Nokea
A nurse is admitting a client who has a diagnosis of preterm labor. The nurse anticipates a prescription by the provider for which of the following medications? (Select all that apply.)
- A. Prostaglandin E2
- B. Indomethacin
- C. Magnesium sulfate
- D. Methylergonovine
Correct Answer: A
Rationale: A. Prostaglandin E2: Prostaglandin E2 is used to manage preterm labor by helping to ripen the cervix and promote contractions.
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The nurse is monitoring a client at 39 weeks' gestation receiving oxytocin for labor induction. What finding requires the nurse to stop the infusion?
- A. Contractions every 2–3 minutes.
- B. Contractions lasting 120 seconds.
- C. Baseline fetal heart rate of 140 beats/minute.
- D. Client reports mild back pain.
Correct Answer: B
Rationale: Contractions lasting longer than 90 seconds indicate uterine hyperstimulation and can compromise fetal oxygenation.
A client at 20 weeks' gestation asks about the purpose of an anatomy ultrasound. What is the nurse's best response?
- A. To confirm the baby’s sex.
- B. To assess the baby’s growth and development.
- C. To detect early signs of labor.
- D. To evaluate amniotic fluid levels.
Correct Answer: B
Rationale: The anatomy ultrasound assesses fetal growth, development, and structural abnormalities.
Which is the most dangerous effect on the fetus of a patient who smokes cigarettes while pregnant?
- A. Intrauterine growth restriction
- B. Genetic changes and anomalies
- C. Extensive central nervous system damage
- D. Fetal addiction to the substance inhaled
Correct Answer: A
Rationale: Smoking cigarettes during pregnancy is known to have harmful effects on the fetus, with one of the most serious consequences being intrauterine growth restriction (IUGR). IUGR occurs when the fetus does not grow at a normal rate inside the womb, leading to a lower birth weight. This can have long-term implications on the overall health and development of the baby, including increased risk of various health problems later in life such as respiratory issues, cardiovascular disease, and metabolic disorders. In severe cases, IUGR can even result in stillbirth or neonatal death. Therefore, it is crucial for pregnant individuals to avoid smoking to protect the health and well-being of their unborn child.
The nurse is monitoring a client receiving oxytocin for labor induction. What finding requires the nurse to take immediate action?
- A. Contractions lasting 90 seconds.
- B. Contractions every 2–3 minutes.
- C. Fetal heart rate of 180 beats/minute.
- D. Client reports mild nausea.
Correct Answer: C
Rationale: A fetal heart rate of 180 bpm indicates tachycardia, which may suggest fetal distress requiring immediate intervention.
The patient came for an induction and under which circumstances does the nurse remove prostaglandin from the patient's cervix? SATA
- A. N&V
- B. Late deceleration
- C. Contractions every 90 seconds
- D. Contractions every 5 minutes
Correct Answer: B
Rationale: A. Nausea and vomiting (N&V) are not typically indications for removing prostaglandin from the patient's cervix during induction. These symptoms are common side effects and can be managed without removing the prostaglandin.