Nokea
The nurse is caring for a pregnant patient who is concerned about preterm labor. Which of the following symptoms should the nurse instruct the patient to report immediately?
- A. Mild back pain and cramping
- B. Feeling of pelvic pressure
- C. Leaking of clear fluid from the vagina
- D. Increased fatigue during the day
Correct Answer: C
Rationale: The correct answer is C: Leaking of clear fluid from the vagina. This symptom could indicate premature rupture of membranes, which is a serious concern in preterm labor. Prompt reporting is crucial to prevent complications. A: Mild back pain and cramping are common in pregnancy and may not necessarily indicate preterm labor. B: Feeling of pelvic pressure can be normal in the third trimester. D: Increased fatigue is common in pregnancy and not a direct sign of preterm labor.
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The nurse has taken a health history on four primigravid clients at their first prenatal visits. It is high priority that which of the clients receives nutrition counseling?
- A. The woman diagnosed with phenylketonuria.
- B. The woman who has Graves’ disease.
- C. The woman with Cushing’s syndrome.
- D. The woman diagnosed with myasthenia gravis.
Correct Answer: A
Rationale: Phenylketonuria (PKU) requires strict dietary management, especially during pregnancy, to prevent harm to the fetus. The other conditions do not have the same immediate dietary implications.
Which client consumed the most dairy servings in one day?
- A. Client 1
- B. Client 2
- C. Client 3
- D. Client 4
Correct Answer: B
Rationale: Client 2 consumed the highest number of dairy servings based on the provided quantities of yogurt, milk, cottage cheese, and hard cheese.
During a vaginal birth, a birthing person experienced a second-degree perineal laceration. What is a characteristic of a second-degree laceration?
- A. It involves only the vaginal mucosa.
- B. It extends through the vaginal and perineal muscles.
- C. It is the least severe type of laceration.
- D. It does not require suturing.
Correct Answer: B
Rationale: The correct answer is B because a second-degree perineal laceration extends through the vaginal mucosa and perineal muscles. First, a second-degree laceration involves more than just the vaginal mucosa, as it also affects the perineal muscles. This type of laceration is more severe than a first-degree laceration, which only involves the vaginal mucosa. Second, due to the involvement of deeper structures like the perineal muscles, suturing is typically required to promote proper healing and prevent complications. Therefore, choice B is correct. Choices A and C are incorrect because a second-degree laceration involves more than just the vaginal mucosa and is not the least severe type of laceration. Choice D is incorrect because suturing is usually necessary for second-degree lacerations.
Which of the following is true about the use of a birthing ball during labor?
- A. It is contraindicated for patients with high blood pressure
- B. It promotes pelvic mobility and can help reduce pain
- C. It should only be used during the second stage of labor
- D. It is only effective in early labor
Correct Answer: B
Rationale: The correct answer is B because a birthing ball promotes pelvic mobility, which can help reduce pain during labor by encouraging movement and optimal positioning of the baby. It is not contraindicated for patients with high blood pressure unless specifically advised by a healthcare provider. It can be used throughout labor, not just during the second stage, and is effective at various stages, not just in early labor.
A nurse is educating a pregnant patient about safe sleep practices for the infant. Which of the following statements by the patient indicates the need for further teaching?
- A. I will always place my baby on their back to sleep.
- B. I will place my baby in the same bed with me to make sure they are safe.
- C. I will keep soft bedding out of my baby's crib.
- D. I will encourage tummy time when my baby is awake.
Correct Answer: B
Rationale: The correct answer is B because placing the baby in the same bed increases the risk of suffocation, Sudden Infant Death Syndrome (SIDS), and other sleep-related accidents. Co-sleeping is not recommended due to the potential hazards. Choices A, C, and D are safe sleep practices. Placing the baby on their back reduces the risk of SIDS, keeping soft bedding out of the crib prevents suffocation, and tummy time is beneficial for the baby's development when they are awake.