Nokea
The nurse is preparing to teach a prenatal class about fetal circulation. Which statements should be included in the teaching plan?
- A. The ductus arteriosus allows blood to bypass the fetal lungs.
- B. One vein carries oxygenated blood from the placenta to the fetus.
- C. The normal fetal heart tone range is 140 to 160 beats per minute in early pregnancy.
- D. Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta.
Correct Answer: A
Rationale: The ductus arteriosus bypasses fetal lungs. The umbilical vein carries oxygenated blood, and arteries carry deoxygenated blood to the placenta.
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A 29-year-old low-risk primiparous patient has just placental abruption?
- A. Mild: Grade 1
- B. Moderate: Grade 2
- C. Marked: Grade 3
- D. Severe: Grade 4
Correct Answer: B
Rationale: Placental abruption is classified based on the severity of symptoms and extent of separation of the placenta from the uterine wall. In a low-risk primiparous patient like the one described, a moderate placental abruption (Grade 2) is likely when there is some vaginal bleeding, mild to moderate abdominal pain, and signs of fetal distress such as abnormal fetal heart rate patterns.
The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which activity is typical of advocacy?
- A. Instructing parents about proper home care
- B. Educating the family about choices they have
- C. Telling parents about clinical guidelines
- D. Teaching the family about types of cancers
Correct Answer: B
Rationale: Educating the family about choices they have regarding therapies for the cancer in the child's liver is an example of advocacy, in which the nurse advances the interests of the child and family by informing them of options and assisting them to make informed decisions.
The nurse is monitoring a client receiving magnesium sulfate for preeclampsia. What finding indicates the need to discontinue the infusion?
- A. Urine output of 50 mL/hour.
- B. Respiratory rate of 10 breaths per minute.
- C. Blood pressure of 140/90 mmHg.
- D. Deep tendon reflexes +3.
Correct Answer: B
Rationale: A respiratory rate below 12 breaths per minute is a sign of magnesium sulfate toxicity, requiring immediate discontinuation.
What information should be included in teaching a breastfeeding woman about Seasonale (ethinyl estradiol and levonorgestrel)?
- A. The woman will menstruate every 8 to 9 weeks.
- B. The pills are taken for 3 out of every 4 weeks.
- C. Breakthrough bleeding is a common side effect.
- D. Breastfeeding is compatible with the medication.
Correct Answer: C
Rationale: Breakthrough bleeding is a known side effect of hormonal contraceptives.
When integrating the principles of family-centered care, the nurse would include which concept?
- A. Parents want nurses to make decisions about their child's treatment.
- B. Families are unable to make informed choices.
- C. People have taken increased responsibility for their own health.
- D. Families require little information to make appropriate decisions.
Correct Answer: C
Rationale: Due to the influence of managed care, the focus on prevention, better education, and technological advances, people have taken increased responsibility for their own health.