Nokea
The nurse is counseling the pregnant client who has painful hemorrhoids. Which initial recommendation should be made by the nurse?
- A. Apply steroid-based creams.
- B. Modify the diet to include more fiber.
- C. Treat these surgically before delivery.
- D. Increase intake of foods with flavonoids.
Correct Answer: B
Rationale: An initial recommendation should be a high-fiber diet because high-fiber foods increase intestinal bulk and make passage of stool easier. Steroid-based creams are frequently used for hemorrhoids, although evidence does not support their effectiveness. Surgical intervention to remove hemorrhoids is not recommended in pregnancy because hemorrhoids frequently resolve after pregnancy. Flavonoids aid in symptom relief, although they are not recommended as the first line of treatment.
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The nurse assesses the 34-week pregnant client (G2P1). Place the assessment findings in the sequence that they should be addressed by the nurse from the most significant to the least significant.
- A. Pedal edema at +3
- B. BP 144/94 mm Hg
- C. Positive group beta streptococcus vaginal culture
- D. Fundal height increase of 4.5 cm in 1 week
Correct Answer: B,D,A,C
Rationale: BP 144/94 mm Hg warrants immediate evaluation. It could indicate preeclampsia, a condition that can progress to serious complications. Fundal height increase of 4.5 cm in 1 week is abnormal and requires further follow-up. Normal fundal height increase is 1 to 2 cm per week. An increase in fundal size can be related to gestational diabetes, large-for-gestational-age fetus, fetal anomalies, or polyhydramnios. Pedal edema at +3 may be a normal physiological process if it is an isolated finding. Pedal edema warrants further assessment because it can be a symptom of preeclampsia. Positive group beta streptococcus vaginal culture warrants antibiotic treatment in labor but does not warrant intervention during the pregnancy.
When teaching the class about varicose veins, which symptom should the nurse instruct clients to report immediately?
- A. The appearance of additional varicose veins
- B. Varicose veins that are purple in color
- C. Legs that begin to ache and feel heavy
- D. Calves that become red, tender, and warm
Correct Answer: D
Rationale: Red, tender, warm calves may indicate deep vein thrombosis, a serious condition requiring immediate reporting.
Which instruction is most appropriate for a client with a history of preterm birth?
- A. Monitor for uterine contractions
- B. Avoid prenatal vitamins
- C. Limit fluid intake
- D. Resume normal activity levels
Correct Answer: A
Rationale: Monitoring for uterine contractions is critical for a client with a history of preterm birth to detect early signs of preterm labor.
Which response by the nurse about Chadwick's sign is most accurate?
- A. It's a bluish discoloration of the cervix, vagina, and vulva that occurs as a result of the presence of an increased number of blood vessels.
- B. It's a softening of the cervix that occurs because of an increased amount of blood flowing to the reproductive organs.
- C. It's a dark brown line extending from the umbilicus to the symphysis pubis that occurs as a result of hormonal changes.
- D. None of the above
Correct Answer: A
Rationale: Chadwick's sign is the bluish discoloration of the cervix, vagina, and vulva due to increased vascularity, a probable sign of pregnancy.
The nurse practitioner informs the new nurse that the laboring client’s monitor is showing prolonged decelerations. Which interpretation by the new nurse is correct?
- A. The monitor pattern is U or V shaped, with a decrease in FHR to less than 70 beats/minute (bpm), lasting more than 60 seconds.
- B. The FHR shows an episodic or periodic acceleration that lasts 2 minutes or more but less than 10 minutes in duration.
- C. There is an FHR decrease of 15 bpm or more below baseline occurring for at least 2 but not more than 10 minutes.
- D. The mother’s heart rate is exhibiting intermittent or transient deviations or changes from the baseline heart rate.
Correct Answer: C
Rationale: A prolonged deceleration occurs when the FHR decreases 15 bpm or more below baseline for at least 2 but not more than 10 minutes. The prolonged deceleration may resolve spontaneously or with the aid of interventions. A U- or V-shaped pattern with abrupt decrease in the FHR to less than 70 bpm, lasting more than 60 seconds, describes variable (not prolonged) deceleration typically associated with cord compression. Any episodic or periodic acceleration of FHR that lasts 2 minutes or more but less than 10 minutes in duration describes prolonged acceleration, not deceleration. The fetal heart monitor is monitoring the FHR and not the mother’s heart rate.