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How should a nurse handle a newborn with meconium-stained amniotic fluid?
- A. Suction the airway immediately after birth
- B. Monitor for signs of aspiration
- C. Encourage immediate skin-to-skin contact
- D. Administer antibiotics to the newborn immediately
Correct Answer: A
Rationale: Suctioning the airway immediately reduces the risk of aspiration and respiratory complications.
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The nurse is assessing a client at 36 weeks' gestation who reports swelling in the hands and face. What is the priority nursing action?
- A. Check the client’s blood pressure.
- B. Reassure the client that swelling is normal.
- C. Encourage the client to reduce salt intake.
- D. Evaluate the fetal heart rate.
Correct Answer: A
Rationale: Swelling in the hands and face may indicate preeclampsia, requiring immediate blood pressure assessment.
Which circumstance is most likely to cause uterine partum assessment with a woman who is 4 days atony and lead to excessive blood loss?
- A. Orthostatic hypotension
- B. Involution of the uterus
- C. Urine retention
- D. Afterpains
Correct Answer: A
Rationale: Orthostatic hypotension, which is a sudden drop in blood pressure upon standing, can result in decreased perfusion to the uterus, leading to poor contraction of the uterine muscles. This can result in uterine atony, where the uterus fails to contract properly after delivery. Uterine atony is a common cause of excessive postpartum bleeding (postpartum hemorrhage). Without proper contraction of the uterus, the blood vessels that supplied the placenta during pregnancy remain open and bleeding can continue unchecked.
The nurse is planning to admit a pregnant client who is obese. Which potential client needs should the nurse anticipate?
- A. Routine administration of subcutaneous heparin may be prescribed.
- B. Bed rest as a necessary preventive measure may be prescribed.
- C. An overbed lift may be necessary if the client requires a cesarean section.
- D. Thromboembolism stockings or sequential compression devices may be prescribed.
Correct Answer: D
Rationale: Obese clients may need thromboembolism prevention and specialized equipment for safe cesarean handling.
The nurse is monitoring a pregnant client with gestational hypertension. What is the primary complication to prevent?
- A. Preterm labor.
- B. Placenta previa.
- C. Eclampsia.
- D. Abruptio placentae.
Correct Answer: C
Rationale: Gestational hypertension can progress to eclampsia, characterized by seizures, and requires close monitoring.
Positive signs of pregnancy
- A. FHR detected by electronic doppler @10-12 wks
- B. Active fetal movements palpable by examiner
- C. Outline of fetus by radiography or ultrasound
Correct Answer: B
Rationale: One of the positive signs of pregnancy is the active fetal movements palpable by the examiner. This occurs when the examiner is able to feel the movements of the fetus inside the uterus. This sign usually becomes noticeable in the second half of pregnancy and is a clear indication that the pregnancy is progressing normally. It is a reassuring sign for both the pregnant individual and the healthcare provider that the fetus is active and healthy.