Nokea
The nurse is assisting a patient who wishes to use hydrotherapy during labor. What is the primary benefit of hydrotherapy?
- A. Accelerates cervical dilation.
- B. Increases maternal relaxation.
- C. Reduces the risk of perineal trauma.
- D. Shortens the duration of labor.
Correct Answer: B
Rationale: The correct answer is B: Increases maternal relaxation. Hydrotherapy during labor helps relax the mother by reducing stress, anxiety, and pain perception, promoting a sense of well-being. Relaxation can lead to better pain management and overall labor experience. Choice A is incorrect because hydrotherapy may not directly accelerate cervical dilation. Choice C is incorrect as it may reduce discomfort but does not necessarily prevent perineal trauma. Choice D is incorrect as the duration of labor can vary and is not solely determined by hydrotherapy.
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What is the disadvantage of local anesthesia?
- A. decreased motor function
- B. nausea
- C. hypotension
- D. pain during injection
Correct Answer: D
Rationale: The correct answer is D: pain during injection. Local anesthesia may cause pain during injection due to the needle piercing the skin, which can be uncomfortable for the patient. This is a common disadvantage of local anesthesia.
A: Decreased motor function is not a typical disadvantage of local anesthesia as it mainly affects sensory nerves rather than motor nerves.
B: Nausea is not a direct side effect of local anesthesia as it does not affect the gastrointestinal system.
C: Hypotension is not a common disadvantage of local anesthesia, as it typically does not have a significant impact on blood pressure unless administered in large amounts or combined with other medications that can lower blood pressure.
Which aspect of newborn assessment may be limited by the application of a vacuum extractor at birth?
- A. Anterior fontanel
- B. Coronal suture lines
- C. Posterior fontanel
- D. Biparietal diameter
Correct Answer: C
Rationale: The correct answer is C: Posterior fontanel. When a vacuum extractor is used during birth, it can cause swelling or molding of the baby's head, which may affect the assessment of the posterior fontanel. This fontanel is an important landmark for determining head size and shape. Swelling or molding can make it difficult to accurately assess the fontanel's size and shape, potentially impacting the overall assessment of the newborn's head.
A: The anterior fontanel is not typically affected by the use of a vacuum extractor.
B: The coronal suture lines are not directly impacted by the vacuum extractor.
D: The biparietal diameter can still be measured accurately even with molding caused by the vacuum extractor.
A labor patient has brought in a photograph of her two children and asks the nurse to place it on the wall so that she can look at it during labor contractions. This is an example of
- A. focal point.
- B. distraction.
- C. effleurag
- D. relaxation
Correct Answer: A
Rationale: The correct answer is A: focal point. Placing the photograph on the wall serves as a focal point for the laboring patient, helping her to concentrate and stay focused during contractions. By having a specific point of visual focus, the patient can channel her energy and emotions towards the photo, providing a sense of comfort and motivation. It can also serve as a source of inspiration and reminder of the joy of motherhood, which can help in managing the pain and anxiety of labor.
Summary of other choices:
B: Distraction - While the photograph may provide a distraction, the primary purpose is to serve as a focal point for the patient.
C: Effleurage - Effleurage is a massage technique used in labor, not related to placing a photograph on the wall.
D: Relaxation - While the photograph may help in relaxation indirectly by providing comfort and focus, the primary purpose is not relaxation but rather concentration and emotional support.
The nurse auscultates the fetal heart rate and determines a rate of 152 bpm. Which nursing intervention is most appropriate at this time?
- A. Inform the mother that the fetal heart rate is normal.
- B. Reassess the fetal heart rate in 5 minutes because the rate is too high.
- C. Report the fetal heart rate to the physician or nurse-midwife immediately.
- D. Suggest to the mother that she is going to have a boy because the heart rate is fast.
Correct Answer: C
Rationale: The correct answer is C: Report the fetal heart rate to the physician or nurse-midwife immediately. A fetal heart rate of 152 bpm is within the normal range for a fetus, but it is essential to communicate any findings to the healthcare provider for further assessment and monitoring. This step ensures the safety and well-being of both the mother and the fetus by allowing the healthcare provider to determine if any additional actions are necessary.
Incorrect choices:
A: Inform the mother that the fetal heart rate is normal - While the heart rate may be normal, it is crucial to involve the healthcare provider for proper evaluation.
B: Reassess the fetal heart rate in 5 minutes because the rate is too high - 152 bpm is not considered too high, and immediate reporting to the healthcare provider is necessary.
D: Suggest to the mother that she is going to have a boy because the heart rate is fast - Fetal heart rate is not a reliable indicator of the baby's gender, and this
The pregnant patient expresses a desire to schedule birth during the baby's father's furlough
- A. The nurse explains that prior to induction of labor, it is essential to determine which clinical finding?
- B. Dilated cervix
- C. Fetal lung maturity
- D. Rupture of membranes
Correct Answer: C
Rationale: The correct answer is C: Fetal lung maturity. It is essential to determine fetal lung maturity before induction of labor to ensure that the baby's lungs are developed enough to breathe outside the womb. This is important for the baby's well-being and can help prevent complications.
Rationale:
1. Fetal lung maturity is crucial for the baby's ability to breathe independently.
2. Inducing labor without ensuring fetal lung maturity can lead to respiratory distress syndrome in the newborn.
3. A dilated cervix is important for labor progression but does not directly impact the baby's lung maturity.
4. Rupture of membranes may indicate potential labor but does not address the baby's lung development.