Nokea
During a scheduled cesarean delivery of a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean delivery tend to have an increased incidence of which of the following?
- A. Congenital anomalies.
- B. Pulmonary hypertension.
- C. Meconium aspiration syndrome.
- D. Respiratory distress syndrome.
Correct Answer: D
Rationale: Cesarean delivery, especially without labor, increases the risk of respiratory distress syndrome due to retained lung fluid. Breech presentation may exacerbate this. Congenital anomalies, pulmonary hypertension, and meconium aspiration are less directly related.
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The nurse is evaluating the client who delivered vaginally 2 hours ago and is experiencing postpartum pain rated 8 on scale of 1 to 10. The client is a G 4, P 4, breast-feeding mother who would like medication to decrease the pain in her uterus. Which of the medications listed on the orders sheet would be the most appropriate for this client?
- A. Aspirin 1,000 mg P.O. q 4 to 6 hour p.r.n.
- B. Ibuprofen 800 mg P.O. q 6 to 8 hour p.r.n.
- C. Colace 100 mg P.O. b.i.d.
- D. Vicodin 1 to 2 tabs P.O. q 4 to 6 hour p.r.n.
Correct Answer: B
Rationale: Ibuprofen is safe for breastfeeding mothers and effective for uterine cramping pain, unlike aspirin (risk of bleeding), Colace (stool softener), or Vicodin (opioid, less preferred due to sedation risks).
A primigravid client's baseline blood pressure at her initial visit at 12 weeks' gestation was 110/70 mm Hg. During an assessment at 38 weeks' gestation, which of the following data would indicate mild preeclampsia?
- A. Blood pressure of 160/110 mm Hg on two separate occasions.
- B. Proteinuria, more than 5 g in 24 hours.
- C. Serum creatinine concentration of 1.4 mL/dL.
- D. Weight gain of 2 lb in the last week.
Correct Answer: D
Rationale: Sudden weight gain is characteristic of mild preeclampsia.
A client visits the clinic seeking a prescription for oral contraceptives. Which of the following would alert the nurse to further assess the client before the contraceptives are prescribed?
- A. The client has a history of fibrocystic breast disease.
- B. The client has a family history of ovarian cancer.
- C. The client is a smoker and 37 years old.
- D. The client experienced irregular menstrual cycles as an adolescent.
Correct Answer: C
Rationale: Smoking at age 37 is a significant risk factor for cardiovascular complications with combined oral contraceptives, requiring further assessment. Fibrocystic breast disease and irregular cycles are not contraindications, and family history of ovarian cancer is less relevant.
A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which of the following instructions should the nurse give the client?
- A. Avoid folic acid supplements to prevent megaloblastic anemia.
- B. Severely restrict sodium intake throughout the pregnancy.
- C. Take iron supplements with milk to enhance absorption.
- D. Increase caloric intake to 2,200 calories daily to promote fetal growth.
Correct Answer: D
Rationale: Increased caloric intake supports fetal growth without compromising maternal health.
A client asks about the risks of the hormonal IUD. Which of the following would the nurse include?
- A. Increased risk of breast cancer.
- B. Irregular bleeding, especially initially.
- C. Permanent infertility.
- D. Guaranteed regular menstrual cycles.
Correct Answer: B
Rationale: The hormonal IUD may cause irregular bleeding, especially initially, which often decreases over time. It does not increase breast cancer risk, cause permanent infertility, or guarantee regular cycles.