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What is the most common indication for performing an episiotomy?
- A. to prevent severe perineal tears
- B. to allow the birth to occur more quickly
- C. to relieve the risk of shoulder dystocia
- D. to control excessive vaginal bleeding
Correct Answer: D
Rationale: The correct answer is D: to control excessive vaginal bleeding. Episiotomy is primarily performed to manage and control postpartum hemorrhage by facilitating better visualization and access for suturing any bleeding vessels. It is not routinely done for preventing severe tears, expediting birth, or addressing shoulder dystocia, as there are alternative interventions for these situations. Episiotomy should be carefully considered and performed only when necessary to avoid unnecessary complications and promote better outcomes.
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What part of the fetal body derives from the mesoderm?
- A. Nails
- B. Oil glands
- C. Muscles
- D. Lining of the bladder
Correct Answer: C
Rationale: The mesoderm is responsible for the development of muscles. Nails and oil glands derive from the ectoderm. The lining of the bladder derives from the endoderm.
A pregnant patient is at 24 weeks gestation and reports feeling nauseous after eating. What is the most appropriate recommendation for the nurse to make?
- A. Instruct the patient to take over-the-counter anti-nausea medications.
- B. Encourage the patient to eat smaller, more frequent meals and avoid greasy foods.
- C. Recommend the patient rest in bed to alleviate symptoms.
- D. Advise the patient to reduce fluid intake to prevent nausea.
Correct Answer: B
Rationale: The correct answer is B: Encourage the patient to eat smaller, more frequent meals and avoid greasy foods. This recommendation helps manage nausea during pregnancy by preventing the stomach from becoming too full, which can exacerbate symptoms. Eating smaller, more frequent meals helps maintain stable blood sugar levels and prevents hunger, which can trigger nausea. Avoiding greasy foods reduces the likelihood of indigestion and discomfort.
Explanation of why the other choices are incorrect:
A: Instructing the patient to take over-the-counter anti-nausea medications may not be suitable during pregnancy without consulting a healthcare provider due to potential risks to the fetus.
C: Recommending the patient to rest in bed may provide temporary relief but does not address the underlying cause of nausea and may not be practical for managing symptoms throughout the day.
D: Advising the patient to reduce fluid intake may lead to dehydration, which is particularly concerning during pregnancy. Adequate hydration is important for both the mother and the developing fetus.
A 30-year-old pregnant patient is at 36 weeks gestation and expresses concerns about swelling in her legs. Which of the following assessments is most important for the nurse to make?
- A. Assess the patient's weight gain during the pregnancy.
- B. Examine the legs for any signs of deep vein thrombosis (DVT).
- C. Instruct the patient to elevate her legs and rest.
- D. Evaluate the patient's dietary intake of sodium.
Correct Answer: B
Rationale: The correct answer is B: Examine the legs for any signs of deep vein thrombosis (DVT). At 36 weeks gestation, pregnant women are at higher risk for DVT due to increased blood volume and pressure on the veins from the growing uterus. DVT can be life-threatening if not detected early. Assessing for any signs of DVT such as redness, warmth, swelling, or pain in the legs is crucial for prompt intervention.
Incorrect choices:
A: Assessing weight gain is important but not the priority in this situation where DVT is a concern.
C: Instructing the patient to elevate her legs and rest can help with swelling but does not address the potential serious complication of DVT.
D: Evaluating dietary intake of sodium is not the priority in this situation where DVT is a concern.
A woman missed her menstrual period 1 week ago and has come to the doctor’s office for a pregnancy test. Which placental hormone is measured in pregnancy tests?
- A. Progesterone
- B. Estrogen
- C. Human chorionic gonadotropin
- D. Human placental lactogen
Correct Answer: C
Rationale: Human chorionic gonadotropin is the basis for most pregnancy tests. It is detectable in maternal blood as soon as implantation occurs, usually 7 to 9 days after fertilization.
A nurse is caring for a laboring person who is experiencing fetal tachycardia. What is the priority intervention?
- A. administer oxygen
- B. monitor fetal heart rate
- C. increase fluid intake
- D. increase oxygen flow
Correct Answer: A
Rationale: The correct answer is A: administer oxygen. Fetal tachycardia indicates decreased oxygen supply to the fetus. Administering oxygen helps improve oxygenation to the fetus, addressing the root cause. Monitoring fetal heart rate (B) is important but not the priority over addressing the oxygen supply. Increasing fluid intake (C) does not directly address the fetal tachycardia. Increasing oxygen flow (D) is not necessary if the person is already receiving sufficient oxygen.