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The nurse is caring for a pregnant patient who has been diagnosed with iron-deficiency anemia. Which of the following should the nurse recommend to improve iron absorption?
- A. Take iron supplements with milk to increase absorption.
- B. Take iron supplements with a vitamin C source, such as orange juice.
- C. Take iron supplements with calcium-rich foods to improve absorption.
- D. Take iron supplements with coffee or tea to aid absorption.
Correct Answer: B
Rationale: The correct answer is B: Take iron supplements with a vitamin C source, such as orange juice. Vitamin C enhances iron absorption by converting non-heme iron (plant-based) into a more absorbable form. This combination increases the bioavailability of iron. Options A, C, and D are incorrect. A: Taking iron supplements with milk can decrease iron absorption due to calcium and casein in milk inhibiting iron absorption. C: Calcium-rich foods can inhibit iron absorption when taken together. D: Coffee and tea contain tannins that can inhibit iron absorption.
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A nurse is teaching a lesson on fetal development to a class of high school students and explains the primary germ layers. What are the germ layers? (Select all that apply.)
- A. Ectoderm
- B. Endoderm
- C. Mesoderm
- D. Plastoderm
Correct Answer: A
Rationale: The zygote transforms its embryonic disc into three layers: the ectoderm, the mesoderm, and the endoderm. These layers are responsible for the development of various tissues and organs in the body. Plastoderm and Blastoderm are not part of the primary germ layers.
A laboring person is requesting an epidural for pain relief. What is the most important nursing action before the procedure?
- A. administer an epidural bolus
- B. check for any contraindications
- C. perform a vaginal exam
- D. ensure continuous fetal monitoring
Correct Answer: B
Rationale: The correct answer is B: check for any contraindications. Before administering an epidural, it is crucial to assess for contraindications such as low platelet count, infection at the insertion site, or severe hypotension as these may increase the risk of complications. Administering an epidural bolus (A) without checking for contraindications can be dangerous. Performing a vaginal exam (C) is not necessary before an epidural and could increase the risk of infection. Ensuring continuous fetal monitoring (D) is important during labor but is not the most critical action before administering an epidural.
The nurse’s role in diagnostic testing is to provide which of the following?
- A. Advice to the couple
- B. Information about the tests
- C. Reassurance about fetal safety
- D. Assistance with decision making
Correct Answer: B
Rationale: The nurse's role is to provide all necessary information regarding a procedure to enable the couple to make an informed decision.
A nurse is assisting a laboring person with a vacuum extraction. What is the most important nursing action to ensure a safe procedure?
- A. monitor fetal heart rate continuously
- B. prepare the person for a cesarean section
- C. monitor for signs of uterine rupture
- D. assist with positioning the person
Correct Answer: B
Rationale: The correct answer is B: prepare the person for a cesarean section. In the scenario of vacuum extraction, if there are complications or the procedure is unsuccessful, the person may need to undergo an emergency cesarean section. By preparing the person for this possibility, the nurse ensures timely intervention if needed, prioritizing the safety of both the person and the baby. Monitoring fetal heart rate continuously (A) is important but not the most crucial action in this case. Monitoring for signs of uterine rupture (C) is not directly related to vacuum extraction. Assisting with positioning (D) is important but not as critical as preparing for a potential cesarean section.
What is the priority nursing action when a nurse suspects a cord prolapse during labor?
- A. place the person in the knee-chest position
- B. administer oxygen via mask
- C. apply pressure to the cord
- D. administer an epidural
Correct Answer: A
Rationale: The correct answer is A: place the person in the knee-chest position. This is the priority nursing action because it helps relieve pressure on the cord and prevents further prolapse. Placing the person in the knee-chest position also promotes optimal fetal oxygenation. Administering oxygen via mask (choice B) is important but not the priority. Applying pressure to the cord (choice C) should never be done as it can further compromise blood flow to the fetus. Administering an epidural (choice D) is not the priority in this emergency situation.