Nokea
The nurse is teaching a client about kick counts. When should the client contact the healthcare provider?
- A. Fewer than 10 movements in 2 hours.
- B. Fewer than 20 movements in 1 hour.
- C. No movement in 4 hours.
- D. No movement after eating a meal.
Correct Answer: A
Rationale: Fewer than 10 fetal movements in 2 hours is concerning and warrants further evaluation.
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A patient had unprotected sex yesterday. She is interested in emergency contraception. The nurse knows that the patient has how long to take the medication for it to be effective?
- A. 24 hr
- B. 48 hr
- C. 3 days
- D. 5 days
Correct Answer: C
Rationale: Emergency contraception is most effective if taken within 3 days after unprotected sex. The sooner it is taken, the more effective it is. Choice A and B are incorrect because they are too short a time window for emergency contraception to be effective. Choice D is also incorrect because most emergency contraceptive pills are not effective after 5 days.
A nurse is planning care for a newborn who is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan?
- A. Apply a thin layer of lotion to the newborn skin every 8 hrs.
- B. Give the newborn 1oz of glucose water every 4 hrs.
- C. Ensure the newborn eyes are closed beneath the shield.
- D. Dress the newborn in a thin layer of clothing during therapy
Correct Answer: C
Rationale: The correct action the nurse should include in the care plan for a newborn undergoing phototherapy using a lamp is to ensure that the newborn's eyes are closed beneath the shield. This is important to protect the newborn's eyes from exposure to the bright light emitted during phototherapy, as prolonged exposure can lead to eye damage. Keeping the eyes closed under the shield helps prevent potential harm and ensures the safety and well-being of the newborn during the treatment. Applying a thin layer of lotion, giving glucose water, or dressing the newborn in clothing are not relevant or appropriate actions for phototherapy care in this scenario.
A patient is trying to learn the cervical mucus detec- lung development tion natural family planning method. The patient
- A. Risk for dysfunctional gastrointestinal motility understands that which type of cervical mucus is related to birth before 38 weeks gestation the most fertile?
- B. Activity intolerance related to early gestational age
- C. Scant
- D. Purulent
Correct Answer: C
Rationale: In the cervical mucus detection natural family planning method, the type of cervical mucus that is related to the most fertile period is commonly described as "egg white cervical mucus". This type of mucus is clear, stretchy, and slippery, resembling raw egg whites. In contrast, "scant" cervical mucus refers to mucus that is minimal or in small quantity and is not associated with the peak fertility period. Purulent cervical mucus, on the other hand, is indicative of an infection and is not a normal finding related to fertility.
The nurse is educating a client about signs of labor. Which statement indicates understanding?
- A. False labor contractions cause cervical changes.
- B. True labor contractions decrease with activity.
- C. True labor contractions become stronger and more regular.
- D. False labor contractions are felt in the back.
Correct Answer: C
Rationale: True labor is characterized by regular, strong contractions that lead to cervical changes.
Which will indicate a concealed hemorrhage in an abruptio placenta?
- A. Hard board-like abdomen
- B. Decreased fundal height
- C. Bradycardia
- D. Decreased abdominal pain
Correct Answer: A
Rationale: A concealed hemorrhage in abruptio placentae, also known as a concealed retroplacental hematoma, can cause rapid, significant bleeding behind the placenta with limited visible external bleeding. This internal bleeding can lead to significant blood loss and can cause the uterus to become tense and firm, resulting in a hard board-like abdomen upon palpation. This clinical sign is a key indicator of a concealed hemorrhage in abruptio placentae and should prompt immediate medical attention to prevent maternal and fetal complications. The other choices, such as decreased fundal height, bradycardia, and decreased abdominal pain, are not typically associated with a concealed hemorrhage in abruptio placentae.