When the nurse is assisting a person desiring contraception, a history and physical is done. What is an important question the nurse should ask?
- A. What is your education level?
- B. Have you ever been pregnant?
- C. Are you married?
- D. What is your exercise routine?
Correct Answer: B
Rationale: When assisting a person desiring contraception, asking whether they have ever been pregnant is an important question because it helps the healthcare provider assess the individual's past reproductive history, including any pregnancies and potential complications. This information is important in determining the most suitable contraceptive options for the person, taking into account their previous experiences with pregnancy and childbirth. It can also help in evaluating the effectiveness of their past contraceptive methods and guide the selection of appropriate contraceptive counseling and options.
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What is the priority nursing action for a newborn with a temperature of 35.5°C (95.9°F)?
- A. Place the newborn under a radiant warmer
- B. Administer warm IV fluids
- C. Swaddle the newborn in warm blankets
- D. Provide glucose supplementation
Correct Answer: A
Rationale: Placing the newborn under a radiant warmer helps raise body temperature and prevent complications.
A patient has just been prescribed birth control pills and asks about possible side effects. Which of the following should be discussed with the patient?
- A. Increase in menstrual flow
- B. Headaches or nausea
- C. Decrease in libido
- D. Increased risk of breast cancer
Correct Answer: B
Rationale: Headaches and nausea are common side effects of oral contraceptives. Choice A is incorrect because birth control pills typically decrease the menstrual flow. Choice C is not commonly reported with oral contraceptives, and many women report no change in libido. Choice D is incorrect because while oral contraceptives may slightly increase the risk of certain cancers, breast cancer risk is not significantly elevated compared to the general population.
A nurse is caring for a client who has hyperemesis gravidarum. Which of the following laboratory tests should the nurse anticipate?
- A. Urine Ketones
- B. Rapid plasma regain
- C. Prothrombin time
- D. Urine culture
Correct Answer: A
Rationale: Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that can lead to dehydration and electrolyte imbalances. One important laboratory test that the nurse should anticipate for a client with hyperemesis gravidarum is the urine ketones test. Ketones in the urine can indicate that the body is breaking down fat for energy instead of using glucose, which can occur during prolonged fasting or in conditions like hyperemesis gravidarum where there is severe vomiting leading to inadequate intake of nutrients. Monitoring urine ketones levels helps healthcare providers assess the severity of dehydration and metabolic derangement in these patients. It guides the management of fluid and electrolyte replacement to prevent complications like ketosis and metabolic acidosis.
A nurse is providing dietary teaching for a client who is at 29 weeks of gestation and has phenylketonuria. Which of the following suggested foods should the nurse include in the teaching?
- A. A peanut butter sandwich on wheat bread.
- B. A sliced apple and red grapes.
- C. A chocolate chip cookie with a glass of skim milk.
- D. A scrambled egg with cheddar cheese.
Correct Answer: B
Rationale: Phenylketonuria (PKU) is a genetic disorder where the body cannot metabolize phenylalanine, an amino acid found in protein-containing foods. Patients with PKU need to follow a strict low-phenylalanine diet to prevent the buildup of phenylalanine in the body. Fruits like apples and grapes are low in protein and contain minimal phenylalanine, making them suitable choices for individuals with PKU. The other options listed contain higher amounts of protein and phenylalanine, such as peanut butter, chocolate chip cookies, milk, scrambled eggs, and cheese, which should be avoided by individuals with PKU.
What immediate action should a nurse take for a mother reporting a severe headache postpartum?
- A. Administer analgesics and monitor blood pressure
- B. Encourage the mother to rest
- C. Apply a cold compress to the mother's head
- D. Notify the healthcare provider immediately
Correct Answer: D
Rationale: A severe headache postpartum can indicate preeclampsia or other serious conditions requiring immediate action.