Nokea
The nurse is caring for a pregnant patient who has been diagnosed with gestational diabetes. Which of the following interventions should be implemented first?
- A. Administer insulin to control blood glucose levels.
- B. Instruct the patient to follow a diabetic diet and monitor blood glucose levels.
- C. Schedule a cesarean delivery due to the risk of macrosomia.
- D. Start the patient on antihypertensive medications to control blood pressure.
Correct Answer: B
Rationale: The correct answer is B because instructing the patient to follow a diabetic diet and monitor blood glucose levels is the initial intervention for managing gestational diabetes. This step is crucial in controlling blood glucose levels and preventing complications for both the mother and the baby. Administering insulin (option A) may be necessary but is not the first step. Scheduling a cesarean delivery (option C) is not indicated unless there are specific obstetric indications. Starting the patient on antihypertensive medications (option D) is not relevant for managing gestational diabetes unless the patient also has hypertension.
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A nurse is assessing a pregnant patient at 34 weeks gestation who reports feeling itchy and has noticed jaundice. Which of the following conditions should the nurse suspect?
- A. Gestational diabetes
- B. Preeclampsia
- C. Cholestasis of pregnancy
- D. Hyperthyroidism
Correct Answer: C
Rationale: The correct answer is C: Cholestasis of pregnancy. This condition presents with itching, especially on the palms and soles, and jaundice. It is more common in the third trimester. Cholestasis of pregnancy is a liver condition that can lead to complications for both the mother and the baby if not managed promptly. Gestational diabetes (Choice A) presents with high blood sugar levels. Preeclampsia (Choice B) is characterized by high blood pressure and protein in the urine. Hyperthyroidism (Choice D) involves an overactive thyroid gland, which can present with symptoms such as weight loss and palpitations.
A patient in labor is experiencing vaginal bleeding with no pain. What is the most likely cause?
- A. Placental abruption
- B. Placenta previa
- C. Uterine rupture
- D. Cervical laceration
Correct Answer: B
Rationale: The correct answer is B: Placenta previa. In placenta previa, the placenta partially or completely covers the cervix, leading to painless vaginal bleeding. Placental abruption (choice A) presents with painful bleeding. Uterine rupture (choice C) typically causes severe abdominal pain. Cervical laceration (choice D) usually occurs during delivery and is not typically associated with painless bleeding during labor. Placenta previa is the most likely cause in this scenario due to painless bleeding and the absence of contractions.
Which of the following is the most important nursing intervention for a laboring person who is receiving oxytocin for induction of labor?
- A. monitor for signs of uterine hyperstimulation
- B. monitor fetal heart rate continuously
- C. provide emotional support
- D. encourage ambulation
Correct Answer: B
Rationale: The correct answer is B: monitor fetal heart rate continuously. This is crucial because oxytocin can cause uterine hyperstimulation leading to fetal distress. Continuous monitoring allows for early detection of fetal compromise. Monitoring for signs of uterine hyperstimulation (A) is important but secondary to fetal well-being. Emotional support (C) and encouraging ambulation (D) are beneficial but not as critical as ensuring fetal safety during oxytocin administration.
A pregnant patient at 36 weeks gestation reports sudden swelling of the face and hands. What is the nurse's priority action?
- A. Monitor the patient's blood pressure and check for signs of preeclampsia.
- B. Instruct the patient to rest and elevate her feet.
- C. Recommend the patient drink more water to reduce swelling.
- D. Administer diuretics as prescribed to manage fluid retention.
Correct Answer: A
Rationale: The correct answer is A: Monitor the patient's blood pressure and check for signs of preeclampsia. At 36 weeks gestation, sudden swelling of the face and hands can indicate preeclampsia, a serious condition characterized by high blood pressure and proteinuria in pregnancy. Monitoring blood pressure and assessing for other signs of preeclampsia, such as headache or vision changes, is crucial for timely diagnosis and intervention to prevent complications for both the mother and baby.
Summary:
B: Instructing the patient to rest and elevate her feet may provide some relief for swelling but does not address the underlying potential issue of preeclampsia.
C: Recommending increased water intake may not be appropriate if the swelling is due to preeclampsia and can worsen the condition.
D: Administering diuretics without proper assessment and diagnosis of preeclampsia can be harmful and is not the initial priority action.
The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks’ gestation. What sample will be collected for the initial screening process?
- A. Urine
- B. Blood
- C. Saliva
- D. Amniotic fluid
Correct Answer: B
Rationale: AFP screening is done using a blood sample, which is less invasive than an amniocentesis.