Nokea
Relaxation of muscles in labor provides many benefits. What is one benefit of this technique in labor?
- A. Relaxation will prevent a cesarean section.
- B. Relaxation of the pelvic floor helps in pushing the fetus in the second stage.
- C. Relaxation of the abdomen ensures an unmedicated birth.
- D. Relaxation causes the contractions to decrease in strength.
Correct Answer: B
Rationale: Relaxing the pelvic floor facilitates smoother fetal descent during the second stage of labor.
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The nurse is monitoring a client in labor. What finding indicates the transition phase?
- A. Cervix dilated to 4 cm.
- B. Cervix dilated to 8 cm.
- C. Irregular contractions.
- D. Client reports feeling the urge to push.
Correct Answer: B
Rationale: The transition phase is marked by cervical dilation of 8–10 cm, intense contractions, and significant discomfort.
The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which medical treatment would the nurse ensure that an informed consent is completed beyond the one signed at admission?
- A. Diagnostic imaging
- B. Cardiac monitoring
- C. Blood testing
- D. Spinal tap
Correct Answer: D
Rationale: Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; photography involving children; and applying restraints to children.
Which assessment finding indicates a complication in a client attempting a VBAC?
- A. Complaint of pain between the scapula (could be uterine
- C. Contraction every 3 minutes lasting 70 seconds
- D. Pain level 6 at acme of
Correct Answer: C
Rationale: A client attempting a Vaginal Birth After Cesarean (VBAC) is at higher risk for uterine rupture. A concerning assessment finding in this scenario would be the occurrence of contractions every 3 minutes that are lasting 70 seconds. This pattern of contractions could potentially indicate uterine hyperstimulation, which increases the risk of uterine rupture. It is essential to closely monitor these contractions and address any signs of distress or complications promptly to ensure the safety of both the mother and the baby.
A nurse is caring for a client following an amniocentesis. The nurse should observe the client for which of the following complications?
- A. Hyperemesis
- B. Proteinuria
- C. Hypoxia
- D. Hemorrhage
Correct Answer: D
Rationale: Following an amniocentesis, the nurse should observe the client for the potential complication of hemorrhage. Amniocentesis is a procedure where a small amount of amniotic fluid is extracted from the amniotic sac surrounding the fetus for various diagnostic purposes. The risk of hemorrhage is associated with this invasive procedure due to the possibility of damaging blood vessels within the uterus during the insertion of the needle. It is important for the nurse to closely monitor the client for any signs of bleeding, such as vaginal bleeding, abdominal pain, or signs of shock, and report any concerns promptly to the healthcare provider for further evaluation and management.
Which aspect of client wellness has not been a focus of health during the 21st century ?
- A. Disease prevention
- B. Health promotion
- C. Wellness
- D. Analysis of morbidity and mortality
Correct Answer: D
Rationale: The focus on health has shifted to disease prevention, health promotion, and wellness. In the last century, much of the focus was on analyzing morbidity and mortality rates.