Nokea
The nurse is caring for a client at 34 weeks' gestation with suspected preterm labor. What is the priority nursing action?
- A. Administer corticosteroids as prescribed.
- B. Encourage ambulation to relieve contractions.
- C. Provide the client with a high-protein snack.
- D. Monitor maternal blood pressure.
Correct Answer: A
Rationale: The correct answer is A: Administer corticosteroids as prescribed. Administering corticosteroids helps accelerate fetal lung maturity and reduce the risk of respiratory distress syndrome in preterm infants. It is the priority action in suspected preterm labor at 34 weeks' gestation.
Explanation for why other choices are incorrect:
B: Encouraging ambulation may not be safe in preterm labor as it can increase the risk of delivering the baby prematurely.
C: Providing a high-protein snack is not the priority action in suspected preterm labor.
D: Monitoring maternal blood pressure is important, but not the priority in this situation where the focus is on preventing complications for the preterm infant.
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A nurse is caring for a client who is in the transition phase of labor. Which of the following...
- A. Assist the client to void every 3 hr.
- B. Monitor contractions every 30 min.
- C. Place the client into a lithotomy position.
- D. Encourage the client to use a pant-blow breathing pattern.
Correct Answer: B
Rationale: The correct answer is B: Monitor contractions every 30 min. During the transition phase of labor, contractions are typically intense and frequent. Monitoring contractions every 30 minutes allows the nurse to assess the progress of labor and ensure the safety of both the mother and the baby. This helps in identifying any abnormalities or complications that may arise during this critical stage.
A: Assisting the client to void every 3 hr is important, but it is not specific to the transition phase of labor.
C: Placing the client into a lithotomy position is not recommended during the transition phase as it can restrict blood flow and increase the risk of complications.
D: Encouraging the client to use a pant-blow breathing pattern is a relaxation technique more suited for the earlier stages of labor, not the transition phase.
A 28-year-old primigravida admitted to antepartum unit with a diagnosis of hyperemesis gravidarum. Nursing care is based on which of the following?
- A. Assess for dehydration and starvation
- B. Isolated from family
- C. This condition is caused by psychogenic factor
- D. Similar to morning sickness
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Assessing for dehydration and starvation is crucial in managing hyperemesis gravidarum, as it can lead to serious complications for both the mother and the fetus. Dehydration can result from persistent vomiting and may require intravenous fluids. Starvation can occur due to poor nutrient intake. Monitoring these factors helps in providing appropriate treatment and preventing further health issues.
Summary of Incorrect Choices:
B: Isolating the patient from family is not necessary and can have negative psychological impacts. Support from family is crucial in managing hyperemesis gravidarum.
C: Hyperemesis gravidarum is a physical condition related to pregnancy, not a psychogenic factor.
D: Hyperemesis gravidarum is more severe and persistent than morning sickness, requiring different management strategies.
Upon delivery of the newborn, the nursing intervention that most promotes parental attachment is:
- A. Placing the infant under the radiant warmer
- B. Allowing the mother to rest immediately after delivery
- C. Placing the newborn on mother's chest and abdomen
- D. Taking the newborn to the nursery for the initial assessment
Correct Answer: C
Rationale: The correct answer is C: Placing the newborn on mother's chest and abdomen. This promotes parental attachment through skin-to-skin contact, facilitating bonding and emotional connection. It also helps regulate the baby's temperature and encourage breastfeeding. Placing the infant under the radiant warmer (A) may disrupt immediate bonding. Allowing the mother to rest (B) is important, but promoting attachment should be prioritized. Taking the newborn to the nursery (D) can delay the crucial bonding process.
Why was the Bradley Method originally introduced?
- A. as a novel approach to pregnancy where low-intervention, medication-free births were the goal
- B. as an education program that supported use of twilight birth
- C. as a system of supporting families wanting community birth
- D. as a program of education that focused on the importance of using a doula instead of a partner as a birth support
Correct Answer: A
Rationale: The correct answer is A: as a novel approach to pregnancy where low-intervention, medication-free births were the goal. The Bradley Method was introduced in the late 1940s by Dr. Robert Bradley with the aim of empowering women to have natural childbirth experiences without unnecessary medical interventions. This method promotes education and preparation for childbirth, emphasizing relaxation techniques, partner involvement, and natural pain management strategies. The other choices, B, C, and D, are incorrect because they do not align with the fundamental principles of the Bradley Method, which focuses on promoting low-intervention, medication-free births through education and empowerment of expectant parents.
Alaska Natives experience higher levels of violence, poverty, and drug and alcohol use, and fewer resources. How can the nurse help these patients?
- A. Tell the patient to stop using substances.
- B. Provide resources that are specific for this population.
- C. Tell the patient to call the police.
- D. Report the abuse to the social worker.
Correct Answer: B
Rationale: The correct answer is B because providing resources specific to Alaska Natives addresses the unique challenges they face. This can include culturally sensitive support services, mental health resources, and community programs. Choice A is incorrect as simply telling the patient to stop using substances is not addressing the underlying issues. Choice C is inappropriate as telling the patient to call the police may not be safe or effective in all situations. Choice D is also incorrect as reporting abuse to a social worker may be necessary but does not directly address the patient's immediate needs for support and resources.