Nokea
The midwife has just palpated the fundal height at the location noted on the picture below. It is likely that the client is how many weeks pregnant?
- A. 12
- B. 20
- C. 28
- D. 36
Correct Answer: B
Rationale: At 20 weeks, the fundal height is typically at the level of the umbilicus, which is consistent with the description provided.
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A patient at 36 weeks gestation is undergoing a nonstress test (NST). The nurse observes the fetal heart rate baseline at 135 bpm and four nonepisodic patterns of the fetal heart rate reaching 160 bpm for 20-25 seconds each. How will the nurse record these findings?
- A. NST positive, nonreassuring
- B. NST negative, reassuring
- C. NST reactive, reassuring
- D. NST nonreactive, nonreassuring
Correct Answer: C
Rationale: An NST is reactive and reassuring when two or more accelerations occur within 20 minutes, indicating fetal well-being.
A nurse is caring for a postpartum person with a second-degree perineal tear. What is the most appropriate intervention for pain management?
- A. administer oral pain medication
- B. administer an epidural analgesic
- C. administer non-pharmacological pain relief
- D. administer ice packs
Correct Answer: C
Rationale: The most appropriate intervention for pain management in a postpartum person with a second-degree perineal tear is administering non-pharmacological pain relief (Choice C). This includes methods such as sitz baths, warm compresses, and positioning techniques. These interventions are effective in reducing pain and promoting healing without the side effects associated with medications or invasive procedures. Oral pain medication (Choice A) may not be sufficient for managing the specific pain in this case. Administering an epidural analgesic (Choice B) is not appropriate postpartum, as it is typically used during labor for pain relief. Ice packs (Choice D) may provide temporary relief but do not address the underlying pain and healing process as effectively as non-pharmacological methods.
In preparing a pregnant patient for a nonstress test (NST), which of the following should be included in the plan of care?
- A. Have the patient void prior to being placed on the fetal monitor because a full bladder will interfere with results.
- B. Maintain NPO status prior to testing.
- C. Position the patient for comfort, adjusting the tocotransducer belt to locate fetal heart rate.
- D. Have an infusion pump prepared with oxytocin per protocol for evaluation.
Correct Answer: C
Rationale: The patient should be positioned comfortably, and the tocotransducer should be adjusted to obtain an accurate fetal heart rate reading.
During a preconception counseling session, the nurse encourages a couple to prepare a birth plan.
- A. Promote communication between the couple and health care professionals.
- B. Enable the couple to learn about the types of pain medicine used in labor.
- C. Provide the couple with a list of items that they should take to the hospital for the labor and delivery.
- D. Give the high-risk couple a sense of control over the likelihood of having a surgical delivery.
Correct Answer: A
Rationale: A birth plan fosters open communication between the couple and healthcare providers, ensuring that expectations and preferences are understood.
A client enters the prenatal clinic. She states that she missed her period yesterday and used a home pregnancy test this morning. She states that the results were negative, but 'I still think I am pregnant.' Which of the following statements would be appropriate for the nurse to make at this time?
- A. Your period is probably just irregular.
- B. We could do a blood test to check.
- C. Home pregnancy test results are very accurate.
- D. My recommendation would be to repeat the test in one week.
Correct Answer: B
Rationale: A blood test is more accurate than a home pregnancy test, especially early in pregnancy. Repeating the test in a week is also an option, but a blood test provides more immediate and reliable results.