergan) 25 mg IV push. Vaginal examination reveals that the client cervical dilation is 3 cm, 70% effaced, and at a 0 station. What action should the nurse implement?
- A. Discontinue the Pitocin infusion
- B. Medicate the client with an additional 1 mg of Stadol IV push
- C. Notify the healthcare provider
- D. Instruct the client to use deep breathing during contraction
Correct Answer: D
Rationale: Deep breathing techniques (D) can help manage pain without additional medication.
The nurse is teaching a woman how to use her basal body temperature (BBT) pattern as a tool to assist her in conceiving a child. Which temperature pattern indicates the occurrence of ovulation, and therefore, the best time for intercourse to ensure conception?
- A. Between the time the temperature falls and rises
- B. Between 36 and 48 hours after the temperature rises
- C. When the temperature falls and remains low for 36 hours
- D. Within 72 hours before the temperature falls
Correct Answer: A
Rationale: In most women, the BBT drops slightly 24 to 36 hours before ovulation and rises 24 to 72 hours after ovulation, when the corpus luteum of the ruptured ovary produces progesterone. Therefore, intercourse between the time of the temperature fall and rise (A) is the best time for conception.
A client at 30-weeks gestation, complaining of pressure over the pubic area, is admitted for observation. She is contracting irregularly and demonstrates underlying uterine irritability. Vaginal examination reveals that her cervix is closed, thick, and high. Based on these data, which intervention should the nurse implement first?
- A. Provide oral hydration
- B. Have a complete blood count (CBC) drawn
- C. Obtain a specimen for urine analysis
- D. Place the client on strict bedrest
Correct Answer: C
Rationale: Obtaining a urine analysis (C) should be done first because preterm clients with uterine irritability and contractions are often suffering from a urinary tract infection, and this should be ruled out first.