Nokea
What anticipatory guidance should the nurse provide for new parents regarding sociologic changes?
- A. Explain that roles will not change at home
- B. Explain that stresses will be over now that the newborn is born.
- C. Tell the parents not to stress over household changes.
- D. Prepare them for possible strains on relationships.
Correct Answer: D
Rationale: The correct answer is D because it addresses the potential strains on relationships that can occur after the birth of a child. New parents often experience changes in their relationship dynamics due to increased responsibilities, sleep deprivation, and shifts in priorities. By preparing them for these possible strains, the nurse can help them navigate these challenges effectively.
A is incorrect because roles often do change at home with the arrival of a newborn. B is incorrect as stresses can actually increase after the baby is born. C is incorrect as it dismisses the importance of addressing household changes and potential stressors.
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The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.)
- A. Offer the patient a warm blanket.
- B. Place an ice pack on the perineum.
- C. Massage the uterus if it is boggy.
- D. Delay breastfeeding until the patient is reste
Correct Answer: A
Rationale: The correct answer is A because offering the patient a warm blanket helps prevent hypothermia, which can occur due to heat loss during the delivery process. This intervention promotes patient comfort and helps maintain their body temperature.
Choice B is incorrect because placing an ice pack on the perineum is typically done in the immediate postpartum period to reduce swelling and discomfort, not during the fourth stage of labor.
Choice C is incorrect because massaging the uterus if it is boggy is a postpartum intervention to prevent or treat uterine atony, not typically performed during the fourth stage of labor.
Choice D is incorrect because delaying breastfeeding until the patient is rested is not necessary during the fourth stage of labor. Breastfeeding should be initiated as soon as possible after delivery to promote bonding and stimulate milk production.
The labor and delivery nurse is caring for a 27-year-old primigravida with the following vaginal exam: 2 to 3 cm dilated/70% effaced/-2 station. For the last 2 hours the FHR tracing has displayed a Category I tracing and uterine contractions that are every 2 minutes. The contractions are strong to palpation and the patient is now 3/70%/-2. Which is the nurse’s next best action?
- A. Encourage the patient to ambulate
- B. Request orders to initiate oxytocin
- C. Assist the patient to a warm bath
- D. Document the findings
Correct Answer: D
Rationale: The correct answer is D: Document the findings. In this scenario, the patient is in active labor with a Category I FHR tracing, optimal contractions, and progressing cervical dilation. Documenting the findings is important to maintain an accurate record of the patient's progress, which is crucial for monitoring labor and ensuring appropriate care. Encouraging ambulation (choice A) may be unnecessary or even unsafe given the frequency and strength of contractions. Initiating oxytocin (choice B) is not indicated as the patient is already in active labor. Assisting the patient to a warm bath (choice C) may provide comfort but is not the priority at this stage. Therefore, documenting the findings is the next best action to ensure proper documentation and monitoring of the patient's progress.
Pregnant patients can usually tolerate the normal blood loss associated with childbirth because of which physiologic adaptation to pregnancy?
- A. A higher hematocrit
- B. Increased leukocytes
- C. Increased blood volume
- D. A lower fibrinogen level
Correct Answer: C
Rationale: The correct answer is C: Increased blood volume. During pregnancy, a woman's blood volume increases by about 30-50% to support the growing fetus and prepare for potential blood loss during childbirth. This increased blood volume helps pregnant patients tolerate the normal blood loss associated with childbirth without experiencing severe complications like hypovolemic shock.
Rationale:
A: A higher hematocrit would not directly contribute to increased blood volume and would not help in tolerating blood loss during childbirth.
B: Increased leukocytes are part of the immune response and are not directly related to blood volume or tolerance to blood loss.
D: A lower fibrinogen level would not directly contribute to increased blood volume and would not help in tolerating blood loss during childbirth.
Summary:
Choice C is correct because increased blood volume is a crucial physiologic adaptation during pregnancy that enables pregnant patients to tolerate the normal blood loss associated with childbirth. Choices A, B, and D are incorrect as they are not directly related to this
What changes in hormones initiate labor?
- A. decreased progesterone, decreased estrogen, absence of oxytocin
- B. increased progesterone, decreased estrogen, absence of oxytocin
- C. increased progesterone, decreased estrogen, presence of oxytocin
- D. decreased progesterone, increased estrogen, effects of oxytocin
Correct Answer: D
Rationale: The correct answer is D because decreased progesterone, increased estrogen, and the effects of oxytocin are the hormonal changes that initiate labor. Progesterone inhibits contractions, so its decrease allows labor to begin. Estrogen promotes uterine sensitivity to oxytocin, which stimulates contractions. Oxytocin is released in response to labor contractions and helps to strengthen contractions.
A: Incorrect because decreased progesterone is needed for labor to start, estrogen needs to increase, and oxytocin is present during labor.
B: Incorrect because increased progesterone inhibits labor, estrogen should increase, and oxytocin is present during labor.
C: Incorrect because progesterone should decrease, estrogen should increase, and oxytocin is present during labor.
When does the active phase of labor begin according to ACOG?
- A. 6 cm
- B. 3 cm
- C. 5 cm
- D. 10 cm
Correct Answer: A
Rationale: The active phase of labor begins at 6 cm dilation according to ACOG guidelines. At this point, the cervix is significantly dilated, signaling the transition to active labor. This stage is crucial as it signifies the acceleration of labor progress and typically involves stronger contractions leading to efficient cervical dilation. Choices B, C, and D are incorrect as they do not align with the established criteria for the active phase of labor. Choice B (3 cm) is too early for active labor, choice C (5 cm) is close but not quite at the threshold for active labor, and choice D (10 cm) is actually the full dilation stage, not the beginning of active labor. Hence, choice A (6 cm) is the correct answer.