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A patient 11 weeks' gestation comes to the emergency room department with c/o dizziness, abdominal pain, and shoulder pain. Lab tests reveal a beta-hcg lower than expected level for gestational age
- A. Ultrasound confirms no intrauterine
- B. The nurse knows the most likely diagnostic is an ectopic pregnancy. What statement should the nurse use to explain to the patient?
- C. The baby is in the fallopian tube, the tube has ruptured and is causing bleeding
Correct Answer: B
Rationale: Step 1: Recognize Symptoms - Dizziness, abdominal pain, shoulder pain, low beta-hcg.
Step 2: Consider Ectopic Pregnancy - Symptoms align with ectopic pregnancy.
Step 3: Rule Out Miscarriage - Low beta-hcg indicates not viable intrauterine pregnancy (Choice A).
Step 4: Understand Ectopic Pregnancy - Explaining ectopic pregnancy (Choice C) and rupture to patient may cause distress.
Step 5: Communicate - Nurse should use simple, empathetic statement (Choice B) to explain the likely diagnosis.
Summary: Choice B is correct as it addresses the likely diagnosis without causing undue distress to the patient, unlike Choices A and C which may lead to confusion and anxiety.
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The nurse is reviewing lab results for a pregnant client. Which finding is most concerning?
- A. Hemoglobin of 11 g/dL.
- B. WBC count of 14,000 mm3.
- C. Platelet count of 90,000 mm3.
- D. Fasting blood glucose of 90 mg/dL.
Correct Answer: C
Rationale: The correct answer is C: Platelet count of 90,000 mm3. A low platelet count (thrombocytopenia) in pregnancy can lead to serious complications like bleeding disorders or preeclampsia. Hemoglobin level of 11 g/dL is within normal range for pregnancy. WBC count of 14,000 mm3 may indicate infection but is not as concerning as thrombocytopenia. Fasting blood glucose of 90 mg/dL is also normal in pregnancy.
Who created the Mongan Method?
- A. physician
- B. midwife
- C. hypnotherapist
- D. organization
Correct Answer: C
Rationale: The correct answer is C: hypnotherapist. The Mongan Method was created by Marie Mongan, who is a hypnotherapist. She developed this method as a childbirth education program that incorporates hypnosis techniques to help women have a more positive and empowering birthing experience. The other choices are incorrect because a physician, midwife, or organization did not create the Mongan Method. Marie Mongan's background in hypnotherapy is the key factor in why choice C is the correct answer.
One goal of Healthy People 2030 is to improve pregnancy planning and prevent unintended pregnancy. What is a negative outcome related to unintended pregnancy that is related to this HP goal?
- A. lost jobs related to inabilities to continue to work
- B. depression and anxiety
- C. increased BMI and unintentional weight gain
- D. increased health-care costs in the United States
Correct Answer: B
Rationale: The correct answer is B: depression and anxiety. Unintended pregnancies can lead to mental health issues like depression and anxiety due to the emotional, financial, and social stress associated with unplanned parenthood. This aligns with the goal of Healthy People 2030 to improve pregnancy planning. Choice A is incorrect because while lost jobs can be a consequence of unintended pregnancy, it is not directly related to the mental health aspect targeted by this HP goal. Choice C is incorrect as increased BMI and weight gain are not typically cited as negative outcomes directly related to unintended pregnancy prevention. Choice D is incorrect as while unintended pregnancies can lead to increased healthcare costs, it does not specifically address the mental health aspect targeted by the HP goal.
A nurse on a labor and delivery unit is receiving infection control standards with a newly licensed nurse. The nurse should instruct the newly licensed nurse to don gloves for which of the following procedures?
- A. Assisting a mother with breastfeeding
- B. Performing a newborn's initial bath
- C. Administering the measles, mumps, rubella vaccine
- D. Performing umbilical cord care
Correct Answer: D
Rationale: The correct answer is D: Performing umbilical cord care. Gloves should be worn during this procedure to prevent the spread of infection. The umbilical cord stump is a potential entry point for bacteria, so gloves are necessary to maintain asepsis.
A: Assisting a mother with breastfeeding does not require gloves as it is a clean procedure.
B: Performing a newborn's initial bath does not require gloves unless there are open wounds on the newborn.
C: Administering the measles, mumps, rubella vaccine may require gloves, but the primary concern is needlestick safety rather than infection control through glove use.
A client at 37 weeks' gestation reports sudden gush of clear fluid. What is the nurse's priority action?
- A. Assess for fetal heart rate changes.
- B. Check maternal vital signs.
- C. Perform a sterile vaginal examination.
- D. Notify the healthcare provider.
Correct Answer: A
Rationale: The correct answer is A: Assess for fetal heart rate changes. This is the priority action because the sudden gush of clear fluid may indicate rupture of membranes, potentially leading to fetal distress. Assessing fetal heart rate changes helps determine the urgency of the situation and guides further interventions. Checking maternal vital signs (B) is important but not the priority in this scenario. Performing a sterile vaginal examination (C) should only be done after confirming rupture of membranes to prevent infection. Notifying the healthcare provider (D) can be done after assessing fetal well-being.