Nokea
After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least which of the following time spans?
- A. 6 months.
- B. 12 months.
- C. 18 months.
- D. 24 months.
Correct Answer: B
Rationale: Waiting 12 months allows for monitoring for choriocarcinoma.
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A primigravid client at 39 weeks' gestation is admitted to the hospital for induction of labor. The physician has ordered prostaglandin E2 gel (Dinoprostone) for the client. Before administering prostaglandin E2 gel to the client, which of the following should the nurse do first?
- A. Assess the frequency of uterine contractions.
- B. Place the client in a side-lying position.
- C. Determine whether the membranes have ruptured.
- D. Prepare the client for an amniotomy.
Correct Answer: A
Rationale: Prostaglandin E2 gel stimulates contractions, so assessing baseline contraction frequency ensures it is safe to administer (e.g., no hyperstimulation). Membrane status and positioning are secondary, and amniotomy is not required.
A primigravid client at 39 weeks' gestation is admitted in early labor with contractions every 6 minutes. The nurse notes a fetal heart rate of 145 bpm with occasional variable decelerations. What is the nurse's first action?
- A. Notify the physician immediately.
- B. Administer oxygen via non-rebreather mask.
- C. Reposition the client to her left side.
- D. Increase the IV fluid rate.
Correct Answer: C
Rationale: Variable decelerations may indicate umbilical cord compression. Repositioning the client to her left side is the first action to relieve pressure on the cord and improve fetal oxygenation. Notification, oxygen, or increased fluids are considered if decelerations persist.
The physician orders intravenous magnesium sulfate for a primigravid client at 38 weeks' gestation diagnosed with severe preeclampsia. Which of the following medications should the nurse have readily available at the client's bedside?
- A. Diazepam(Valium).
- B. Hydralazine(Apresoline).
- C. Calcium gluconate.
- D. Phenytoin(Dilantin).
Correct Answer: C
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity.
The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client panting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next?
- A. Tell the client to push between contractions.
- B. Provide gentle support to the fetal head.
- C. Apply gentle upward traction on the neonate's anterior shoulder.
- D. Massage the perineum to stretch the perineal tissues.
Correct Answer: B
Rationale: With the fetal head crowning, providing gentle support prevents rapid expulsion and perineal trauma. Pushing between contractions is incorrect, traction is for shoulder dystocia, and perineal massage is less urgent.
Commercial formulas contain 20 calories per ounce. A 1-day-old infant's weight in the morning was 8 lb and he was fed 45 mL at 2 a.m., 5:30 a.m., 8 a.m., 11 a.m., 2 p.m., 4:30 p.m., 8 p.m., and 10:30 p.m. What is the total amount of calories the infant received today?
- A. calories.
Correct Answer: B
Rationale: The infant was fed 45 mL 8 times, totaling 360 mL. Since 1 oz ≈ 30 mL, 360 mL ÷ 30 mL/oz = 12 oz. At 20 calories per ounce, 12 oz × 20 cal/oz = 240 calories.