Nokea
The nurse is seeing a 17-year-old female in the clinic for complaints of acne. The nurse plans on taking advantage of this teachable moment with the teen. Which topics will the nurse include in the teen's teaching plan?
- A. Smoking habits, folic acid intake, and heart disease
- B. Hyperlipidemia, distracted driving, and menstrual history
- C. Sexual activity, contraception, and screening for violence
- D. Optimum weight, hypothyroidism, and sexually transmitted diseases
Correct Answer: D
Rationale: The most appropriate topics for the nurse to include in the teaching plan for the 17-year-old female with acne are optimum weight, hypothyroidism, and sexually transmitted diseases. Acne can be influenced by hormonal changes, which can be impacted by weight, thyroid function, and hormonal fluctuations related to sexual health. Educating the teen about these topics can help her understand potential contributing factors to her acne and empower her to make informed decisions about her health and lifestyle. It is important to address issues that are relevant to the teen's current health concerns while also providing valuable information for her overall well-being.
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A nurse is planning to teach a group of clients who are about breastfeeding after returning to work. Which of the following infection should the nurse include in the teaching?
- A. "Thawed breast milk can be refrigerated for up to 72 hours."
- B. "Breast milk can be stored in a deep freezer for 12 months."
- C. Breast milk can be stored at room temperature for up to 12 hours."
- D. "Thawed breast milk that is unused can be refrozen."
Correct Answer: D
Rationale: The correct information for breastfeeding after returning to work is that thawed breast milk that is unused should not be refrozen. Once breast milk has been thawed, it should be used within 24 hours and should not be refrozen. This is important to prevent contamination and maintain the quality of the breast milk for the baby. The other statements provided in the options are correct guidelines regarding the storage of breast milk. Thawed breast milk can be refrigerated for up to 24 hours, breast milk can be stored in a deep freezer for up to 12 months, and breast milk can be stored at room temperature for up to 4 hours.
A client reports experiencing painless contractions at 32 weeks' gestation. What should the nurse explain?
- A. These are Braxton Hicks contractions and are normal.
- B. This is a sign of preterm labor.
- C. This indicates cervical dilation.
- D. This requires immediate hospitalization.
Correct Answer: A
Rationale: Braxton Hicks contractions are common in the third trimester and typically do not signify labor.
The nurse is caring for a client in labor who reports intense pressure and the urge to push. What is the priority nursing action?
- A. Perform a sterile vaginal examination.
- B. Instruct the client to breathe through the urge to push.
- C. Notify the healthcare provider.
- D. Increase the oxytocin infusion rate.
Correct Answer: A
Rationale: A vaginal examination is needed to confirm full cervical dilation and readiness for delivery.
A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following information should the nurse include?
- A. Focusing on controlling body functions
- B. "Synchronized breathing will be required during hypnosis"
- C. "Hypnosis can be beneficial in you practiced it during the prenatal period"
- D. "Hypnosis does not work for controlling pain associated with labor".
Correct Answer: C
Rationale: The correct information that the nurse should include is that "Hypnosis can be beneficial if you practiced it during the prenatal period." This statement is true because hypnosis is a tool that can help individuals manage pain and stress through focused attention and suggestion. By practicing hypnosis techniques during the prenatal period, the individual can become more familiar and comfortable with the practice, making it more effective during labor. It is important to establish a routine and practice hypnosis consistently to maximize its benefits during labor.
A nurse is caring for a client who is in labor and has an external fetal monitor. The nurse observes late decelerations on the monitor strip and interprets them as indicating which of the following?
- A. Uteroplacental insufficiency
- B. Maternal bradycardia
- C. Umbilical cord compression
- D. Fetal head compression
Correct Answer: A
Rationale: Late decelerations on the fetal monitor strip indicate uteroplacental insufficiency. These decelerations occur after the peak of a contraction, and the fetus may not receive enough oxygen-rich blood during contractions. Uteroplacental insufficiency can lead to fetal hypoxia and acidosis if not addressed promptly. It is important for the nurse to take appropriate steps to improve fetal oxygenation, such as repositioning the mother, administering oxygen, and adjusting IV fluids. If late decelerations persist, further interventions may be necessary to ensure the well-being of the fetus.