Nokea
A client is to receive Pergonal (menotropins) injections for infertility prior to in-vitro fertilization. Which of the following is the expected action of this medication?
- A. Stimulation of ovulation
- B. Prolongation of the luteal phase
- C. Promotion of cervical mucus production
- D. Suppression of menstruation fertilization. Which of the following is the expected action of this medication?
Correct Answer: A
Rationale: The correct answer is A: Stimulation of ovulation. Pergonal contains menotropins, which are hormones that stimulate the ovaries to produce eggs. During in-vitro fertilization, the goal is to retrieve multiple eggs for fertilization, making ovulation stimulation crucial.
Explanation for incorrect choices:
B: Prolongation of the luteal phase - Pergonal does not affect the luteal phase, which occurs after ovulation.
C: Promotion of cervical mucus production - Pergonal does not directly influence cervical mucus production.
D: Suppression of menstruation - Pergonal does not suppress menstruation but rather induces ovulation.
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A nurse is receiving laboratory results for a term newborn who is 24 hr. old. Which of the following results require intervention by the nurse?
- A. WBC count 10,000/mm3
- B. Platelets 180,000/mm3
- C. Hemoglobin 20g/dL
- D. Glucose 20 mg/dL
Correct Answer: D
Rationale: The correct answer is D because a glucose level of 20 mg/dL in a term newborn is significantly low and requires immediate intervention by the nurse. Low glucose levels can lead to hypoglycemia, which can be harmful to the newborn's brain development and overall health. A WBC count of 10,000/mm3 is within normal range for a newborn. Platelets of 180,000/mm3 and hemoglobin of 20g/dL are also within normal limits for a term newborn and do not require intervention.
A client at 20 weeks' gestation reports leg cramps. What recommendation should the nurse provide?
- A. Increase potassium intake.
- B. Stretch the legs before bed.
- C. Drink fluids during meals.
- D. Reduce physical activity.
Correct Answer: B
Rationale: The correct answer is B: Stretch the legs before bed. Leg cramps during pregnancy are common due to increased weight and pressure on blood vessels. Stretching before bed helps prevent cramps by improving circulation and muscle relaxation. Increasing potassium intake (choice A) can help with muscle function but is not the primary intervention for leg cramps. Drinking fluids during meals (choice C) is important for hydration but does not directly address leg cramps. Reducing physical activity (choice D) may worsen circulation and muscle cramps.
The nurse is performing a prenatal assessment. What finding is considered a positive sign of pregnancy?
- A. Positive pregnancy test.
- B. Auscultation of fetal heart tones.
- C. Hegar's sign.
- D. Chadwick's sign.
Correct Answer: B
Rationale: The correct answer is B, auscultation of fetal heart tones, because it is a definitive sign of pregnancy indicating the presence of a fetus. This can be heard around 10-12 weeks of gestation using a Doppler device. It is a positive sign as it directly confirms the existence of a developing fetus.
A: A positive pregnancy test is a probable sign and can indicate pregnancy but is not definitive.
C: Hegar's sign is a probable sign characterized by softening of the lower uterine segment, not specific to pregnancy.
D: Chadwick's sign is a probable sign of pregnancy indicated by bluish discoloration of the cervix, vagina, and labia, not a definitive sign of pregnancy.
A client is admitted with a vaginal bleeding at 10 weeks' gestation and her fundal height 13cm. Which potential problem should you investigate?
- A. Hydatidiform mole
- B. DIC
- C. Previa
- D. Abruptio placenta
Correct Answer: C
Rationale: The correct answer is C: Previa. At 10 weeks' gestation, fundal height should be close to the pelvic brim, not 13cm above it. This suggests placenta previa, where the placenta implants low in the uterus, causing bleeding. Hydatidiform mole would typically present with earlier bleeding and a larger uterus. DIC and abruptio placenta are not supported by the information given at this gestational age.
A client at 20 weeks' gestation asks about fetal movements. What is the nurse's best response?
- A. Fetal movements are rarely felt before 24 weeks.
- B. You should feel strong, regular movements at this stage.
- C. You may feel fluttering movements, known as quickening.
- D. It is too early to feel any fetal movements.
Correct Answer: C
Rationale: The correct answer is C because quickening, described as fluttering movements, is typically felt by pregnant individuals around 18-20 weeks of gestation. This indicates fetal movement and is an important milestone in pregnancy. Choices A and D are incorrect as fetal movements can be felt as early as 18-20 weeks. Choice B is incorrect as feeling strong, regular movements is not expected until later in the pregnancy.