Nokea
Which factors should be considered a contraindication for transcervical chorionic villus sampling?
- A. Rh-negative mother
- B. Gestation less than 15 weeks
- C. Maternal age younger than 35 years
- D. Positive for group B Streptococcus
Correct Answer: D
Rationale: Maternal infection, such as group B Streptococcus, is a contraindication for the procedure due to the risk of infection.
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A client, in her third trimester, is concerned that she will not know the difference between labor contractions and normal aches and pains of pregnancy.
- A. Don't worry. You'll know the difference when the contractions start.
- B. The contractions may feel just like a backache
- C. but they will come and go.
- D. Contractions are a lot worse than your pregnancy aches and pains.
Correct Answer: B
Rationale: Labor contractions typically have a pattern, coming and going at regular intervals, whereas normal aches and pains do not follow such a predictable pattern.
Which foods should the nurse suggest for improving folic acid intake?
- A. Potatoes and grapes
- B. Cranberries and squash
- C. Apples and corn
- D. Oranges and spinach
Correct Answer: D
Rationale: Oranges and spinach are rich in folic acid, which is crucial for preventing neural tube defects during pregnancy.
What is the primary purpose of performing an episiotomy during delivery?
- A. to reduce the risk of perineal trauma
- B. to promote faster delivery
- C. to facilitate fetal descent
- D. to provide immediate fetal oxygenation
Correct Answer: A
Rationale: The primary purpose of performing an episiotomy during delivery is to reduce the risk of perineal trauma. Episiotomy is a surgical incision made in the perineum to widen the vaginal opening during childbirth, which can help prevent severe tearing of the perineal tissue. This procedure is performed to provide controlled and precise incision, reducing the likelihood of extensive tears that may lead to complications such as infection or prolonged healing time. It is not done to promote faster delivery, facilitate fetal descent, or provide immediate fetal oxygenation. These choices do not accurately reflect the main goal of episiotomy, which is to minimize perineal trauma.
A patient with a history of asthma is about to receive an epidural block for pain management during labor. What should the nurse monitor for after the procedure?
- A. Respiratory depression
- B. Tachycardia
- C. Elevated blood pressure
- D. Hyperthermia
Correct Answer: A
Rationale: The correct answer is A: Respiratory depression. After receiving an epidural block, the nurse should monitor for respiratory depression in a patient with a history of asthma due to the potential for decreased lung function. This is crucial as the medication from the block can affect respiratory drive, leading to compromised breathing. Tachycardia (choice B), elevated blood pressure (choice C), and hyperthermia (choice D) are not typically associated with epidural blocks and are not the primary concerns for a patient with asthma undergoing this procedure.
A nurse is caring for a pregnant patient at 36 weeks gestation who has been diagnosed with preeclampsia. Which of the following interventions should the nurse prioritize?
- A. Encourage the patient to increase fluid intake to prevent dehydration.
- B. Monitor the patient's blood pressure and assess for signs of worsening preeclampsia.
- C. Provide education about managing gestational diabetes.
- D. Administer pain relief to reduce discomfort from swelling.
Correct Answer: B
Rationale: The correct answer is B because monitoring the patient's blood pressure and assessing for signs of worsening preeclampsia is crucial in managing the condition and preventing potential complications. At 36 weeks gestation, close monitoring is essential to detect any changes in the patient's condition promptly. Increasing fluid intake (choice A) may not be recommended for patients with preeclampsia due to the risk of fluid overload. Providing education about managing gestational diabetes (choice C) is irrelevant in this scenario. Administering pain relief (choice D) may provide temporary relief but does not address the underlying issue of worsening preeclampsia. Prioritizing blood pressure monitoring ensures timely intervention and management of preeclampsia to promote the well-being of both the patient and the baby.