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The patient's family history includes sickle cell disease. The patient's partner also has sickle cell disease in the family history. What type of test should the nurse discuss with the couple due to their family history?
- A. carrier screening for both parents
- B. ultrasound at 6 weeks’ gestation
- C. glucose screening for both parents
- D. thyroid testing
Correct Answer: A
Rationale:
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A nurse in the ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage. Which of the following should be included in the teaching?
- A. Vaginal intercourse can be resumed after 2 weeks.
- B. Products of conception will be present in vaginal bleeding.
- C. Increased intake of zinc-rich foods is recommended.
- D. Aspirin may be taken for cramps.
Correct Answer: B
Rationale: Following a dilation and curettage (D&C) procedure for a miscarriage, it is important to inform the client that they may experience vaginal bleeding containing products of conception. This is a normal part of the recovery process after this type of procedure. The presence of these products of conception in the vaginal bleeding should be monitored and reported to the healthcare provider if there are any unusual symptoms or excessive bleeding. It is essential for the nurse to provide appropriate information and guidance to the client about what to expect post-procedure to ensure they can differentiate between normal and abnormal symptoms.
The nurse is monitoring a client receiving oxytocin for labor induction. What finding requires the nurse to stop the infusion?
- A. Contractions every 2 minutes.
- B. Fetal heart rate of 100 beats/minute.
- C. Maternal blood pressure of 120/80 mmHg.
- D. Client reports mild back pain.
Correct Answer: B
Rationale: A fetal heart rate of 100 bpm indicates bradycardia and requires immediate discontinuation of oxytocin.
A client, who is in the second trimester of pregnancy, gestation. The client is receiving magnesium sulfate tells the nurse that she has developed a reddish-pink intravenously for pre-eclampsia. Which assessment skin color on the palm of her hands. Which of the fol- requires immediate intervention?
- A. Blood pressure of 130/90 mm Hg
- B. Urine output of 20 mL in past hour
- C. Facial flushing
- D. Patellar reflexes 2+
Correct Answer: C
Rationale: Facial flushing in a pregnant client receiving magnesium sulfate for pre-eclampsia can be a sign of magnesium toxicity. Magnesium sulfate is a tocolytic agent used to prevent seizures in pre-eclamptic patients; however, excessive levels of magnesium can cause symptoms such as flushing, lethargy, blurred vision, slurred speech, and muscle weakness. In severe cases, magnesium toxicity can progress to respiratory depression, cardiac arrest, and death. Therefore, immediate intervention is required to prevent further complications. The other options do not present immediate concerning signs related to magnesium toxicity.
A male infant delivered at 28 weeks gestation weighs 2 pounds, 12 ounces. When performing an assessment, the nurse would probably observe:
- A. Wide, staring eye
- B. Transparent, red skin
- C. An absence of lanugo
- D. A scrotum with descended testicles
Correct Answer: B
Rationale: A male infant delivered at 28 weeks gestation, as described, would likely have very underdeveloped skin due to the premature birth. The premature skin is often transparent, allowing the prominent blood vessels underneath to be visible, and may also have a reddish hue due to the skin's immaturity. This characteristic appearance is a common finding in premature infants and is a result of their skin being thinner and more fragile than that of full-term infants. The other options, such as a wide, staring eye, an absence of lanugo, and a scrotum with descended testicles, are not specifically associated with premature birth and are not likely to be observed in this scenario.
The woman with the lowest risk for sexually trans-
- A. Red swollen area around distal suture repair of mitted pelvic inflammatory disease is one who uses episiotomy site which of the following?
- B. Oral contraceptives
- C. A barrier method of contraception
- D. An intrauterine device for contraception
Correct Answer: C
Rationale: The lowest risk for sexually transmitted pelvic inflammatory disease is associated with using a barrier method of contraception, such as condoms. Barrier methods create a physical barrier that helps prevent the exchange of bodily fluids, reducing the risk of transmission of sexually transmitted infections, including pelvic inflammatory disease. Oral contraceptives, intrauterine devices, and birth control patches do not provide the same level of protection against sexually transmitted infections as barrier methods like condoms.