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Which intervention is most appropriate for a mother with mastitis?
- A. Advise the mother to stop breastfeeding temporarily
- B. Encourage continued breastfeeding
- C. Apply cold compresses to the affected breast
- D. Refer the mother to a lactation consultant
Correct Answer: B
Rationale: Continuing breastfeeding helps resolve mastitis by clearing milk ducts.
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The nurse is monitoring a laboring client with oxytocin infusion. What finding requires immediate intervention?
- A. Contractions lasting 60 seconds.
- B. Contractions every 2 minutes.
- C. Fetal heart rate of 100 beats/minute.
- D. Client reports back pain.
Correct Answer: C
Rationale: A fetal heart rate of 100 bpm indicates bradycardia, requiring immediate intervention to ensure fetal well-being.
The nurse is caring for a client with preeclampsia. What is the most important assessment?
- A. Daily weight.
- B. Urine protein levels.
- C. Fetal heart rate.
- D. Blood pressure.
Correct Answer: D
Rationale: Blood pressure monitoring is critical to prevent complications such as eclampsia and placental issues in preeclampsia.
A nurse educator is teaching a class to nursing developing cervical cancer. Which client is at students about the incidence of sexually transmitted highest risk? infections (STIs) and their impact on public health.
- A. Client with a Pap test and an HPV screen positive Which is the most commonly reported STI in the for type 12 United States?
- B. Client who is 40 years old and stopped smoking
- C. Syphilis
- D. Gonorrhea
Correct Answer: A
Rationale: Human papillomavirus (HPV) is the most commonly reported sexually transmitted infection (STI) in the United States. HPV infection, especially high-risk types such as HPV-16, is strongly associated with cervical cancer. Therefore, a client who is positive for HPV type 16 on an HPV screen is at the highest risk for developing cervical cancer among the given choices. The nurse educator would need to emphasize the importance of regular screening, follow-up, and prevention strategies for this client to reduce the risk of cervical cancer development.
A male infant delivered at 28 weeks gestation weighs 2 pounds, 12 ounces. When performing an assessment, the nurse would probably observe:
- A. Wide, staring eye
- B. Transparent, red skin
- C. An absence of lanugo
- D. A scrotum with descended testicles
Correct Answer: B
Rationale: A male infant delivered at 28 weeks gestation, as described, would likely have very underdeveloped skin due to the premature birth. The premature skin is often transparent, allowing the prominent blood vessels underneath to be visible, and may also have a reddish hue due to the skin's immaturity. This characteristic appearance is a common finding in premature infants and is a result of their skin being thinner and more fragile than that of full-term infants. The other options, such as a wide, staring eye, an absence of lanugo, and a scrotum with descended testicles, are not specifically associated with premature birth and are not likely to be observed in this scenario.
A client comes to the labor and delivery with polyhydramnios. She was admitted and her membrane ruptures is clear and odorless, but the fetal heart monitor indicate bradycardia and variable decelerations. What should action should be taken next?
- A. Perform vaginal exam (lot of fluid, check to see where baby is)
- B. High fowler position
- C. Warm saline soak vaginal
- D. Perform Leopold maneuver
Correct Answer: A
Rationale: In this scenario, with the presence of polyhydramnios and clear, odorless amniotic fluid, the fetal heart monitor indicating bradycardia and variable decelerations indicates a potential umbilical cord compression due to excessive amniotic fluid volume. It is crucial to perform a vaginal exam promptly as this can help assess the position of the baby and determine if there is a cord prolapse or any other complications that may be affecting the fetal heart rate. The baby's position needs to be identified quickly to address potential issues and ensure a safe delivery process.