Nokea
What question during a family assessment could the nurse ask to determine if the family has necessary resources?
- A. Do you enjoy spending time with your family?
- B. Do you have a group of friends, neighbors, or a church that helps you when you are ill?
- C. How often do you go to the store by yourself?
- D. Do your family members get along well?
Correct Answer: B
Rationale: The correct answer is B: "Do you have a group of friends, neighbors, or a church that helps you when you are ill?" This question assesses the family's support network and resources in times of need. It helps determine if the family has a social support system that can provide assistance during challenging situations. Options A, C, and D are incorrect as they do not directly address the availability of external resources for the family's well-being. Option A focuses on emotional aspects, C on independence, and D on family dynamics, which are not directly related to assessing resources.
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A patient is seen in the primary care clinic for a sinus infection and is prescribed antibiotics. The only other medication that this patient currently takes is an oral contraceptive. What is the most important education the nurse must give to the patient regarding her medications?
- A. If you have nausea with this combination of medication, make sure to take them with food.
- B. You must use a backup method for contraception while taking antibiotics.
- C. Oral contraceptives are contraindicated with many antibiotics.
- D. No education is necessary; these medications do not interact.
Correct Answer: B
Rationale: Step 1: Antibiotics can reduce the effectiveness of oral contraceptives by altering gut flora.
Step 2: Failure to use a backup method can lead to unintended pregnancy.
Step 3: Therefore, it is crucial for the nurse to educate the patient on using a backup method to prevent pregnancy.
Summary: Choice A is incorrect as nausea is not the main concern. Choice C is incorrect as not all antibiotics interact with oral contraceptives. Choice D is incorrect as there is a potential interaction between antibiotics and oral contraceptives.
What should health-care providers be attentive to during the trauma-informed gynecologic examination to avoid retraumatization? Select all that apply.
- A. providing information about trauma support resources
- B. establishing safety and trust
- C. recognizing signs of distress and offering support
- D. using trauma-sensitive language and communication
Correct Answer: B,C,D
Rationale: The correct answer is B, C, and D.
B: Establishing safety and trust is crucial to avoid retraumatization during the examination. It helps create a secure environment for the patient.
C: Recognizing signs of distress and offering support shows empathy and helps address any emotional reactions that may arise during the examination.
D: Using trauma-sensitive language and communication is essential to avoid triggering past traumas and ensuring clear and respectful communication.
Choices A is incorrect because while providing information about trauma support resources is important, it is not directly related to avoiding retraumatization during the examination.
A woman had a miscarriage at 12 weeks' gestation and had D&C,
- A. While you are assessing her response to loss, she tells you she had
- B. Based on your assessment what nursing intervention would you use first?
- C. You ask her what items she bought for the baby
Correct Answer: B
Rationale: The correct answer is B because the priority in nursing care after a miscarriage and D&C is to assess the woman's physical and emotional well-being. By using the nursing intervention of assessment first, the nurse can determine any immediate needs for pain management, emotional support, or further medical intervention. This helps in providing individualized care and addressing any potential complications promptly.
Choice A is incorrect because assessing her response to loss comes after ensuring her immediate physical and emotional needs are met. Choice C is incorrect as it focuses on material items rather than the woman's well-being. Choice D is incomplete and does not provide a viable option for nursing intervention.
The client delivered a 4200 g fetus. The physician performed a
midline episiotomy which extended into a 3rd degree laceration. The
client asks the nurse where she tore. Which response is best?
- A. Through your rectal sphincter
- B. Through your vaginal mucosa
- C. Through your cervix
- D. Through your bladder
Correct Answer: A
Rationale: The correct answer is A: Through your rectal sphincter. A 3rd degree laceration involves the perineal body and extends through the anal sphincter muscles. This type of laceration can occur with a midline episiotomy during childbirth. The rectal sphincter is a part of the anal canal and can be torn in severe cases. Choices B, C, and D are incorrect because a 3rd degree laceration does not involve the vaginal mucosa, cervix, or bladder. The tear is specifically related to the rectal area due to the extension of the episiotomy.
Which client teaching instruction is necessary for a pregnant client who is to undergo a glucose challenge test (GCT) as part of a routine pregnancy treatment plan at 28 weeks?
- A. No dietary restriction (done 24-28 weeks' gestation)
Correct Answer: A
Rationale: The correct answer is A: No dietary restriction (done 24-28 weeks' gestation). This is because the glucose challenge test (GCT) is typically performed between 24-28 weeks of gestation to screen for gestational diabetes. It is important not to have any dietary restrictions before the test to ensure accurate results. Restricting food intake before the test can lead to false results. Other choices are incorrect because they do not align with the standard practice of performing the GCT between 24-28 weeks and avoiding dietary restrictions before the test.