Nokea
The nurse correctly informs the participants that women who smoke during pregnancy have a greater risk of which problem?
- A. Having a premature delivery
- B. Having a cesarean birth
- C. Having a large, overweight baby
- D. Developing a prenatal infection
Correct Answer: A
Rationale: Smoking during pregnancy increases the risk of premature delivery due to reduced oxygen and nutrient delivery to the fetus.
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The pregnant client asks the nurse, who is teaching a prepared childbirth class, when she should expect to feel fetal movement. The nurse responds that fetal movement usually can first be felt during which time frame?
- A. 8 to 12 weeks of pregnancy
- B. 12 to 16 weeks of pregnancy
- C. 18 to 20 weeks of pregnancy
- D. 22 to 26 weeks of pregnancy
Correct Answer: C
Rationale: Subtle fetal movement (quickening) can be felt as early as 18 to 20 weeks of gestation, and it gradually increases in intensity. Eight to 12 weeks of pregnancy is too early to expect the first fetal movement to be felt. Twelve to 16 weeks of pregnancy is too early to expect the first fetal movement to be felt. Twenty-two to 26 weeks of pregnancy is later than expected to feel the first fetal movement.
While assessing the postpartum client who is 10 hours post—vaginal delivery, the nurse notes a perineal pad that is totally saturated. To determine the significance of this finding, which question should the nurse ask the client first?
- A. “How often are you experiencing uterine cramping?”
- B. “When was the last time you changed your peri-pad?”
- C. “Are you having any bladder urgency or frequency?”
- D. “Did you pass clots that required changing your peri-pad?”
Correct Answer: B
Rationale: Once the nurse has determined the length of time the pad has been in place, the nurse could decide if asking about uterine cramping is appropriate. The amount of lochia on a perineal pad is influenced by the individual client’s pad changing practices. Thus, the nurse should ask about the length of time the current pad has been in place before making a judgment about whether the amount is concerning. Although bladder incontinence could cause pad saturation, it is more important to ask about the length of time the pad has been in place. Based on the client’s answer, the nurse could decide if asking about bladder urgency or frequency needs further assessment. Passing clots may require more frequent pad change, but first the nurse should determine if the reason for the saturated pad is the length of time it has been in place.
The RN and the student nurse are caring for the postpartum client who is 16 hours postdelivery. The RN evaluates that the student needs more education about uterine assessment when the student is observed doing which activity?
- A. Elevating the client’s head 30 degrees before doing the assessment
- B. Supporting the lower uterine segment during the assessment
- C. Gently palpating the uterine fundus for firmness and location
- D. Observing the abdomen before beginning palpation
Correct Answer: A
Rationale: For uterine assessment, the client should be positioned in a supine position so the height of the uterus is not influenced by an elevated position. When beginning the assessment, one hand should be placed at the base of the uterus just above the symphysis pubis to support the lower uterine segment. This prevents the inadvertent inversion of the uterus during palpation. Once the lower hand is in place, the fundus of the uterus can be gently palpated. The abdomen should be observed prior to palpation for contour to detect distention and for the appearance of striae or a diastasis.
The nurse explains that true labor contractions are characterized by which feature?
- A. Irregular timing
- B. Increasing intensity and frequency
- C. Relief with walking
- D. Occurrence only at night
Correct Answer: B
Rationale: True labor contractions increase in intensity and frequency, distinguishing them from false labor.
Immediately after delivery of the client’s placenta, the nurse palpates the client’s uterine fundus. The fundus is firm and located halfway between the umbilicus and symphysis pubis. Which action should the nurse take based on the assessment findings?
- A. Immediately begin to massage the uterus
- B. Document the findings of the fundus
- C. Assess the client for bladder distention
- D. Monitor for increased vaginal bleeding
Correct Answer: B
Rationale: Uterine massage is indicated only if the uterus does not feel firm and contracted. Immediately after birth, the uterus should contract, and the fundus should be located one-half to two-thirds of the way between the symphysis pubis and umbilicus. Thus the only action required is to document the assessment finding. There is no indication that the bladder is full. A full bladder will cause uterine displacement to either side of the abdomen. The uterus is firm; there is no reason to infer that increased vaginal bleeding would occur.