Nokea
A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. Which of the following vessels should the nurse expect to observe in the umbilical cord?
- A. Two veins and one artery
- B. One artery and one vein
- C. Two arteries and one veins
Correct Answer: C
Rationale: The correct answer is C: Two arteries and one vein. The umbilical cord typically contains two arteries (carrying deoxygenated blood from the fetus to the placenta) and one vein (carrying oxygenated blood from the placenta to the fetus). This is known as the "AVA" pattern. This configuration is essential for fetal circulation and oxygenation. Option A is incorrect as it has two veins and one artery, which is not the norm. Option B is also incorrect as it has one artery and one vein, missing one artery. Option D is incomplete, so it is also incorrect. Ultimately, the presence of two arteries and one vein in the umbilical cord is the correct and expected vascular arrangement for fetal circulation.
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The nurse is preparing a client for induction of labor. What is the purpose of administering oxytocin?
- A. Stimulate uterine contractions.
- B. Relieve pain during labor.
- C. Promote cervical ripening.
- D. Reduce maternal blood pressure.
Correct Answer: A
Rationale: The correct answer is A: Stimulate uterine contractions. Oxytocin is administered to induce labor by increasing the frequency and strength of uterine contractions. This helps progress labor and facilitate delivery. Choice B is incorrect as pain relief is usually achieved through analgesics or anesthesia. Choice C is incorrect because cervical ripening is typically promoted with medications like prostaglandins. Choice D is also incorrect as oxytocin can actually cause a temporary increase in blood pressure.
The nurse is aware that a pre-term neonate may have a potential nutritional problem because of:
- A. Poor sucking reflex
- B. A decreased metabolic rate
- C. Decreased caloric requirement
- D. Increased absorption of nutrients
Correct Answer: A
Rationale: The correct answer is A: Poor sucking reflex. Pre-term neonates often have immature sucking reflexes, which can lead to difficulty in feeding and obtaining adequate nutrition. This can result in a potential nutritional problem. Option B is incorrect because pre-term neonates actually have an increased metabolic rate to support their growth and development. Option C is incorrect as pre-term neonates have increased caloric requirements due to their rapid growth. Option D is incorrect as pre-term neonates typically have decreased absorption of nutrients due to an immature gastrointestinal system.
The nurse is teaching a client about morning sickness. What recommendation should the nurse provide?
- A. Eat large meals three times a day.
- B. Drink fluids with meals.
- C. Consume dry crackers before getting out of bed.
- D. Avoid eating before bedtime.
Correct Answer: C
Rationale: The correct answer is C: Consume dry crackers before getting out of bed. This recommendation helps alleviate morning sickness by providing a bland and easily digestible snack to settle the stomach before getting up. By consuming dry crackers, the client can avoid an empty stomach, which can contribute to nausea. Eating large meals three times a day (A) can worsen morning sickness due to heavy digestion, while drinking fluids with meals (B) may exacerbate nausea. Avoiding eating before bedtime (D) is generally recommended, but it does not specifically address morning sickness.
The nurse is educating an adolescent patient about Depo-Provera. Which statement should be included in this teaching session?
- A. You only need to come in every 5 months to get each injection.
- B. You may lose weight on this medication, so make sure to maintain a well-balanced diet.
- C. You may experience heavy bleeding or spotting monthly or none at all.
- D. You will not be able to start this medication until you have been pregnant at least once.
Correct Answer: C
Rationale: Correct Answer: C
Rationale:
1. Choice C is correct because it accurately informs the adolescent about the potential side effects of Depo-Provera, which include irregular bleeding patterns such as heavy bleeding or spotting, or even the absence of periods.
2. This information is crucial for the patient's understanding and preparedness while using the medication.
3. Choices A, B, and D are incorrect because:
- Choice A is inaccurate as Depo-Provera injections are typically required every 3 months, not 5 months.
- Choice B is irrelevant to Depo-Provera as weight changes are not a common side effect of this medication.
- Choice D is false as pregnancy history does not determine eligibility for Depo-Provera use.
A nurse is completing a health history for a client who is at 6-week gestation. The client informs the nurse that she smokes one park of cigarettes per day. The nurse should advise the client that smoking places the client9s newborn at risk for what complication?
- A. Hearing loss
- B. Intrauterine growth restriction
- C. Type 1 diabetes mellitus
- D. Congenital heart defects
Correct Answer: B
Rationale: The correct answer is B: Intrauterine growth restriction (IUGR). Smoking during pregnancy can restrict blood flow to the fetus, leading to inadequate oxygen and nutrients, resulting in IUGR. This can lead to low birth weight and potential health complications for the newborn. Hearing loss (A) is not directly associated with smoking during pregnancy. Type 1 diabetes mellitus (C) is an autoimmune condition not caused by maternal smoking. Congenital heart defects (D) can be a risk with smoking during pregnancy, but the most direct risk is IUGR.