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A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the patient's history, she has reached 8 weeks' gestation. Which recommendation would the nurse provide regarding folic acid supplementation?
- A. Have the patient continue to take 400 mcg folic acid throughout her pregnancy.
- B. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins.
- C. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy.
- D. Schedule the patient to go for an AFP (alpha-fetoprotein) test.
Correct Answer: B
Rationale: Step 1: The patient has been taking an additional 400 mcg of folic acid prior to pregnancy.
Step 2: Folic acid is crucial in the early stages of pregnancy for neural tube development.
Step 3: By 8 weeks' gestation, the neural tube has already formed.
Step 4: Prenatal vitamins typically contain the recommended amount of folic acid.
Step 5: Therefore, the nurse would recommend the patient to stop taking additional folic acid as it's included in prenatal vitamins.
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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.
A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?
- A. Wear a cotton bra
- B. Increase nursing time gradually
- C. Correctly place the infant on the breast
- D. Manually express a small amount of milk before nursing
Correct Answer: C
Rationale: The most common cause of nipple soreness is incorrect positioning (C) of the infant on the breast, e.g., grasping too little of the areola or grasping on the nipple.
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 newborn infant is receiving immunization prior discharge. Which action should the nurse implement?
- A. Give the first dose of the vaccine for rotavirus if any have diarrhea now.
- B. Obtain signed consent from the mother for administration of hepatitis B vaccine
- C. Prepare the first dose for DTaP
- D. Ask the mother if she wants the infant immunized for
Correct Answer: B
Rationale: Hepatitis B vaccine is routinely given at birth, and consent is required (B).
When teaching a gravid client how to perform kick (fetal movement) counts which instruction should the nurse includes.
- A. Exercise for 15 before starting the counting to help increase fetal movement
- B. Count the movements once daily for one hour, before breakfast
- C. Avoid caffeinated drinks for 24 hours before conducting the kick test.
- D. If 10 kicks are not felt within 1 hr, drink orange juice and count for another hour.
Correct Answer: D
Rationale: Drinking orange juice can stimulate fetal movement if counts are low (D).