Nokea
The nurse is aware that the diagonal conjugate is 12 centimeters. What is the measurement in centimeters of the obstetric conjugate?
- A. 10 to 10.5
- B. 11 to 11.5
- C. 12.5 to 13
- D. 14 to 14.5
Correct Answer: A
Rationale: The obstetric conjugate is approximately 1.5 to 2 centimeters shorter than the diagonal conjugate.
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The nurse is developing a plan of care for a child who is 7-years-old. Which developmental period does the child fall under?
- A. Trust vs. mistrust
- B. Autonomy vs. shame/doubt
- C. Initiative vs. guilt
- D. Industry vs. inferiority
Correct Answer: D
Rationale: Per Erikson, 7-year-olds are in the industry vs. inferiority stage (school age, 6-12 years), focusing on competence and achievement.
How many hours of hospital stay does legislation currently allow for a postpartum patient who has delivered vaginally without complications?
- A. 24
- B. 48
- C. 36
- D. 72
Correct Answer: B
Rationale: Postpartum patients who deliver vaginally stay in the hospital for an average of 48 hours; patients who have had a cesarean delivery usually stay 4 days.
The nurse is preparing to administer vaccines to a 4-month-old infant. Which vaccines should the nurse prepare? (Select one that does not apply.)
- A. DTaP
- B. MMR
- C. IPV
- D. Hib
Correct Answer: B
Rationale: At 4 months, per CDC guidelines, infants receive DTaP (diphtheria, tetanus, pertussis), IPV (inactivated poliovirus), and Hib (Haemophilus influenzae type b). MMR and Varicella are typically given at 12-15 months.
A child breaks out with the varicella infection (chickenpox) while hospitalized for a minor surgical procedure. Which interventions should the nurse implement? (Select one that does not apply.).
- A. Place a mask on the child before transporting the child outside the room.
- B. Immunize exposed family members with the varicella vaccine.
- C. Place the child in strict isolation to prevent an outbreak on the unit.
- D. Determine which staff have had varicella before making assignments.
Correct Answer: B
Rationale: Varicella is airborne; a mask during transport, strict isolation (negative pressure room), and staff immunity checks prevent spread. Vaccine is post-exposure prophylaxis but not immediate nursing action.
In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. What is the nurses first action?
- A. Ask if the patient has taken a sedative.
- B. Notify the physician.
- C. Turn the patient to her right side.
- D. Record the rate as a normal finding.
Correct Answer: D
Rationale: The FHR at term ranges from a low of 110 to 120 beats/min to a high of 150 to 160 beats/min. This should be recorded as normal. The FHR drops in the late stages of pregnancy.