The nurse’s role in diagnostic testing is to provide which of the following?
- A. Advice to the couple
- B. Information about the tests
- C. Reassurance about fetal safety
- D. Assistance with decision making
Correct Answer: B
Rationale: The nurse's role is to provide all necessary information regarding a procedure to enable the couple to make an informed decision.
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What factor should the nurse consider when counseling a Chinese immigrant?
- A. Many Chinese eat little protein
- B. Many Chinese believe in eating cold foods
- C. Many Chinese are prone to anemia
- D. Many Chinese believe strawberries cause birth defects
Correct Answer: D
Rationale: Cultural beliefs, such as the idea that strawberries might cause birth defects, should be considered to provide culturally sensitive care.
A nurse is educating a pregnant patient about the importance of iron supplementation during pregnancy. Which statement by the patient indicates effective teaching?
- A. I will take iron supplements daily, even if I feel fine.
- B. I will only take iron supplements if my hemoglobin levels drop.
- C. I will stop taking iron supplements after the second trimester.
- D. I will take iron supplements only when I experience symptoms of anemia.
Correct Answer: A
Rationale: Rationale: Choice A is correct because taking iron supplements daily, even if feeling fine, ensures the patient maintains adequate iron levels throughout pregnancy. Iron is crucial for the mother and baby's health, preventing anemia and complications. Choice B is incorrect as waiting for hemoglobin levels to drop may lead to deficiency. Choice C is incorrect as iron needs remain high throughout pregnancy. Choice D is incorrect as symptoms of anemia indicate an existing deficiency rather than prevention.
A woman in labor has a history of previous cesarean section. What is the most important factor to monitor for during this labor?
- A. Uterine rupture
- B. Maternal hypotension
- C. Fetal malpresentation
- D. Prolonged labor
Correct Answer: A
Rationale: The correct answer is A: Uterine rupture. The most important factor to monitor in a woman with a history of previous cesarean section is the risk of uterine rupture during labor. Uterine rupture is a serious complication that can lead to life-threatening hemorrhage for both the mother and the baby. Monitoring for signs such as sudden onset of severe abdominal pain, abnormal fetal heart rate patterns, and cessation of contractions is crucial. Maternal hypotension (Choice B) is important but not as critical as uterine rupture. Fetal malpresentation (Choice C) and prolonged labor (Choice D) are important factors to monitor but do not pose the same level of immediate risk as uterine rupture in this situation.
A laboring person is requesting an epidural for pain relief. What is the most important nursing action before the procedure?
- A. administer an epidural bolus
- B. check for any contraindications
- C. perform a vaginal exam
- D. ensure continuous fetal monitoring
Correct Answer: B
Rationale: The correct answer is B: check for any contraindications. Before administering an epidural, it is crucial to assess for contraindications such as low platelet count, infection at the insertion site, or severe hypotension as these may increase the risk of complications. Administering an epidural bolus (A) without checking for contraindications can be dangerous. Performing a vaginal exam (C) is not necessary before an epidural and could increase the risk of infection. Ensuring continuous fetal monitoring (D) is important during labor but is not the most critical action before administering an epidural.
A patient in labor is undergoing an epidural block and develops hypotension. What should the nurse do first?
- A. Increase intravenous fluids
- B. Place the patient in a Trendelenburg position
- C. Administer oxygen via face mask
- D. Notify the physician immediately
Correct Answer: A
Rationale: The correct first action is to increase intravenous fluids (Choice A). This will help improve the patient's blood volume and subsequently increase blood pressure. Trendelenburg position (Choice B) is not recommended due to potential complications. Administering oxygen (Choice C) may be helpful but doesn't directly address the hypotension. Notifying the physician (Choice D) is important but addressing hypotension promptly is the priority. Increasing fluids helps address the underlying cause of hypotension in this scenario.