Nokea
When analyzing the need for health teaching of a prenatal multigravida, the nurse should ask which of the following questions?
- A. What are the ages of your children?
- B. What is your marital status?
- C. Do you ever drink alcohol?
- D. Do you have any allergies?
Correct Answer: C
Rationale: Asking about alcohol consumption is directly related to health teaching needs, as it can impact fetal development. The other questions, while important, are not directly related to health teaching.
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A patient is being discharged after giving birth to a healthy baby. The nurse educates the patient about safe sleep practices for the infant. Which of the following statements by the patient indicates the need for further teaching?
- A. I will always place my baby on their back to sleep.
- B. I will let my baby sleep in the same bed with me to make sure they are safe.
- C. I will avoid placing pillows and soft bedding in my baby's crib.
- D. I will encourage tummy time when my baby is awake.
Correct Answer: B
Rationale: Correct Answer: B
Rationale: Co-sleeping increases the risk of sudden infant death syndrome (SIDS) and suffocation. Placing the baby in a separate crib reduces these risks.
Incorrect Choices:
A: Placing the baby on their back to sleep is the recommended position to reduce the risk of SIDS.
C: Avoiding pillows and soft bedding in the crib reduces the risk of suffocation.
D: Tummy time is important for infant development when the baby is awake.
A nurse is caring for a postpartum person who is at risk for infection. What is the most important intervention to reduce the risk of infection?
- A. administer antibiotics
- B. apply a sterile dressing
- C. perform a vaginal exam
- D. administer pain relief
Correct Answer: A
Rationale: Correct Answer: A (administer antibiotics)
Rationale:
1. Administering antibiotics targets potential infection-causing pathogens directly.
2. Antibiotics help prevent the spread of infection within the body.
3. Prophylactic antibiotics are commonly used postpartum for high-risk individuals.
4. This intervention directly addresses the root cause of infection risk.
Summary:
B: Applying a sterile dressing is important for wound care but doesn't target systemic infection risk.
C: Performing a vaginal exam can introduce pathogens and increase infection risk.
D: Administering pain relief is important for comfort but doesn't directly reduce infection risk.
A nurse is preparing a postpartum person for discharge. What is the most important aspect of discharge teaching for a person who has had a cesarean section?
- A. ensure proper incision care
- B. teach about signs of infection
- C. provide skin-to-skin contact
- D. assess for bleeding
Correct Answer: B
Rationale: The correct answer is B: teach about signs of infection. This is the most important aspect of discharge teaching for a person who has had a cesarean section because infection is a common complication post-surgery. By educating the person on signs of infection such as fever, increased pain, redness, or discharge from the incision site, they can promptly seek medical attention if needed. Ensuring proper incision care (choice A) is important but preventing infection through early detection is crucial. Providing skin-to-skin contact (choice C) is beneficial for bonding but not directly related to post-cesarean care. Assessing for bleeding (choice D) is important but typically done in a healthcare setting post-surgery.
A patient who is 38 weeks pregnant presents to the labor and delivery unit. Upon vaginal examination, it is determined the fetus is engaged. What is the correct interpretation by the nurse?
- A. The cervix is completely effaced.
- B. The lie is longitudinal.
- C. The fetal head is flexed.
- D. The biparietal diameter of the fetal head is at the level of the ischial spines.
Correct Answer: D
Rationale: The correct interpretation by the nurse is D: The biparietal diameter of the fetal head is at the level of the ischial spines. At 38 weeks, engagement indicates the fetal head has descended into the pelvis and reached the level of the ischial spines. This is a crucial landmark in labor progress, indicating descent and readiness for birth. Choices A, B, and C are incorrect. Choice A refers to cervical effacement, which is not related to engagement. Choice B refers to fetal lie, which describes the relationship of the fetal spine to the maternal spine. Choice C refers to fetal head flexion, which is important for the mechanism of labor but not specifically related to engagement.
The nurse is reviewing fetal circulation with a pregnant patient and explains that blood circulates through the placenta to the fetus. What vessel(s) carry blood to the fetus?
- A. One umbilical vein
- B. Two umbilical veins
- C. One umbilical artery
- D. Two umbilical arteries
Correct Answer: A
Rationale: The umbilical vein transports richly oxygenated blood from the placenta to the fetus.