Nokea
A nurse teaches newly pregnant clients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is which of the following?
- A. Estrogen
- B. Human chorionic gonadotropin (hCG)
- C. Progesterone
- D. Luteinizing hormone
Correct Answer: B
Rationale: hCG is a hormone secreted by the fertilized egg shortly after implantation. It signals the body to maintain the corpus luteum, which produces progesterone essential for sustaining the early stages of pregnancy.
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A client in the third trimester reports severe itching without rash. What condition should the nurse suspect?
- A. Cholestasis of pregnancy.
- B. Preeclampsia.
- C. Gestational diabetes.
- D. Fungal infection.
Correct Answer: A
Rationale: Severe itching in pregnancy without a rash is commonly associated with cholestasis of pregnancy.
The nurse is monitoring a client receiving oxytocin for labor induction. What finding requires the nurse to take immediate action?
- A. Contractions lasting 90 seconds.
- B. Contractions every 2–3 minutes.
- C. Fetal heart rate of 180 beats/minute.
- D. Client reports mild nausea.
Correct Answer: C
Rationale: A fetal heart rate of 180 bpm indicates tachycardia, which may suggest fetal distress requiring immediate intervention.
A patient who uses a diaphragm as contraception asks if they need to use a backup method. What should the nurse respond?
- A. No, the diaphragm is effective on its own and does not require a backup method.
- B. Yes, a diaphragm is effective only when used with spermicide, so a backup method is advised.
- C. Yes, a diaphragm should always be used with a condom for additional protection.
- D. No, but the diaphragm should be replaced every 6 months.
Correct Answer: B
Rationale: The diaphragm should be used with spermicide for maximum effectiveness. Choice A is incorrect because while the diaphragm is effective, spermicide enhances its performance and ensures greater protection. Choice C is unnecessary, as the diaphragm alone with spermicide is sufficient. Choice D is incorrect because while regular replacement is recommended, it does not require a backup method.
The nurse is conducting a prenatal class on the female reproductive system. When a client asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the best response?
- A. It promotes the fertilized ovum's chances of survival.
- B. It promotes the fertilized ovum's exposure to estrogen and progesterone.
- C. It promotes the fertilized ovum's normal implantation in the top portion of the uterus.
- D. It promotes the fertilized ovum's exposure to luteinizing hormone and follicle-stimulating hormone.
Correct Answer: C
Rationale: The delay ensures the ovum reaches the uterus at the right developmental stage for proper implantation in the upper uterine segment.
What teaching is most important for a mother with a newborn receiving phototherapy?
- A. Ensure the newborn wears protective eyewear
- B. Increase the newborn's fluid intake
- C. Turn the newborn frequently to prevent pressure sores
- D. Monitor bilirubin levels every 8 hours
Correct Answer: A
Rationale: Protective eyewear prevents retinal damage during phototherapy.