Nokea
The nurse is educating a patient on what constitutes IPV. What is an example of an act of IPV?
- A. child endangerment
- B. stalking
- C. workplace harassment
- D. legal allegations
Correct Answer: B
Rationale: Stalking is a deliberate act where the perpetrator repeatedly follows, harasses, or intimidates the victim, which can instill fear or threaten safety. It is recognized as a specific form of intimate partner violence (IPV).
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The nurse is monitoring a client in the second stage of labor. What finding indicates the client is ready to push?
- A. Membranes have ruptured.
- B. Cervix is completely dilated.
- C. Client reports back pain.
- D. Contractions are 10 minutes apart.
Correct Answer: B
Rationale: Complete cervical dilation marks the beginning of the second stage, signaling readiness to push.
On examination the hands and feet of a 6 hours old infant is cyanotic without signs of distress. The nurse should document these findings as:
- A. Potential for respiratory distress
- B. Poor oxygenation
- C. Cold stress
- D. Acrocyanosis
Correct Answer: D
Rationale: Acrocyanosis is a condition commonly seen in newborns where the hands and feet appear blue or purple in color due to decreased circulation in the peripheral blood vessels. It is usually a normal finding in newborns and is not associated with distress or poor oxygenation. Unlike central cyanosis which indicates a more serious underlying issue affecting oxygen levels in the blood, acrocyanosis is a benign and self-limiting condition. It is important for the nurse to recognize and document acrocyanosis to differentiate it from other potentially concerning conditions.
A woman's temperature has just risen 0.4°F and will remain elevated during the remainder of her cycle. She expects to menstruate in about 2 weeks. Which of the following hormones is responsible for the change?
- A. Progesterone
- B. Follicle stimulating hormone
- C. Luteinizing hormone
- D. Estrogen
Correct Answer: D
Rationale: The hormone responsible for the increase in body temperature prior to menstruation is estrogen. Estrogen is the primary female sex hormone that plays a key role in regulating the menstrual cycle. Around the time of ovulation, estrogen levels peak, which can lead to a slight rise in body temperature. This increase in temperature is known as the "estrogenic temperature shift" and is a normal part of the menstrual cycle. The rise in body temperature indicates that ovulation has occurred and that a woman is approaching her fertile window. Estrogen also helps prepare the uterine lining for pregnancy and plays a role in many other reproductive functions.
A client at 28 weeks' gestation reports feeling fewer fetal movements. What should the nurse recommend first?
- A. Perform a nonstress test.
- B. Drink a glass of juice and lie down.
- C. Notify the healthcare provider immediately.
- D. Schedule an ultrasound.
Correct Answer: B
Rationale: Drinking juice and lying down can stimulate fetal movement and help evaluate whether further action is needed.
Before giving a client oral combination contraceptives, which side effects should the nurse tell the patient to be aware of? Select one that does not apply.
- A. Irregular bleeding
- B. Thick vaginal discharge
- C. Nausea
- D. Breast tenderness
Correct Answer: B
Rationale: The common side effects of oral combination contraceptives include irregular bleeding, nausea, and breast tenderness. Choice B is incorrect because thick vaginal discharge is not a typical side effect of oral contraceptives.