The nurse is educating a client about kick counts. What instruction is most appropriate?
- A. Perform kick counts once a week.
- B. Lie on your back to count fetal movements.
- C. Count 10 fetal movements over 2 hours.
- D. Start counting movements at 36 weeks.
Correct Answer: C
Rationale: Counting 10 fetal movements within 2 hours is a standard method to monitor fetal well-being.
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A nurse is caring for a client who is gravida 3, para 2, and is in active labor. The fetal head is at 3+ station after a vaginal examination. Which of the following actions should the nurse take
- A. Apply fundal pressure.
- B. Observe for the presence of a nuchal cord.
- C. Observe for crowning.
- D. Prepare to administer oxytocin.
Correct Answer: C
Rationale: Observing for crowning is the appropriate action for the nurse to take when the fetal head is at 3+ station after a vaginal examination. Crowning refers to the appearance of the baby's head at the vaginal opening during delivery. This indicates that the baby is descending and will be born soon. It is important for the nurse to be prepared for the actual birth once crowning is observed, as it signifies that the second stage of labor is progressing and delivery is imminent. Applying fundal pressure, observing for a nuchal cord, or preparing to administer oxytocin are not appropriate actions at this stage of labor when crowning has been observed.
A nurse is teaching a client who is 28 weeks of gestation and not up-to date on current immunization. Which of the following immunizations should the nurse inform the client to anticipate receiving following birth?
- A. Pneumococcal
- B. Hepatitis
- C. Human papillomavirus
- D. Rubella
Correct Answer: D
Rationale: The CDC recommends that women who are not up-to-date with the MMR (measles, mumps, rubella) vaccine should receive it immediately postpartum. Rubella, also known as German measles, is particularly important during pregnancy because contracting rubella during pregnancy can lead to serious complications in the baby, such as birth defects and miscarriage. By ensuring the client receives the MMR vaccine postpartum, it helps protect both the mother and any future pregnancies from the risk of rubella infection.
Which of the following is true about the three layers juries, and parents are concerned about the long-term of involuntary smooth muscles of the uterus?
- A. Designed to provide expansion of the growing fetus.
- B. Meant to inhibit the contraction of the uterus
- C. These injuries require immediate surgery. prior to the onset of labor.
- D. Your child will have permanent paralysis.
Correct Answer: A
Rationale: The correct statement about the three layers juries, and parents are concerned about the long-term of involuntary smooth muscles of the uterus is that they are designed to provide expansion of the growing fetus. The three layers of the uterus, consisting of the perimetrium, myometrium, and endometrium, play essential roles during pregnancy. The myometrium, which is the middle layer of the uterus, contains involuntary smooth muscle fibers that contract during labor to help expel the fetus. These muscles are designed to expand and contract to accommodate the growing fetus during pregnancy and aid in the birthing process.
A client at 12 weeks' gestation asks about managing constipation during pregnancy. What is the nurse's best advice?
- A. Take a laxative daily.
- B. Increase fiber intake and fluids.
- C. Avoid physical activity.
- D. Limit vegetable consumption.
Correct Answer: B
Rationale: Increasing dietary fiber and fluids helps relieve constipation, which is common during pregnancy.
A client has just given birth, during labor the fetus was in brow presentation, but after prolonged laboring the fetus convert to occiput presentation and was delivered vaginally by vacuum extraction
- A. What should be explained
- B. Molding of the head will subside in a few days
- C. Meconium aspiration
- D. Infant will have prophylactic antibiotic
Correct Answer: A
Rationale: In this scenario, it is important to explain to the client what happened during labor and delivery. It is essential to communicate that the fetus was in a brow presentation initially, which can sometimes lead to complications during labor. However, the fetus converted to occiput presentation and was successfully delivered vaginally with the help of vacuum extraction. Providing this information to the client helps in ensuring transparency and understanding of the events that occurred, addressing any concerns or questions they may have about the delivery process.
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