Nokea
What is the recommended method of feeding for a preterm infant?
- A. Breastfeeding
- B. Formula feeding
- C. Bottle feeding with breast milk
- D. Parenteral nutrition
Correct Answer: C
Rationale: The correct answer is C: Bottle feeding with breast milk. Preterm infants may have difficulty latching onto the breast due to their immature sucking reflex. Bottle feeding with breast milk allows for easier feeding and enables monitoring of intake. Breast milk provides essential nutrients and antibodies crucial for preterm infant development. Formula feeding (B) may lack these benefits. Breastfeeding (A) may be challenging for preterm infants initially. Parenteral nutrition (D) is typically used when a baby cannot tolerate oral feedings.
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Which of the following is a potential complication of a postpartum hemorrhage?
- A. Disseminated intravascular coagulation (DIC)
- B. Anemia
- C. Hyperglycemia
- D. All of the above
Correct Answer: A
Rationale: Postpartum hemorrhage can lead to disseminated intravascular coagulation (DIC), a serious condition where blood clotting is disrupted.
A nurse is caring for a client who has a placenta previa. Which of the following findings should the nurse expect?
- A. Spotting
- B. Nausea
- C. Polyhydramnios
- D. Uterine tenderness
Correct Answer: A
Rationale: Spotting is a common symptom of placenta previa due to the abnormal placement of the placenta near or over the cervix. Nausea, polyhydramnios, and uterine tenderness are not typically associated with this condition.
A nurse is preparing to assess fetal heart tones for a client who is at 12 weeks of gestation. Which of the following actions should the nurse take?
- A. Place the client in a side-lying position prior to assessing the fetal heart rate
- B. Measure the fundal height to determine the placement of the ultrasound stethoscope.
- C. Position the ultrasound stethoscope above the symphysis pubis to assess the fetal heart rate.
- D. Perform Leopold maneuvers prior to auscultating the fetal heart rate.
Correct Answer: C
Rationale: At 12 weeks of gestation, the fetal heart rate is best assessed using an ultrasound stethoscope positioned above the symphysis pubis. Leopold maneuvers are not necessary at this early stage.
Which of the following is a potential complication of a retained placenta?
- A. Preeclampsia
- B. Postpartum hemorrhage
- C. Gestational diabetes
- D. All of the above
Correct Answer: B
Rationale: The correct answer is B: Postpartum hemorrhage. A retained placenta can lead to postpartum hemorrhage due to incomplete delivery of the placenta, causing excessive bleeding. Preeclampsia and gestational diabetes are not directly related to a retained placenta. Therefore, the correct answer is B.
Select the 5 actions the nurse should take
- A. Increase the flow rate of the maintenance IV fuid
- B. Have the charge nurse notify the provider
- C. Place the client in a Trendelenburg position
- D. Exert upward pressure on the presenting part.
- E. Attempt to push the umbilical cord back into the cervix
- F. Administer oxygen at 10 L/mm via nonrebreather face mask
Correct Answer: A,B,C,D,F
Rationale: A prolapsed umbilical cord is a life-threatening emergency requiring immediate intervention to relieve cord compression and restore fetal oxygenation. The priority actions are:
Notify the provider
Reposition the client (Trendelenburg or knee-chest)
Manually relieve pressure on the cord
Administer oxygen
Increase IV fluids for better circulation