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During a vaginal exam on a client in labor who reports severe pressure and pain in the lower back, a nurse notes that the fetal head is in a posterior position. Which of the following is the best nonpharmacological intervention for the nurse to perform to relieve the client's discomfort?
- A. Back rub
- B. Counter-pressure
- C. Playing music
- D. Foot massage
Correct Answer: B
Rationale: The correct answer, B: Counter-pressure, is the best nonpharmacological intervention for a client with a posterior fetal head position causing lower back pain. Counter-pressure applied to the sacrum can help alleviate discomfort by reducing pressure on the lower back and providing support during contractions. This technique can aid in rotating the baby's head to a more optimal position for delivery.
Choice A: Back rub, may offer some comfort but may not specifically address the issue of lower back pain caused by the fetal position. Choice C: Playing music, and Choice D: Foot massage, are unlikely to provide direct relief for the client's specific discomfort related to the baby's posterior position.
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When teaching a new mother how to use a bulb syringe to suction her newborn's secretions, which of the following instructions should the nurse include?
- A. Insert the syringe tip after compressing the bulb.
- B. Suction each nare before suctioning the mouth.
- C. Insert the tip of the syringe at the center of the newborn's mouth.
- D. Stop suctioning when the newborn's cry sounds clear.
Correct Answer: D
Rationale: The correct answer is D because it is important to stop suctioning when the newborn's cry sounds clear to avoid causing unnecessary discomfort or injury. Step 1: Gently compress the bulb syringe. Step 2: Insert the tip into the nostril, not the mouth. Step 3: Release the bulb to suction out the secretions. Step 4: Repeat in the other nostril. Incorrect choices: A is incorrect because you should insert the syringe tip before compressing the bulb. B is incorrect as you should suction the mouth before the nose. C is incorrect as you should not insert the syringe tip in the center of the mouth.
Which of the following medications should the provider prescribe for a client with gonorrhea?
- A. Ceftriaxone
- B. Fluconazole
- C. Metronidazole
- D. Zidovudine
Correct Answer: A
Rationale: The correct answer is A: Ceftriaxone. It is the recommended first-line treatment for gonorrhea due to increasing resistance to other antibiotics. Ceftriaxone is a third-generation cephalosporin that effectively treats gonorrhea. Fluconazole (B) is used for fungal infections, not bacterial. Metronidazole (C) is used for anaerobic bacterial infections like bacterial vaginosis, not gonorrhea. Zidovudine (D) is used to treat HIV, not gonorrhea. Therefore, A is the correct choice for treating gonorrhea effectively.
A healthcare professional is preparing to administer magnesium sulfate 2 g/hr IV to a client who is in preterm labor. Available is 20 g of magnesium sulfate in 500 mL of dextrose 5% in water (D5W). How many mL/hr should the IV infusion pump be set to administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
- A. 60
- B. 30
- C. 50
- D. 80
Correct Answer: C
Rationale: To calculate the mL/hr for the IV infusion pump, we need to use the formula: (Desired dose in mg/hr * Volume of solution in mL) / Concentration of solution in mg/mL.
Given:
Desired dose = 2 g/hr = 2000 mg/hr
Volume of solution = 500 mL
Concentration of solution = 20 g in 500 mL = 20,000 mg in 500 mL = 40 mg/mL
Now, plug these values into the formula:
(2000 mg/hr * 500 mL) / 40 mg/mL = 25,000 mL/hr
Round this to the nearest whole number, which is 25,000 mL/hr ≈ 50 mL/hr. Therefore, the IV infusion pump should be set to administer 50 mL/hr, making choice C the correct answer.
Option A (60 mL/hr) and Option D (80 mL/hr) are incorrect as they do not match the calculated value. Option
A client is in labor, and a nurse observes late decelerations on the electronic fetal monitor. What should the nurse identify as the first action that the registered nurse should take?
- A. Assist the client into the left-lateral position
- B. Apply a fetal scalp electrode
- C. Insert an IV catheter
- D. Perform a vaginal exam
Correct Answer: A
Rationale: The correct answer is A: Assist the client into the left-lateral position. This is the first action because it helps improve placental perfusion, which can alleviate late decelerations associated with uteroplacental insufficiency. The left-lateral position promotes optimal blood flow and oxygenation to the placenta by reducing pressure on the vena cava and improving maternal perfusion. This position can potentially prevent further fetal distress.
Summary of other choices:
B: Applying a fetal scalp electrode is not the first action for addressing late decelerations. It may be considered later for more precise monitoring.
C: Inserting an IV catheter is important but not the priority when late decelerations are observed.
D: Performing a vaginal exam is not indicated as the first action for addressing late decelerations and could potentially increase the risk of infection.
A healthcare professional is assisting with the care for a client who is experiencing a ruptured ectopic pregnancy. Which of the following findings is expected with this condition?
- A. No alteration in menses
- B. Transvaginal ultrasound indicating a fetus in the uterus
- C. Blood progesterone greater than the expected reference range
- D. Report of severe shoulder pain
Correct Answer: D
Rationale: The correct answer is D: Report of severe shoulder pain. In a ruptured ectopic pregnancy, the fertilized egg implants outside the uterus, usually in the fallopian tube. As the tube ruptures, there is internal bleeding which can irritate the diaphragm, causing referred pain to the shoulder. This phenomenon is known as Kehr's sign. The other choices are incorrect because with a ruptured ectopic pregnancy, there would typically be altered menses due to the pregnancy disruption, a transvaginal ultrasound would not show a fetus in the uterus, and blood progesterone levels would not be elevated.