Nokea
Which assessment finding suggests that the laboring client's
- B. Reflex grade 0
- C. Urine output 60
- D. Generalized seizure
Correct Answer: D
Rationale: The correct answer is D, Generalized seizure. During labor, a generalized seizure is a critical finding that indicates eclampsia, a severe complication of pregnancy characterized by seizures, hypertension, and proteinuria. This requires immediate medical intervention to prevent harm to the mother and baby. Reflex grade 0 (choice B) is not a typical assessment finding during labor, and it does not indicate any immediate life-threatening condition. Urine output of 60 (choice C) is within the normal range and does not suggest any immediate critical issue. Therefore, choice D is the correct answer due to the urgency and severity of the condition it represents.
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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.
Nutrition is an integral part of the Bradley Method. What important nutrition advice is taught in this method?
- A. Only eat low-fat foods.
- B. Increase protein to 100 g per day.
- C. Do not eat dairy because it causes food allergies.
- D. Eat a low-protein diet.
Correct Answer: B
Rationale: The correct answer is B because the Bradley Method emphasizes the importance of increasing protein intake to support a healthy pregnancy. Protein is essential for fetal development and maternal health. It is recommended to consume around 100g of protein per day during pregnancy. Adequate protein intake helps in the growth of the baby and helps to maintain the health of the mother.
Explanation of why the other choices are incorrect:
A: Only eat low-fat foods - This is incorrect as fat is also important for a healthy pregnancy and should not be eliminated entirely.
C: Do not eat dairy because it causes food allergies - Dairy is a good source of calcium and other essential nutrients during pregnancy, so this advice is not recommended.
D: Eat a low-protein diet - This is incorrect as protein is crucial for the development of the baby and overall health during pregnancy.
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.
After several hours of labor, the fetal heart monitor shows
- A. The nurse would interpret this deceleration to be consistent with which presentation?
- B. Umbilical cord compression
- C. Uteroplacental insufficiency
- D. Compression of fetal head
Correct Answer: B
Rationale: The correct answer is B: Umbilical cord compression. When the fetal heart monitor shows deceleration after several hours of labor, it indicates reduced oxygen supply to the fetus. Umbilical cord compression can restrict blood flow and oxygen delivery to the fetus, leading to decelerations. This is a common cause during labor. Choices A, C, and D do not directly relate to the decreased oxygen supply indicated by decelerations on the fetal heart monitor.
Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include which of the following? (Select all that apply.)
- A. Continuing to deny the pregnancy
- B. Uncertainty about where to go for care
- C. Lack of realization that they are pregnant
- D. A desire to gain control over their situation
Correct Answer: A
Rationale: The correct answer is A: Continuing to deny the pregnancy. This is because some teens may struggle to come to terms with their pregnancy and deny it, leading to delays in seeking prenatal care. The other choices are incorrect. B: Uncertainty about where to go for care is not a common reason for delaying prenatal care as resources and information are usually available. C: Lack of realization that they are pregnant is unlikely as most teens eventually become aware of their pregnancy. D: A desire to gain control over their situation does not usually lead to delaying prenatal care as seeking care is a proactive step towards gaining control.