What alternative could the nurse suggest to someone practicing pica?
- A. Replace laundry starch with salt
- B. Replace ice with frozen fruit juice
- C. Replace soap with cream cheese
- D. Replace soil with uncooked pie crust
Correct Answer: B
Rationale: Replacing ice with frozen fruit juice provides a safer alternative while satisfying the craving for cold substances.
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A nurse is educating a pregnant patient who is at 30 weeks gestation about safe physical activity. Which of the following recommendations should the nurse prioritize?
- A. Perform strenuous exercise to strengthen muscles and improve endurance.
- B. Engage in moderate exercise, such as walking or swimming, to maintain health.
- C. Avoid all physical activity during pregnancy to reduce the risk of complications.
- D. Engage in high-impact exercises to strengthen bones and joints.
Correct Answer: B
Rationale: The correct answer is B because engaging in moderate exercise like walking or swimming is safe and beneficial for pregnant women at 30 weeks gestation. Moderate exercise helps maintain health, improves circulation, reduces stress, and prepares the body for labor. Strenuous exercise (A) can be risky and may lead to complications. Avoiding all physical activity (C) can result in deconditioning and potential complications. High-impact exercises (D) can be too intense and pose a risk of injury during pregnancy. Prioritizing moderate exercise aligns with current guidelines for safe physical activity during pregnancy.
What is the embryonic membrane that contains fingerlike projections on its surface, which attach to the uterine wall?
- A. Amnion
- B. Yolk sac
- C. Chorion
- D. Decidua basalis
Correct Answer: C
Rationale: The chorion is a thick membrane with fingerlike projections (villi) on its outermost surface.
What is the priority intervention for a laboring person with a suspected uterine rupture?
- A. prepare for an emergency cesarean section
- B. perform uterine massage
- C. apply pressure to the abdomen
- D. monitor the fetal heart rate continuously
Correct Answer: B
Rationale: The correct answer is B: perform uterine massage. This intervention aims to prevent excessive bleeding and stabilize the uterus. Uterine massage helps to maintain uterine tone, which is crucial in managing uterine rupture. This intervention can help reduce the risk of maternal hemorrhage and improve fetal oxygenation.
Incorrect choices:
A: Emergency cesarean section may be necessary but is not the priority as immediate measures to control bleeding and maintain uterine tone are crucial.
C: Applying pressure to the abdomen is not recommended as it can further exacerbate uterine rupture and increase the risk of complications.
D: Continuous monitoring of the fetal heart rate is important but not the priority in managing uterine rupture, which requires immediate intervention to prevent maternal and fetal complications.
A nurse is caring for a patient in labor who is receiving oxytocin for induction. Which of the following is a priority assessment for the nurse?
- A. Fetal heart rate monitoring
- B. Fluid intake and output
- C. Uterine tone assessment
- D. Maternal blood pressure monitoring
Correct Answer: A
Rationale: The correct answer is A: Fetal heart rate monitoring. This is a priority assessment because oxytocin can cause uterine hyperstimulation, leading to fetal distress. Monitoring the fetal heart rate allows early detection of any signs of fetal compromise. Choices B, C, and D are important assessments but not the priority in this situation. Monitoring fluid intake and output, uterine tone, and maternal blood pressure are also crucial but do not directly assess fetal well-being, which is the primary concern during labor induction with oxytocin.
A woman delivers a fetal demise that has lanugo covering the entire body, nails that are present on the fingers and toes, but eyes that are still fused. Prior to the death, the mother stated that she had felt quickening. Based on this information, the nurse knows that the baby is about how many weeks’ gestation?
- A. 15 weeks.
- B. 22 weeks.
- C. 29 weeks.
- D. 36 weeks.
Correct Answer: B
Rationale: Lanugo typically appears around 16-20 weeks and covers the entire body by 22-24 weeks. Nails begin forming at around 18-20 weeks and are fully developed by 22 weeks. Fused eyelids occur up until about 24-26 weeks, after which they open. Quickening (feeling of fetal movement) usually occurs between 18-22 weeks in first-time pregnancies. Therefore, the most likely gestational age is 22 weeks.