Nokea
Select the 5 actions the nurse should take
- A. Increase the flow rate of the maintenance IV fuid
- B. Have the charge nurse notify the provider
- C. Place the client in a Trendelenburg position
- D. Exert upward pressure on the presenting part.
- E. Attempt to push the umbilical cord back into the cervix
- F. Administer oxygen at 10 L/mm via nonrebreather face mask
Correct Answer: A,B,C,D,F
Rationale: A prolapsed umbilical cord is a life-threatening emergency requiring immediate intervention to relieve cord compression and restore fetal oxygenation. The priority actions are:
Notify the provider
Reposition the client (Trendelenburg or knee-chest)
Manually relieve pressure on the cord
Administer oxygen
Increase IV fluids for better circulation
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Which of the following is a potential barrier to patient-centered care in maternal and newborn healthcare?
- A. Lack of cultural competence
- B. Provider bias
- C. Limited resources
- D. All of the above
Correct Answer: D
Rationale: Barriers to patient-centered care include lack of cultural competence, provider bias, and limited resources.
A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take?
- A. Monitor blood glucose level every hr.
- B. Place the infant on his back with legs extended.
- C. Initiate seizure precautions.
- D. Provide a stimulating environment.
Correct Answer: C
Rationale: The correct answer is C: Initiate seizure precautions. The infant with neonatal abstinence syndrome is at risk for seizures due to drug withdrawal. By initiating seizure precautions, the nurse can ensure the safety of the infant by implementing measures such as padding the crib, having emergency medications readily available, and closely monitoring for any signs of seizure activity.
Choice A is incorrect because monitoring blood glucose levels every hour is not typically indicated for neonatal abstinence syndrome. Choice B is incorrect as placing the infant on his back with legs extended does not address the risk of seizures. Choice D is incorrect as providing a stimulating environment can exacerbate the symptoms of withdrawal.
A nurse is collecting data from a client who is at 30 weeks of gestation. Which of the following findings should the nurse identify as a manifestation of pyelonephritis?
- A. Epigastric discomfort
- B. Flank pain
- C. Temperature 37.7°C (99.8°F)
- D. Abdominal cramping
Correct Answer: B
Rationale: The correct answer is B: Flank pain. Pyelonephritis is an infection of the kidneys, which commonly presents with symptoms like flank pain. This pain is typically described as a dull ache in the lower back or sides. Other options are incorrect because: A) Epigastric discomfort is more indicative of gastrointestinal issues; C) A temperature of 37.7°C (99.8°F) is within normal range and not specific to pyelonephritis; D) Abdominal cramping is more likely related to gastrointestinal or uterine issues in pregnancy.
Which of the following is a potential complication of a vaginal birth after cesarean (VBAC)?
- A. Uterine rupture
- B. Postpartum hemorrhage
- C. Maternal infection
- D. All of the above
Correct Answer: A
Rationale: Uterine rupture is a potential complication of VBAC.
Which of the following is a potential complication of a postpartum hemorrhage?
- A. Disseminated intravascular coagulation (DIC)
- B. Anemia
- C. Hyperglycemia
- D. All of the above
Correct Answer: A
Rationale: Postpartum hemorrhage can lead to disseminated intravascular coagulation (DIC), a serious condition where blood clotting is disrupted.