Nokea
A primiparous client bottle-feeding her neonate asks about sterilizing bottles. The nurse should instruct the client to:
- A. Boil bottles for 10 minutes after each use.
- B. Use a dishwasher with a sanitize cycle.
- C. Soak bottles in bleach solution daily.
- D. Wash bottles with hot soapy water only.
Correct Answer: B
Rationale: A dishwasher with a sanitize cycle effectively sterilizes bottles, ensuring safety for the neonate.
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When developing a teaching plan for a primigravid client with insulin-dependent diabetes about monitoring blood glucose control and insulin dosages at home, which of the following would the nurse expect to include as a desired target range for blood glucose levels?
- A. 40 to 60 mg/dL between 2:00 and 4:00 p.m.
- B. 60 to 100 mg/dL before meals and bedtime snacks.
- C. 110 to 140 mg/dL before meals and bedtime snacks.
- D. 140 to 160 mg/dL 1 hour after meals.
Correct Answer: B
Rationale: Target range before meals and bedtime snacks is 60-100 mg/dL.
A primiparous client 3 days postpartum is to be discharged on heparin therapy. After teaching her about possible adverse effects of heparin therapy, the nurse determines that the client needs further instruction when she states the adverse effects include which of the following?
- A. Epistaxis.
- B. Bleeding gums.
- C. Slow pulse.
- D. Petechiae.
Correct Answer: C
Rationale: Slow pulse is not a typical adverse effect of heparin; bleeding symptoms like epistaxis, bleeding gums, and petechiae are expected.
Following an epidural and placement of internal monitors, a client's labor is augmented. Contractions are lasting greater than 90 seconds and occurring every 1½ minutes. The uterine resting tone is greater than 20 mm mercury with a nonreassuring fetal heart rate and pattern. Which of the following actions should the nurse take first?
- A. Notify the health care provider.
- B. Turn off the oxytocin (Pitocin) infusion.
- C. Turn the client to her left side.
- D. Increase the maintenance I.V. fluids.
Correct Answer: B
Rationale: Hyperstimulation (contractions >90 seconds, frequent, with high resting tone) and nonreassuring fetal heart rate indicate fetal distress. Stopping oxytocin is the first step to reduce uterine activity and improve fetal oxygenation. Repositioning, notifying the provider, or increasing fluids follow.
The nurse is caring for a multigravid client at 34 weeks' gestation diagnosed with preterm labor. The client has delivered two stillborn infants at 30 weeks' gestation. The client is scheduled for a sonogram before an amniocentesis. Which of the following would be a priority nursing diagnosis for the client?
- A. Acute pain related to abnormal uterine contractions.
- B. Anxiety related to diagnostic tests for fetal well-being.
- C. Ineffective coping related to hospitalization.
- D. Deficient knowledge related to consequences of preterm birth.
Correct Answer: B
Rationale: Anxiety related to diagnostic tests is a priority.
Before placing the fetal monitoring device on a primigravid client's fundus, the nurse performs Leopold's maneuvers. When performing the third maneuver, the nurse explains that this maneuver is done for which of the following reasons?
- A. To determine whether the fetal presenting part is engaged.
- B. To locate the fetal cephalic prominence.
- C. To distinguish between a breech and a cephalic presentation.
- D. To locate the position of the fetal arms and legs.
Correct Answer: A
Rationale: The third Leopold's maneuver assesses the presenting part's engagement in the pelvis, helping determine labor progression. Other maneuvers address cephalic prominence, presentation type, or fetal positioning.