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A primigravid client at 37 weeks' gestation with gestational diabetes is in active labor at 5 cm dilation. The nurse notes a blood glucose level of 45 mg/dL. What is the nurse's first action?
- A. Administer 50% dextrose IV push.
- B. Offer the client a high-carbohydrate snack.
- C. Recheck the blood glucose level.
- D. Notify the physician of the result.
Correct Answer: B
Rationale: A blood glucose of 45 mg/dL indicates maternal hypoglycemia, common in gestational diabetes due to insulin use. Offering a high-carbohydrate snack is the first action to stabilize glucose safely. Dextrose is for severe cases, rechecking delays treatment, and notification follows initial management.
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A multigravid laboring client has an extensive documented history of drug addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with contractions every 3 minutes of moderate intensity. The physician orders nalbuphine (Nubain) 15 mg slow I.V. push for pain relief followed by an epidural when the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client states she thinks she is going to have her baby now. Of the following drugs available at the time of the delivery, which should the nurse avoid using with this client in this situation?
- A. 1% lidocaine (Xylocaine).
- B. Naloxone hydrochloride (Narcan).
- C. Local anesthetic.
- D. Pudendal block.
Correct Answer: B
Rationale: In a client with recent opioid use, naloxone (Narcan) could precipitate withdrawal symptoms, which is risky during delivery. Lidocaine, local anesthetics, or pudendal blocks are safe for perineal anesthesia and do not interact with the client's history.
A client asks the nurse about the effectiveness of natural family planning methods. Which of the following responses by the nurse is most accurate?
- A. Natural family planning is as effective as oral contraceptives when used correctly.
- B. The effectiveness of natural family planning depends on consistent monitoring and abstinence during fertile periods.
- C. Natural family planning is less effective than barrier methods likeå®çŸ³
- D. Natural family planning requires no special equipment or cost.
Correct Answer: B
Rationale: The effectiveness of natural family planning depends on consistent monitoring and abstinence during fertile periods. It is less effective than oral contraceptives or barrier methods due to variability in ovulation and user adherence.
In response to the nurse's question about how she is feeling, a postpartum client states that she is fine. She then begins talking to the baby, checking the diaper, and asking infant care questions. The nurse determines the client is in which postpartal phase of psychological adaptation?
- A. Taking in.
- B. Taking on.
- C. Taking hold.
- D. Letting go.
Correct Answer: C
Rationale: The 'taking hold' phase is characterized by the mother becoming more active, showing interest in caring for the infant, and asking questions about infant care, as described in the scenario.
While caring for a neonate delivered at 32 weeks' gestation, the nurse assesses the neonate daily for symptoms of necrotizing enterocolitis (NEC). Which of the following would alert the nurse to notify the neonatologist?
- A. The presence of $1 \mathrm{~mL}$ of gastric residual before a gavage feeding.
- B. Jaundice appearing on the face and chest.
- C. An increase in bowel peristalsis.
- D. Abdominal distention.
Correct Answer: D
Rationale: Abdominal distention is a key sign of NEC, indicating potential intestinal compromise.
A client asks about the risks of the contraceptive patch. Which of the following would the nurse include?
- A. Increased risk of blood clots.
- B. Permanent infertility.
- C. Guaranteed weight loss.
- D. Elimination of menstrual periods.
Correct Answer: A
Rationale: The contraceptive patch may increase the risk of blood clots, especially in smokers or those with risk factors. It does not cause permanent infertility, guarantee weight loss, or eliminate periods (it causes withdrawal bleeding).