Nokea
A nurse is receiving laboratory results for a term newborn who is 24 hr. old. Which of the following results require intervention by the nurse?
- A. WBC count 10,000/mm3
- B. Platelets 180,000/mm3
- C. Hemoglobin 20g/dL
- D. Glucose 20 mg/dL
Correct Answer: D
Rationale: The correct answer is D because a glucose level of 20 mg/dL in a term newborn is significantly low and requires immediate intervention by the nurse. Low glucose levels can lead to hypoglycemia, which can be harmful to the newborn's brain development and overall health. A WBC count of 10,000/mm3 is within normal range for a newborn. Platelets of 180,000/mm3 and hemoglobin of 20g/dL are also within normal limits for a term newborn and do not require intervention.
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A nurse is completing a health history for a client who is at 6-week gestation. The client informs the nurse that she smokes one park of cigarettes per day. The nurse should advise the client that smoking places the client9s newborn at risk for what complication?
- A. Hearing loss
- B. Intrauterine growth restriction
- C. Type 1 diabetes mellitus
- D. Congenital heart defects
Correct Answer: B
Rationale: The correct answer is B: Intrauterine growth restriction (IUGR). Smoking during pregnancy can restrict blood flow to the fetus, leading to inadequate oxygen and nutrients, resulting in IUGR. This can lead to low birth weight and potential health complications for the newborn. Hearing loss (A) is not directly associated with smoking during pregnancy. Type 1 diabetes mellitus (C) is an autoimmune condition not caused by maternal smoking. Congenital heart defects (D) can be a risk with smoking during pregnancy, but the most direct risk is IUGR.
A nurse is providing nutritional guidance to a client who is pregnant and follows a vegan diet. The client asks the nurse which foods she should eat to ensure adequate calcium intake. The nurse should instruct the client that which of the following foods has the highest amount of calcium?
- A. ½ cup cubed avocado
- B. 1 large banana
- C. 1 medium potato
- D. 1 cup cooked broccoli
Correct Answer: D
Rationale: The correct answer is D: 1 cup cooked broccoli. Broccoli is a good source of calcium, with approximately 70 mg per cup. This is higher than the other options provided. Avocado, banana, and potato are not significant sources of calcium compared to broccoli. Broccoli is a suitable choice for a pregnant vegan to ensure adequate calcium intake. It is important for the client to consume a variety of plant-based calcium-rich foods to meet their nutritional needs during pregnancy.
Which condition is a transient self-limiting mood disorder that affects new moms after childbirth?
- A. Postpartum blues
- B. Postpartum depression
- C. Postpartum psychosis
- D. Generalized anxiety disorder
Correct Answer: A
Rationale: The correct answer is A: Postpartum blues. This condition is a common, self-limiting mood disorder that affects new moms after childbirth. It is characterized by mild symptoms such as mood swings, weepiness, and irritability, usually resolving within a few weeks. Postpartum depression (B) is more severe and long-lasting, with persistent feelings of sadness, hopelessness, and anxiety. Postpartum psychosis (C) is a rare but serious condition marked by hallucinations, delusions, and extreme mood swings, requiring immediate medical attention. Generalized anxiety disorder (D) is a chronic condition characterized by excessive worry and anxiety unrelated to specific events, different from the transient nature of postpartum blues.
Which intervention should the nurse prioritize for a pregnant client with placenta previa?
- A. Monitor the client for contractions
- B. Prepare for immediate cesarean delivery
- C. Monitor for signs of fetal distress
- D. Encourage the client to remain in bed rest
Correct Answer: B
Rationale: The correct answer is B: Prepare for immediate cesarean delivery. Placenta previa is a condition where the placenta partially or completely covers the cervix, which can lead to life-threatening bleeding during labor. Immediate cesarean delivery is the priority to prevent maternal and fetal complications. Monitoring for contractions (A) is important but not the priority. Monitoring for fetal distress (C) is crucial but not the immediate intervention. Encouraging bed rest (D) may be recommended but is not the priority intervention in placenta previa.
The nurse is preparing a client for induction of labor. What is the purpose of administering oxytocin?
- A. Stimulate uterine contractions.
- B. Relieve pain during labor.
- C. Promote cervical ripening.
- D. Reduce maternal blood pressure.
Correct Answer: A
Rationale: The correct answer is A: Stimulate uterine contractions. Oxytocin is administered to induce labor by increasing the frequency and strength of uterine contractions. This helps progress labor and facilitate delivery. Choice B is incorrect as pain relief is usually achieved through analgesics or anesthesia. Choice C is incorrect because cervical ripening is typically promoted with medications like prostaglandins. Choice D is also incorrect as oxytocin can actually cause a temporary increase in blood pressure.