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The nurse has received change of shift report on the following four clients. Which of the clients should the nurse assess first?
- A. G1 P0000, 9 weeks’ gestation, hyperemesis gravidarum, vomited twice during the last shift.
- B. G2 P0101, 24 weeks’ gestation, receiving terbutaline po q 2 h for preterm labor, no complaints of cramping during last shift.
- C. G1 P0000, 1 day postpartum, vacuum extraction, for bilateral tubal ligation during this shift.
- D. G2 P0101, 2 days postpartum, spontaneous delivery, had asthma attack during last shift.
Correct Answer: D
Rationale: The client who had an asthma attack during the last shift should be assessed first due to the potential for respiratory complications.
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Which of the following complications of labor and delivery may develop when a baby enters the pelvis in the LMP position?
- A. Cephalopelvic disproportion.
- B. Placental abruption.
- C. Breech presentation.
- D. Acute fetal distress.
Correct Answer: A
Rationale: LMP (left mentum posterior) position can lead to cephalopelvic disproportion, making delivery difficult.
A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patient's health care provider. When is the best time for the nurse to schedule the patient's ultrasound?
- A. Immediately
- B. In 2 weeks
- C. In 4 weeks
- D. In 6 weeks
Correct Answer: A
Rationale: The best time to schedule the ultrasound immediately is because in early pregnancy, it is crucial to confirm the gestational age, rule out ectopic pregnancy, and assess fetal viability. This allows for accurate dating, identification of potential complications, and timely interventions if needed. Waiting for 2, 4, or 6 weeks could delay necessary care and potentially compromise the well-being of the patient and the fetus. Early detection and management of any issues are essential in ensuring a healthy pregnancy outcome.
The nurse is performing the interval history on a patient at 30 weeks of gestation. What data would the prenatal nurse bring to the attention of the health-care provider?
- A. Hgb change from 12 g/dL (at first prenatal visit) to 11 g at 28 weeks
- B. negative ketones in the urine
- C. dysuria for 3 days
- D. weight gain of 3 pounds in the last 2 weeks
Correct Answer: C
Rationale: Rationale: Choice C (dysuria for 3 days) is the correct answer as it could indicate a urinary tract infection (UTI) which can lead to complications during pregnancy. Dysuria may be a sign of UTI, which can progress quickly in pregnant women. Bringing this to the health-care provider's attention is essential for prompt treatment to prevent potential harm to both the mother and baby.
Summary of other choices:
A: Hgb change is within normal range for pregnancy, not necessarily alarming.
B: Negative ketones in the urine are expected and indicate adequate glucose utilization.
D: Weight gain of 3 pounds in 2 weeks is considered normal in the third trimester and not typically a cause for concern unless sudden or excessive.
Which laboratory result would be a cause for concern if exhibited by a patient at her first prenatal visit during the second month of her pregnancy?
- A. Rubella titer, 1:6
- B. Platelets, 300,000/mm3
- C. White blood cell count, 6000/mm3
- D. Hematocrit 38%, hemoglobin 13 g/dL
Correct Answer: A
Rationale: The correct answer is A: Rubella titer, 1:6. A low rubella titer indicates susceptibility to rubella infection, which can be harmful during pregnancy. Rubella can lead to birth defects or miscarriage. Platelets, WBC count, and hematocrit/hemoglobin levels are within normal range and not typically concerning during the early stages of pregnancy.
The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient?
- A. Capitation provides the hospital with a means of recovering variable charges.
- B. The hospital will be paid for the full cost of the patient’s hospitalization.
- C. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost.
- D. Medicare will pay the national average for the patient’s condition.
Correct Answer: C
Rationale: In 1983, Congress established the prospective payment system (PPS), which grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs), each of which provides a fixed reimbursement amount based on assigned DRG, regardless of a patient’s length of stay or use of services.