Nokea
A woman in active labor is experiencing a shoulder dystocia during delivery. What nursing intervention should be prioritized?
- A. Apply suprapubic pressure to dislodge the shoulder.
- B. Perform an episiotomy to facilitate delivery.
- C. Insert an oropharyngeal airway to maintain airway patency.
- D. Administer intravenous magnesium sulfate for uterine relaxation.
Correct Answer: A
Rationale: Shoulder dystocia is an obstetric emergency where one of the baby's shoulders becomes impacted behind the mother's pubic bone after the head delivers. This can lead to compression of the umbilical cord and compromise fetal oxygenation. The most critical nursing intervention in managing shoulder dystocia is applying suprapubic pressure to dislodge the impacted shoulder and allow for delivery of the baby. By gently pushing downwards on the mother's abdomen just above the pubic bone, the shoulder can be released, and the baby can be delivered successfully. This intervention should be prioritized to prevent potential complications for both the mother and the baby. Episiotomy may be considered if necessary, but it is secondary to addressing the shoulder dystocia. Oropharyngeal airway insertion and administering magnesium sulfate are not indicated in the immediate management of shoulder dystocia.
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Which of the following laboratory findings is characteristic of a patient with a diagnosis of gestational diabetes mellitus (GDM)?
- A. Fasting blood glucose ≥126 mg/dL
- B. Random plasma glucose ≥200 mg/dL
- C. Hemoglobin A1c (HbA1c) ≥6.5%
- D. Oral glucose tolerance test (OGTT) 2-hour plasma glucose ≥140 mg/dL
Correct Answer: D
Rationale: The diagnosis of gestational diabetes mellitus (GDM) is typically confirmed through an oral glucose tolerance test (OGTT) during pregnancy. In GDM, the 2-hour plasma glucose level during the OGTT is equal to or greater than 140 mg/dL. This finding is characteristic of GDM and distinguishes it from other types of diabetes. Fasting blood glucose ≥126 mg/dL is diagnostic of diabetes mellitus outside of pregnancy, not specifically GDM. Random plasma glucose ≥200 mg/dL is indicative of uncontrolled diabetes in general. Hemoglobin A1c (HbA1c) ≥6.5% is used for diagnosing diabetes outside of pregnancy and is not specific to GDM.
During the active phase of labor, the nurse observes that the cervix is dilated to 6 cm and the contractions are regular, lasting 60 seconds each, occurring every 3 minutes. What action should the nurse take?
- A. Encourage the mother to push.
- B. Administer oxytocin to augment labor.
- C. Prepare for delivery.
- D. Continue to monitor the progress of labor.
Correct Answer: D
Rationale: During the active phase of labor, a cervical dilation of 6 cm and regular contractions lasting 60 seconds each, occurring every 3 minutes indicate good progress in labor. The nurse should continue to monitor the progress closely by assessing the mother's vital signs, fetal heart rate, and the pattern of contractions. It is important to provide support and encouragement to the mother, continue with comfort measures, and be prepared to assist with the delivery when the cervix is fully dilated. This stage of labor is focused on active dilation and effacement of the cervix, and it is not yet time for the mother to push or for the nurse to administer oxytocin to augment labor.
In healthcare facility, a planned program of loss prevention and liability control refers to
- A. quality assurance
- B. risk management
- C. critical pathways
- D. peer review
Correct Answer: B
Rationale: Risk management in a healthcare facility involves identifying, assessing, and minimizing risks to prevent potential harm to patients and reduce liability issues. A planned program of loss prevention and liability control falls under the umbrella of risk management. This program includes strategies to mitigate risks such as patient safety protocols, infection control measures, staff training, and proper documentation practices to minimize legal liabilities. By implementing risk management practices, healthcare facilities aim to provide safe and high-quality care to their patients while also protecting themselves against potential legal challenges.
Transcription of doctor's order is a nurse's responsibility to put the order into action. Which of the following principles of medication safety is NOT considered to belong to transcription error?
- A. Illegible handwriting of the physician.
- B. Misinterpretation of the directions ordered.
- C. Use of unapproved abbreviation in the chart.
- D. Wrong route of medication administration.
Correct Answer: D
Rationale: Transcription errors are typically associated with issues such as illegible handwriting, misinterpretation of directions, and the use of unapproved abbreviations. However, the wrong route of medication administration is not specifically related to transcription errors but rather falls under the category of medication administration errors. Administering medication via the wrong route can lead to serious consequences for the patient and is a separate issue from the act of transcribing doctor's orders.
Nurse Chona saw Patient Noel reading his own chart and question the nurse why (-) smoking and (-) liquor was recorded when he does not smoke and drink alcohol? What is the INITIAL explanation of Nurse Chona on the record?
- A. Get the chart from him and reprimand him from reading the chart
- B. The sign of negative before the word means he is not drinking alcohol or smoking cigarette.
- C. Ask patient Noel to apologize for reading the chart.
- D. Tell Noel that alcohol and liquor are important factors in diagnosing his ailment.
Correct Answer: B
Rationale: Nurse Chona should explain to Patient Noel that the sign of negative before the word means that he is not drinking alcohol or smoking cigarettes. This is a simple misunderstanding and clarification should help clear up any confusion. It is important to uphold patient confidentiality and respect their autonomy, rather than reprimanding the patient for looking at their own chart. It is also essential to address any discrepancies in the patient's medical record to ensure accurate information is documented for proper treatment and care.