Nokea
What method is used to visualize soft tissue and to determine adequacy of the pelvis with no detrimental effects to the fetus?
- A. Pelvimetry
- B. Palpation
- C. Ultrasonography
- D. X-ray
Correct Answer: C
Rationale: In more than 20 years of use, ultrasonography has had no detrimental effects on the fetus. Pelvimetry and x-ray uses radiation to visualize bony prominences. Pelvimetry is not used in the pregnant patient due to detrimental effects to the fetus. Palpation does not allow for visualization of soft tissue.
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When the nurse performs the Nitrazine test on vaginal secretions of a patient who thinks her membranes have ruptured the paper turns yellow. What does this finding indicate?
- A. Acidic discharge membranes intact
- B. Acidic discharge membranes have ruptured
- C. Neutral not enough discharge to measure
- D. Alkaline membranes have ruptured
Correct Answer: A
Rationale: When the Nitrazine paper turns yellow it is indicative of acidic discharge, meaning the membranes are intact. Amniotic fluid is alkaline and turns the paper blue.
The nurse explains to the patient whose membranes ruptured an hour ago that delivery is usually accomplished in ___ to 24 hours postrupture.
Correct Answer: 18
Rationale: After the rupture of membranes, labor is usually accomplished in 18 to 24 hours.
What is the ideal attitude for the fetal body during labor?
- A. Extension
- B. Lateral
- C. Flexion
- D. Transverse
Correct Answer: C
Rationale: The ideal attitude for the fetal body is flexion.
A patient arrives at the hospital having contractions. How should the nurse determine that the patient is in true labor?
- A. There is no dilation.
- B. The contractions are in the fundus.
- C. The cervix has softened and effaced.
- D. The contractions are irregular.
Correct Answer: C
Rationale: One sign of true labor is when the cervix has softened and effaced. True labor contractions are regular and rhythmic.
During labor the patient screams at her husband to get out of her sight. What would be the most appropriate action for the nurse?
- A. Ask the husband to leave the room.
- B. Assure the husband that such behavior is normal.
- C. Remind the patient that the husband wants to help.
- D. Change the patient's position.
Correct Answer: B
Rationale: During labor the patient frequently becomes angry and outspoken. It is a normal occurrence, but the husband needs to be reassured that such behavior is normal.