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A pregnant woman who is 20 weeks gestation asks about the risk of consuming caffeine during pregnancy. Which of the following responses is most appropriate?
- A. It is safe to consume up to 200 mg of caffeine per day during pregnancy.
- B. You should avoid caffeine completely during pregnancy.
- C. Moderate caffeine consumption is okay, but avoid drinking coffee in the afternoon.
- D. Caffeine has no impact on your pregnancy, so you can drink it as desired.
Correct Answer: A
Rationale: The correct answer is A because current guidelines suggest that consuming up to 200 mg of caffeine per day is considered safe during pregnancy. This amount is unlikely to harm the developing fetus. Excessive caffeine intake has been associated with an increased risk of miscarriage and low birth weight.
Option B is incorrect as complete avoidance of caffeine is not necessary, but rather moderation is key. Option C is partially correct in emphasizing moderation but the recommendation to avoid coffee in the afternoon is not supported by evidence. Option D is incorrect as caffeine does have an impact on pregnancy, and unrestricted consumption is not advisable.
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The nurse is caring for a pregnant patient who is 38 weeks gestation and has a history of gestational hypertension. Which of the following symptoms would indicate the need for immediate medical attention?
- A. Mild swelling in the feet and ankles
- B. Headaches and blurred vision
- C. Occasional lower back pain
- D. Fatigue and slight nausea
Correct Answer: B
Rationale: The correct answer is B: Headaches and blurred vision. These symptoms can indicate a serious condition called preeclampsia, which can be life-threatening for both the mother and the baby. Headaches and blurred vision are signs of increased blood pressure and potential organ damage. Immediate medical attention is crucial to monitor and manage preeclampsia.
A: Mild swelling in the feet and ankles is common in pregnancy and not necessarily indicative of a serious issue.
C: Occasional lower back pain is also common in pregnancy and may not require immediate medical attention.
D: Fatigue and slight nausea are common pregnancy symptoms and do not typically indicate a need for immediate medical attention.
A nurse is assessing a laboring person for signs of uterine rupture. What is the most common sign of uterine rupture?
- A. abdominal pain
- B. vaginal bleeding
- C. decreased fetal movement
- D. increased fetal heart rate
Correct Answer: C
Rationale: The correct answer is C: decreased fetal movement. Uterine rupture can lead to decreased blood flow to the fetus, resulting in reduced fetal movement. This sign is crucial as it indicates fetal distress and the need for immediate medical intervention. Abdominal pain (A) can be present but is not specific to uterine rupture. Vaginal bleeding (B) is a sign of placental abruption, not uterine rupture. Increased fetal heart rate (D) can occur due to fetal distress, but decreased fetal movement is a more direct sign of uterine rupture.
Which finding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client?
- A. Anemia.
- B. Thrombocytopenia.
- C. Polycythemia.
- D. Hyperbilirubinemia.
Correct Answer: A
Rationale: Anemia is relatively common in pregnancy due to increased blood volume and iron demands. Polycythemia, thrombocytopenia, and hyperbilirubinemia are not typical findings.
A nurse is caring for a postpartum person who is breastfeeding. What is the most appropriate intervention for sore nipples?
- A. apply lanolin cream
- B. administer IV fluids
- C. perform uterine massage
- D. apply cold compress
Correct Answer: A
Rationale: The correct answer is A: apply lanolin cream. Lanolin cream helps soothe and moisturize sore nipples, providing relief during breastfeeding. It is safe for both the mother and the baby. Applying lanolin cream after each feeding can prevent further irritation and promote healing.
Incorrect choices:
B: Administering IV fluids is not indicated for sore nipples.
C: Performing uterine massage is unrelated to treating sore nipples.
D: Applying cold compress may provide temporary relief but does not address the underlying issue of sore nipples.
A pregnant woman is scheduled to undergo chorionic villus sampling (CVS) based on genetic family history. Which medication does the nurse anticipate will be administered?
- A. Magnesium sulfate
- B. Prostaglandin suppository
- C. RhoGAM if the patient is Rh-negative
- D. Betamethasone
Correct Answer: C
Rationale: Rh-negative women undergoing CVS require RhoGAM to prevent Rh sensitization.