Nokea
The client is diagnosed with pregnancy-related diabetes at 28 weeks’ gestation. In teaching the client, the nurse includes which information for managing her blood glucose levels? Select all that apply.
- A. Drawing glycosylated hemoglobin A1c levels
- B. Performing home blood glucose monitoring
- C. Developing a weight management plan
- D. Engaging in appropriate daily exercise
- E. Taking oral diabetic agents in the am.
Correct Answer: A,B,C,D
Rationale: Hgb A1c will be drawn and monitored throughout the pregnancy, with a goal of reaching a level of less than 7%. Home blood glucose monitoring will help the client identify when her blood glucose is outside normal parameters. Excessive weight gain worsens control of glucose levels. Exercise adapted for the pregnant body is important to glucose control. Oral diabetic agents are contraindicated in pregnant clients.
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The nurse is caring for the client who is Rh negative at 13 weeks’ gestation. The client is having cramping and has moderate vaginal bleeding. Which HCP order should the nurse question?
- A. Administer Rho(D) immune globulin (RhoGAM).
- B. Obtain a beta human chorionic gonadotropin level (BHCG).
- C. Schedule for an immediate ultrasound.
- D. Place on continuous external fetal monitoring.
Correct Answer: B
Rationale: Obtaining the BHCG level is not indicated at 13 weeks’ gestation. BHCG levels are followed in early pregnancy before a fetal heartbeat can be confirmed. RhoGAM is indicated for any pregnant client with bleeding who is Rh negative. An ultrasound can identify the cause of bleeding and confirm fetal viability. Continuous external fetal monitoring can be used to confirm a fetal heartbeat, fetal viability, and fetal risk.
The client, who had a vaginal delivery 18 hours ago, asks the nurse how she should take care of her perineal laceration. Which statements by the nurse are appropriate? Select all that apply.
- A. “You should change your peripad at least twice each day.”
- B. “Once home, use a warm sitz bath to sooth your perineum.”
- C. “Keep your perineum warm and dry until stitches are removed.”
- D. “Use your peri-bottle to apply water to the perineum after each void.”
- E. “Wash your perineum with mild soap at least once each 24 hours.”
- F. “Check your perineum for foul odor or increased redness, heat, or pain.”
Correct Answer: B,D,E,F
Rationale: The peripad should be changed more frequently to reduce the risk of infection. Lochia amount should never exceed a moderate amount (less than a 6-inch stain on a perineal pad). A warm sitz bath is used after the first 24 hours to provide comfort, increase circulation to the area, and reduce the incidence of infection. Perineal lacerations are repaired with sutures that dissolve. Clients do not need to have perineal sutures removed. Cleansing the perineum after each void with the peri-bottle of water provides comfort and helps reduce the chance of infection. Washing with mild soap and rinsing with water each 24 hours reduces the risk of infection. Teaching the client to watch for signs and symptoms of infection is important and allows the client to be an active participant in her care.
The nurse uses which tool to measure fundal height?
- A. Tape measure
- B. Doppler device
- C. Ultrasound machine
- D. Blood pressure cuff
Correct Answer: A
Rationale: A tape measure is used to measure fundal height, assessing uterine growth and fetal development.
The delivery nurse is reporting to the postpartum nurse about the client who just delivered her first baby, a term newborn. Which number should the delivery nurse report for the client’s parity?
Correct Answer: 1
Rationale: The client has given birth to her first child; her parity is 1.
Multiple women are being seen in a clinic for various conditions. From which clients should the nurse prepare to obtain a group beta streptococcus (GBS) culture? Select all that apply.
- A. The client who is having symptoms of preterm labor
- B. The women who had a neonatal death 1 year ago
- C. All pregnant women coming to the clinic for care
- D. The women who had a spontaneous abortion 1 week ago
- E. The women who had an abortion for an unwanted pregnancy
Correct Answer: A,C
Rationale: The client in preterm labor should be screened for GBS infection. Between 10% and 30% of all women are colonized for GBS. All pregnant women, regardless of risk status, should be screened for GBS infection. Between 10% and 30% of all women are colonized for GBS. There is no indication that the client with a previous neonatal death is pregnant. The client would not be screened for GBS solely because of a history of spontaneous abortion. The client would not be screened for GBS solely because of an elective abortion.