Nokea
Which condition increases the risk of congenital anomalies in the fetus?
- A. Maternal diabetes
- B. Mild anemia
- C. Normal weight gain
- D. Regular exercise
Correct Answer: A
Rationale: Maternal diabetes, if poorly controlled, increases the risk of congenital anomalies due to elevated blood glucose levels.
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Which instruction should the nurse provide about newborn feeding?
- A. Feed on a strict schedule
- B. Breastfeed or formula-feed on demand
- C. Avoid feeding at night
- D. Offer water between feedings
Correct Answer: B
Rationale: Feeding on demand supports the newborn's nutritional needs and promotes bonding and growth.
Multiple women are being seen in a clinic for various conditions. From which clients should the nurse prepare to obtain a group beta streptococcus (GBS) culture? Select all that apply.
- A. The client who is having symptoms of preterm labor
- B. The women who had a neonatal death 1 year ago
- C. All pregnant women coming to the clinic for care
- D. The women who had a spontaneous abortion 1 week ago
- E. The women who had an abortion for an unwanted pregnancy
Correct Answer: A,C
Rationale: The client in preterm labor should be screened for GBS infection. Between 10% and 30% of all women are colonized for GBS. All pregnant women, regardless of risk status, should be screened for GBS infection. Between 10% and 30% of all women are colonized for GBS. There is no indication that the client with a previous neonatal death is pregnant. The client would not be screened for GBS solely because of a history of spontaneous abortion. The client would not be screened for GBS solely because of an elective abortion.
On the basis of the health history data, how should the nurse record the client's pregnancy status on the prenatal records?
- A. Multipara
- B. Primipara
- C. Primigravida
- D. Multigravida
Correct Answer: C
Rationale: A primigravida is a woman pregnant for the first time, which matches the client's status of being possibly 2 months pregnant with no prior pregnancies.
The laboring multigravida client’s last vaginal examination was 8/90/+1. The client now states feeling rectal pressure. Which action should the nurse perform first?
- A. Encourage the client to push.
- B. Notify the obstetrician or midwife.
- C. Help the client to the bathroom.
- D. Complete another vaginal exam.
Correct Answer: D
Rationale: The nurse should first evaluate labor progress by performing another vaginal exam. Previously the client was almost fully effaced (90%), and fetal station was 1 cm below the ischial spines (+1). Rectal pressure is often due to pressure exerted during descent of the fetal presenting part. The client needs to be fully dilated (10 cm, not 8 cm) and fully effaced (100%, not 90%) before being encouraged to push. Pushing too early may cause cervical edema and lacerations and may slow the labor process. Rectal pressure may indicate that the client has progressed since the last vaginal exam. Another vaginal exam should be performed before contacting the obstetrician or midwife. During labor, rectal pressure is usually not due to the need for a bowel movement because intestinal motility decreases.
The client, whose parity is 1, had a vaginal delivery 6 days ago and arrived home yesterday after treatment for endometritis. The home health nurse visits the client and plans teaching after seeing which most concerning item in the client’s bathroom?
- A. A box of tampons on the floor outside of the shower stall.
- B. Loofa bath sponge sitting on the seat of the shower stall.
- C. Damp towel bunched on the towel bar and near the floor.
- D. Can of bathroom cleaner on the floor of the shower stall.
Correct Answer: A
Rationale: The nurse should plan teaching about the use of tampons during postpartum. The tampon may irritate or dry the vagina, holds lochia in the body, and increases the risk of infection. The client should be instructed to wear a peripad. Loofas or bath sponges for bathing the body postpartum are not contraindicated. While it is a good idea to hang towels neatly so that they dry more rapidly and reduce mold growth, this is not a priority for teaching. The bathroom cleaner would be dangerous to an older child who is more mobile, but the client’s parity is 1. The client would be wise to start considering safety issues by placing this out of reach, but this is not the priority teaching item.