Nokea
The nurse is teaching a client with preeclampsia about home care. Which statement indicates understanding?
- A. I should monitor my blood pressure once a week.
- B. I should limit my fluid intake to reduce swelling.
- C. I will report any headache or vision changes immediately.
- D. I can exercise daily to maintain health.
Correct Answer: C
Rationale: Headache and vision changes can signal worsening preeclampsia, requiring prompt medical attention.
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A nurse caring for a client who is at 20 weeks of gestation and has trichomoniasis. Which of the following findings should the nurse expect?
- A. Thick, White Vaginal Discharge
- B. Urinary Frequency
- C. Vulva Lesions
- D. Malodorous Discharge
Correct Answer: D
Rationale: Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. In pregnant individuals, trichomoniasis can result in adverse pregnancy outcomes such as preterm birth and low birth weight. A common symptom of trichomoniasis is a frothy, yellow-green, malodorous vaginal discharge. Therefore, in this client scenario, the nurse should expect to find a malodorous discharge as a result of trichomoniasis. The other options presented are not typically associated with trichomoniasis.
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 assessing a client with suspected gestational hypertension. What finding supports this diagnosis?
- A. Blood pressure of 150/90 mmHg.
- B. Proteinuria of +2.
- C. Fetal heart rate of 140 beats/minute.
- D. Mild edema in the lower extremities.
Correct Answer: A
Rationale: Gestational hypertension is diagnosed with a blood pressure of 140/90 mmHg or higher without proteinuria.
The nurse is educating a client about Rh incompatibility. What statement indicates understanding?
- A. Rh incompatibility only occurs in first pregnancies.
- B. I will need Rho(D) immune globulin if my baby is Rh positive.
- C. Rh incompatibility is treated with antibiotics.
- D. Rh incompatibility does not affect the baby.
Correct Answer: B
Rationale: Rho(D) immune globulin prevents the mother's immune system from attacking Rh-positive fetal red blood cells.
The nurse assesses a patient for medical eligibility for contraceptive use. What is the meaning of an MEC score of 2?
- A. There is no restriction for the use of the contraceptive method.
- B. There is an unacceptable health risk if the contraceptive method is used.
- C. There is a risk that outweighs the advantages of the contraceptive method.
- D. There is an advantage of using a contraceptive method that outweighs any risk.
Correct Answer: B
Rationale: An MEC score of 2 indicates that there is an unacceptable health risk if the contraceptive method is used. This means that the potential health risks associated with using this particular contraceptive method outweigh the benefits. Therefore, the nurse should advise against using this method for contraception due to the elevated health risks involved. It is essential for healthcare providers to meticulously assess the medical eligibility of a patient before recommending any contraceptive method to ensure the safety and well-being of the individual.