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What does optimal nursing care after an amniocentesis include?
- A. Pushing fluids by mouth
- B. Monitoring uterine activity
- C. Placing the patient in a supine position for 2 hours
- D. Applying a pressure dressing to the puncture site
Correct Answer: B
Rationale: Monitoring uterine activity after an amniocentesis is important to detect any contractions that may indicate complications.
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A nurse is preparing a laboring person for an epidural. What is the most important intervention before the procedure?
- A. ensure informed consent
- B. assist with proper positioning
- C. check for allergies to anesthesia
- D. educate on wound care
Correct Answer: C
Rationale: The correct answer is C: check for allergies to anesthesia. Before administering an epidural, it is crucial to check for any allergies to anesthesia to prevent potential allergic reactions. This step ensures the safety and well-being of the laboring person. Informed consent (choice A) is important but not the most critical step before an epidural. Proper positioning (choice B) is essential during the procedure but not the top priority before it. Educating on wound care (choice D) is not directly relevant to preparing for an epidural.
A pregnant patient at 32 weeks gestation reports a sudden headache and blurred vision. What is the nurse's priority action?
- A. Assess the patient's blood pressure and check for signs of preeclampsia.
- B. Administer pain medication and advise the patient to rest.
- C. Encourage the patient to drink fluids and take deep breaths.
- D. Perform a visual acuity test and schedule a follow-up appointment.
Correct Answer: A
Rationale: The correct answer is A: Assess the patient's blood pressure and check for signs of preeclampsia. This is the priority action because sudden headache and blurred vision are symptoms of preeclampsia, a serious condition in pregnancy. Step 1: Assessing blood pressure is crucial to identify hypertension, a hallmark of preeclampsia. Step 2: Checking for other signs of preeclampsia, such as proteinuria and edema, helps confirm the diagnosis. Step 3: Prompt intervention is necessary to prevent complications for both the mother and the baby. Choices B, C, and D are incorrect because they do not address the potential life-threatening condition of preeclampsia and may delay appropriate treatment.
Which of the following vital sign changes should the nurse highlight for a pregnant woman’s obstetrician?
- A. Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90.
- B. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 22 rpm.
- C. Prepregnancy heart rate (HR) 76 bpm and third trimester HR 88 bpm.
- D. Prepregnancy temperature (T) 98.6°F and third trimester T 99.2°F.
Correct Answer: A
Rationale: A significant increase in blood pressure, particularly to 140/90, could indicate preeclampsia and should be highlighted for further evaluation. The other changes are within normal limits for pregnancy.
During an ultrasound, two amnions and two placentas are observed. What will be the most likely result of this pregnancy?
- A. Dizygotic twins
- B. Monozygotic twins
- C. Conjoined twins
- D. High birth-weight twins
Correct Answer: A
Rationale: Dizygotic twins always have two amnions and two chorions (placentas).
A nurse is providing prenatal education to a pregnant patient. Which of the following statements indicates a need for further teaching about maternal weight gain during pregnancy?
- A. I should aim to gain about 25 to 35 pounds during my pregnancy.
- B. I should eat for two during pregnancy.
- C. I can exercise as long as I stay within my doctor's recommendations.
- D. Gaining too much weight during pregnancy can increase my risk of complications.
Correct Answer: B
Rationale: The correct answer is B because the statement "I should eat for two during pregnancy" is incorrect. The rationale is that during pregnancy, a woman does not need to eat for two individuals. Instead, she needs to consume additional calories to support the growth and development of the fetus. Eating for two could lead to excessive weight gain and potential complications. The other choices indicate correct understanding and knowledge about maternal weight gain during pregnancy. A suggests the recommended weight gain range, C acknowledges the importance of exercising within doctor's limits, and D highlights the risks of gaining too much weight during pregnancy.