Nokea
An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? Select all that apply.
- A. Amenorrhea.
- B. Breast tenderness.
- C. Quickening.
- D. Frequent urination.
Correct Answer: A
Rationale: Presumptive signs of pregnancy are subjective and include amenorrhea, breast tenderness, quickening, and frequent urination. Uterine growth is a probable sign of pregnancy.
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What is the purpose of amniocentesis for a patient hospitalized at 34 weeks of gestation with pregnancy-induced hypertension?
- A. Determine if a metabolic disorder exists.
- B. Identify the sex of the fetus.
- C. Identify abnormal fetal cells.
- D. Determine fetal lung maturity.
Correct Answer: D
Rationale: At 34 weeks, amniocentesis is primarily used to assess fetal lung maturity, which is critical if early delivery is being considered.
A birthing person who delivered a newborn vaginally is receiving care in the labor and birth unit. The health-care provider diagnosed a retained placenta. What is the primary risk associated with a retained placenta?
- A. neonatal jaundice
- B. postpartum hemorrhage
- C. delayed bonding
- D. postpartum anemia
Correct Answer: B
Rationale: The primary risk associated with a retained placenta is postpartum hemorrhage. When the placenta does not deliver completely after childbirth, it can lead to excessive bleeding, risking the mother's health. This condition requires immediate medical attention to prevent severe complications. Neonatal jaundice, delayed bonding, and postpartum anemia are not directly linked to a retained placenta, making them incorrect choices. Neonatal jaundice is caused by elevated bilirubin levels, delayed bonding is related to emotional factors, and postpartum anemia is characterized by low red blood cell count, none of which are the primary risk associated with a retained placenta.
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.
What fetal change occurs when the fundal height reaches the xiphoid process?
- A. Surfactant forms in lungs
- B. Eyes begin to open and close
- C. Respiratory movements begin
- D. Spinal column is complete
Correct Answer: A
Rationale: Surfactant production begins in the lungs around this stage of pregnancy, preparing them for postnatal breathing.
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.