Nokea
Which disease process improves during pregnancy?
- A. Epilepsy
- B. Bell's palsy
- C. Rheumatoid arthritis
- D. Systemic lupus erythematosus (SLE)
Correct Answer: C
Rationale: Pregnancy often leads to an improvement in rheumatoid arthritis due to the immunosuppressive state that occurs to prevent rejection of the fetus. This reduction in immune activity can alleviate symptoms of rheumatoid arthritis. On the other hand, epilepsy, Bell's palsy, and SLE do not typically improve during pregnancy and may even worsen due to hormonal changes and stress on the body. Epilepsy can be challenging to manage during pregnancy, as seizures can potentially harm both the mother and the fetus. Bell's palsy may not improve and could be exacerbated by hormonal changes. SLE is a chronic autoimmune disease that can be unpredictable during pregnancy, with potential flares and complications for both the mother and the fetus.
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Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?
- A. Rubella
- B. Cytomegalovirus (CMV)
- C. Syphilis
- D. HIV
Correct Answer: A
Rationale: The correct answer is A: Rubella. Rubella infection during pregnancy can lead to congenital rubella syndrome, which includes bilateral cataracts in newborns. Rubella virus can cross the placenta and affect the developing fetus, leading to various congenital abnormalities. The other choices, B: CMV, C: Syphilis, and D: HIV, can also cause congenital abnormalities but are not specifically associated with bilateral cataracts in newborns. Rubella is the most likely cause in this scenario based on the clinical presentation.
A placenta previa when the placental edge just reaches the internal os is called
- A. total.
- B. partial.
- C. low-lying.
- D. marginal.
Correct Answer: D
Rationale: The correct answer is D: marginal. In placenta previa, when the placental edge just reaches the internal os, it is classified as marginal. This indicates that the placenta is close to, but not covering, the cervical os. Total previa covers the entire os, partial covers part of it, and low-lying indicates the placental edge is near the os but not reaching it. The key is to understand the specific location of the placental edge in relation to the internal os for each classification.
As the triage nurse in the emergency room, you are reviewing results for the high-risk obstetric patient who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer–Betke test is positive. Based on this information, you anticipate that
- A. immediate birth is required.
- B. the patient should be transferred to the critical care unit for closer observation.
- C. RhoGAM should be administered.
- D. a tetanus shot should be administered.
Correct Answer: A
Rationale: The correct answer is A: immediate birth is required. The positive Kleihauer–Betke test indicates fetal-maternal hemorrhage, where fetal blood enters the maternal circulation. This can lead to fetal-maternal transfusion, causing fetal anemia. Immediate birth is necessary to assess and manage potential fetal distress, such as anemia and hypoxia, due to the trauma from the MVA.
Choices B, C, and D are incorrect:
B: Transferring to critical care unit is not the immediate priority. The focus should be on addressing the fetal distress.
C: RhoGAM is given to Rh-negative mothers to prevent Rh sensitization, but it is not directly related to the positive Kleihauer–Betke test result.
D: Tetanus shot administration is important for tetanus prevention, but it is not the priority in this case where immediate birth is required due to fetal-maternal hemorrhage.
Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area?
- A. 1
- B. 2
- C. 3
- D. 4
Correct Answer: C
Rationale: The correct answer is C: 3. A score of 3 in edema assessment indicates significant edema in the lower extremities, face, hands, and sacral area. This score reflects a higher level of pitting edema, which is commonly observed in these areas in cases of fluid retention. Scores 1 and 2 are typically used to indicate mild to moderate edema in specific areas or generalized mild edema, not as extensive as described in the question. Score 4 would typically indicate severe edema involving not only the mentioned areas but also potentially other body parts. Therefore, choice C is the most appropriate answer based on the extent and distribution of edema described in the question.
What should the nurse recognize as evidence that the patient is recovering from preeclampsia?
- A. 1+ protein in urine
- B. 2+ pitting edema in lower extremities
- C. Urine output >100 mL/hour
- D. Deep tendon reflexes +2
Correct Answer: C
Rationale: The correct answer is C: Urine output >100 mL/hour. This signifies improved kidney function, a key indicator of recovery in preeclampsia. Increased urine output indicates better kidney perfusion and reduced risk of complications like renal failure. A: 1+ protein in urine suggests ongoing kidney damage. B: 2+ pitting edema in lower extremities indicates fluid retention, a common symptom of preeclampsia. D: Deep tendon reflexes +2 are not specific to preeclampsia recovery, although hyperreflexia can be seen in severe cases.