Nokea
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.
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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.
A patient asks the nurse when her infant’s heart will begin to pump blood. What will the nurse reply?
- A. By the end of week 3
- B. Beginning in week 8
- C. At the end of week 16
- D. Beginning in week 24
Correct Answer: A
Rationale: The fetal heart begins to pump by week 3 of gestation.
A gravida, G1 P0000, is having her first prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day? Select all that apply.
- A. Pap smear.
- B. Mammogram.
- C. Glucose challenge test.
- D. Biophysical profile.
Correct Answer: A
Rationale: A Pap smear and complete blood count are standard assessments during the first prenatal visit. A mammogram, glucose challenge test, and biophysical profile are not typically performed at this stage.
A nurse is caring for a pregnant patient who is at 22 weeks gestation and reports experiencing vaginal bleeding. What is the nurse's priority action?
- A. Encourage the patient to rest and avoid strenuous activity.
- B. Monitor the fetal heart rate and assess for any signs of preterm labor.
- C. Assess the bleeding and notify the healthcare provider immediately.
- D. Instruct the patient to use a sanitary pad to monitor for changes in bleeding.
Correct Answer: C
Rationale: The correct answer is C: Assess the bleeding and notify the healthcare provider immediately. This is the priority action because vaginal bleeding during pregnancy can indicate serious complications such as placental abruption or preterm labor. By assessing the bleeding, the nurse can determine the severity and nature of the bleeding to provide crucial information to the healthcare provider for prompt intervention. Notifying the healthcare provider immediately ensures timely assessment and appropriate management to protect the health and well-being of both the mother and fetus. Encouraging rest (choice A) may be appropriate, but assessing the bleeding and notifying the healthcare provider take precedence. Monitoring fetal heart rate (choice B) is important but secondary to assessing the bleeding. Instructing the patient to use a sanitary pad (choice D) is not sufficient to address the potential underlying causes of vaginal bleeding.
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.