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A pregnant patient is at 24 weeks gestation and reports feeling fatigued and weak. What is the most appropriate action for the nurse to take?
- A. Instruct the patient to rest and avoid physical activity.
- B. Assess the patient's hemoglobin and hematocrit levels to check for anemia.
- C. Recommend that the patient eat a high-calorie diet to increase energy.
- D. Encourage the patient to perform regular exercise to combat fatigue.
Correct Answer: B
Rationale: The correct answer is B: Assess the patient's hemoglobin and hematocrit levels to check for anemia. Fatigue and weakness in pregnancy can be symptoms of anemia, a common condition due to increased blood volume demands. By checking hemoglobin and hematocrit levels, the nurse can confirm or rule out anemia as the cause. Resting alone may not address the underlying issue, and high-calorie diet or regular exercise may not be appropriate if anemia is present. It is crucial to identify the root cause to provide the most effective intervention.
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Which of the following is the most accurate description of fetal station during labor?
- A. The distance from the cervix to the fetal head
- B. The level of the presenting part in relation to the ischial spines
- C. The degree of fetal flexion during contractions
- D. The amount of cervical dilation during labor
Correct Answer: B
Rationale: The correct answer is B: The level of the presenting part in relation to the ischial spines. Fetal station refers to the position of the baby's head in the mother's pelvis during labor. It is measured in centimeters above or below the ischial spines. This measurement helps determine the progress of labor and the descent of the baby through the birth canal. Choices A, C, and D do not accurately describe fetal station and are therefore incorrect. Choice A refers to the cervical length, choice C refers to fetal position, and choice D refers to cervical dilation, which are not related to fetal station.
What is the purpose of amniocentesis for a patient hospitalized at 34 weeks of gestation with pregnancy-induced hypertension?
- A. Determine if a metabolic disorder exists.
- B. Identify the sex of the fetus.
- C. Identify abnormal fetal cells.
- D. Determine fetal lung maturity.
Correct Answer: D
Rationale: At 34 weeks, amniocentesis is primarily used to assess fetal lung maturity, which is critical if early delivery is being considered.
Which food can a lactose-intolerant pregnant woman consume for calcium?
- A. Turnip greens
- B. Green beans
- C. Cantaloupe
- D. Nectarines
Correct Answer: A
Rationale: Turnip greens are rich in calcium, making them a suitable alternative for lactose-intolerant individuals.
A birthing person who delivered a newborn vaginally is receiving care in the labor and birth unit. The health-care provider diagnosed a retained placenta. What is the primary risk associated with a retained placenta?
- A. neonatal jaundice
- B. postpartum hemorrhage
- C. delayed bonding
- D. postpartum anemia
Correct Answer: B
Rationale: The primary risk associated with a retained placenta is postpartum hemorrhage. When the placenta does not deliver completely after childbirth, it can lead to excessive bleeding, risking the mother's health. This condition requires immediate medical attention to prevent severe complications. Neonatal jaundice, delayed bonding, and postpartum anemia are not directly linked to a retained placenta, making them incorrect choices. Neonatal jaundice is caused by elevated bilirubin levels, delayed bonding is related to emotional factors, and postpartum anemia is characterized by low red blood cell count, none of which are the primary risk associated with a retained placenta.
A nurse is caring for a postpartum person who is at risk for deep vein thrombosis (DVT). What is the most appropriate nursing intervention?
- A. Encourage ambulation
- B. Apply compression stockings
- C. Administer low-molecular-weight heparin
- D. Monitor for signs of edema
Correct Answer: B
Rationale: The correct answer is B: Apply compression stockings. This intervention is appropriate for a postpartum person at risk for DVT as it helps promote circulation and prevent blood clots by applying pressure to the legs. Compression stockings are a safe and non-invasive method to reduce the risk of DVT. Encouraging ambulation (choice A) is important but may not be feasible immediately postpartum. Administering low-molecular-weight heparin (choice C) would require a prescription and may not be the first-line intervention. Monitoring for signs of edema (choice D) is important but does not directly address the prevention of DVT like compression stockings do.