Relaxin is a hormone that is released throughout a woman's pregnancy to help prepare her uterine ligaments for the growth of her fetus and uterus. A downside to relaxin is that it may:
- A. Cause high blood pressure in some women
- B. Lead to musculoskeletal injury due to loose ligaments
- C. Make urinating more difficult than normal
- D. Increase bowel motility
Correct Answer: B
Rationale: Relaxin loosens ligaments, increasing the risk of musculoskeletal injuries during pregnancy.
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The nurse is caring for a pregnant client at 28 weeks' gestation who presents to the emergency department with signs of preeclampsia. The primary healthcare provider (PHCP) orders magnesium sulfate. What potential complication should the nurse closely monitor for during magnesium sulfate administration?
- A. Pulmonary edema
- B. Hyperglycemia
- C. Hyporeflexia
- D. Increased fetal movement
Correct Answer: C
Rationale: Hyporeflexia is a sign of magnesium toxicity, a critical complication to monitor during administration.
The nurse is teaching a class on substance use disorders. It would be correct for the nurse to characterize physical dependence as
- A. obsessive desire for the euphoric effects of a drug
- B. a need for a drug to avoid physical withdrawal symptoms
- C. severe effects that may be life-threatening
- D. unpleasant symptoms related to the absence of a drug
Correct Answer: B
Rationale: Physical dependence is defined as needing a drug to avoid withdrawal symptoms.
While preparing to change the dressing of a female patient with end-stage renal disease, the nurse notices that the patient's son is silently holding her hand and praying. Which of the following should be the nurse's initial action?
- A. Continue preparing for the procedure in the room.
- B. Notify the chaplain.
- C. Leave the room quietly and come back after 15 minutes to change the client's dressing.
- D. Ask the son if he wants the nurse to join in prayer.
Correct Answer: C
Rationale: Respecting the spiritual moment, leaving the room quietly allows privacy and maintains dignity.
The nurse observes a parent swaddling their infant with an unrepaired omphalocele. Which of the following statements would be appropriate?
- A. Stop! You will kill your baby.
- B. That is a nice, tight swaddle. It will help soothe your new baby.
- C. May I help you? We must be careful with the baby's intestines since we do not want the swaddle to push them back inside.
- D. Swaddling is not allowed for these babies; please stop.
Correct Answer: C
Rationale: This statement educates the parent gently, explaining the risk to the omphalocele without alarming them.
The nurse is screening clients at risk of sudden infant death syndrome (SIDS). The nurse correctly identifies which client is at the greatest risk for SIDS? An infant who is
- A. a preterm 4-month-old female who sleeps supine and is formula fed
- B. a preterm 12-month-old male who sleeps prone and is formula fed
- C. a term 6-month-old male who sleeps supine and is formula fed
- D. a preterm 3-month-old male who sleeps lateral and is breastfed
Correct Answer: A
Rationale: Preterm infants who are formula-fed and within the peak SIDS risk age (2-4 months) have higher risk, even if sleeping supine.
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