Nokea
The nurse is caring for a client with suspected preterm labor. Which medication is most likely to be prescribed?
- A. Magnesium sulfate.
- B. Methyldopa.
- C. Rho(D) immune globulin.
- D. Oxytocin.
Correct Answer: A
Rationale: The correct answer is A: Magnesium sulfate. This medication is commonly prescribed for preterm labor to relax the uterine muscles and prevent contractions. It helps delay labor and reduce the risk of preterm birth. Methyldopa (B) is used for managing hypertension, not preterm labor. Rho(D) immune globulin (C) is given to Rh-negative mothers to prevent hemolytic disease in newborns. Oxytocin (D) is used to induce or augment labor, not for suspected preterm labor. Therefore, A is the most appropriate choice for managing preterm labor.
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While evaluating the reflexes of the newborn, the nurse notes that with a loud noise the newborn symmetrically abduct and extend his arms, his fingers fan out and forms a c with the thumb and forefinger. What does the nurse document?
- A. Positive Moro reflex
- B. Positive Babinski reflex
- C. Rooting reflex
- D. Tonic neck reflex
Correct Answer: A
Rationale: The correct answer is A: Positive Moro reflex. The Moro reflex is elicited by a sudden loud noise or a jarring movement. The newborn symmetrically abducts and extends their arms, followed by fanning out their fingers and forming a "C" shape with the thumb and forefinger. This reflex is an involuntary response that indicates the normal development of the newborn's nervous system. The other choices are incorrect because:
B: Positive Babinski reflex is elicited by stroking the sole of the foot, resulting in the toes fanning out and big toe dorsiflexing.
C: Rooting reflex is elicited by touching the newborn's cheek, causing them to turn their head towards the stimulus and open their mouth to seek food.
D: Tonic neck reflex is elicited by turning the newborn's head to one side, causing extension of the arm on that side and flexion of the opposite arm.
A 28-year-old primigravida admitted to antepartum unit with a diagnosis of hyperemesis gravidarum. Nursing care is based on which of the following?
- A. Assess for dehydration and starvation
- B. Isolated from family
- C. This condition is caused by psychogenic factor
- D. Similar to morning sickness
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Assessing for dehydration and starvation is crucial in managing hyperemesis gravidarum, as it can lead to serious complications for both the mother and the fetus. Dehydration can result from persistent vomiting and may require intravenous fluids. Starvation can occur due to poor nutrient intake. Monitoring these factors helps in providing appropriate treatment and preventing further health issues.
Summary of Incorrect Choices:
B: Isolating the patient from family is not necessary and can have negative psychological impacts. Support from family is crucial in managing hyperemesis gravidarum.
C: Hyperemesis gravidarum is a physical condition related to pregnancy, not a psychogenic factor.
D: Hyperemesis gravidarum is more severe and persistent than morning sickness, requiring different management strategies.
Which herbs would you counsel a lactating client to use to stimulate blood flow to the breast glands, stimulate milk production, and enrich milk flow?
- A. Milk thistle
- B. Cabbage juice
- C. Lanolin
- D. Aloe vera
Correct Answer: B
Rationale: The correct answer is B: Cabbage juice. Cabbage juice contains phytoestrogens that help stimulate blood flow to the breast glands and promote milk production. It is used traditionally to increase milk supply in lactating women. Milk thistle (A) is more commonly used for liver health and not specifically for lactation. Lanolin (C) is a topical ointment for sore nipples, not for milk production. Aloe vera (D) is not recommended for internal use during lactation due to potential laxative effects. In summary, cabbage juice is the best choice as it directly supports milk production and flow in lactating clients.
What is the best nursing action for a newborn experiencing hypothermia?
- A. Place the newborn in skin-to-skin contact with the mother
- B. Provide a warm blanket and monitor temperature
- C. Administer IV fluids to stabilize temperature
- D. Monitor glucose levels for hypoglycemia
Correct Answer: A
Rationale: The correct answer is A: Place the newborn in skin-to-skin contact with the mother. This is the best nursing action for a newborn experiencing hypothermia because it provides immediate and effective warmth transfer from the mother to the baby. Skin-to-skin contact helps regulate the newborn's body temperature, promotes bonding, and enhances breastfeeding initiation.
Choice B is incorrect because while providing a warm blanket is important, skin-to-skin contact with the mother is more effective in quickly raising the newborn's temperature. Choice C is incorrect because administering IV fluids is not the first-line treatment for hypothermia in newborns. Choice D is incorrect because monitoring glucose levels for hypoglycemia is important but addressing the hypothermia should take precedence.
In a 28-day menstrual cycle, when does ovulation typically occur?
- A. around day 7
- B. around day 14
- C. around day 21
- D. around day 28
Correct Answer: B
Rationale: The correct answer is B: around day 14. Ovulation typically occurs around day 14 in a 28-day menstrual cycle. This is because ovulation usually happens around 14 days before the start of the next menstrual period. This timing aligns with the midpoint of the menstrual cycle, which is around day 14. Ovulation is the release of an egg from the ovary, marking the most fertile period for conception. Choices A, C, and D are incorrect because ovulation does not typically occur on day 7, day 21, or day 28 in a 28-day menstrual cycle.