Nokea
Which is a priority nursing intervention for a post-operative patient who has had an incomplete abortion?
- A. Insertion of IV line and fluid replacement
- B. Methergine IM (Clerie said this one to diminish bleeding, but Quizlet said bolded answer)
- C. Positioning client on left side
- D. Preop teaching for surgery
Correct Answer: A
Rationale: The correct answer is A: Insertion of IV line and fluid replacement. This is the priority nursing intervention for a post-operative patient with an incomplete abortion because fluid replacement is essential to address potential hypovolemia from bleeding. Ensuring adequate IV access allows for prompt administration of fluids and medications to stabilize the patient's condition. Choice B, Methergine IM, may help reduce bleeding but is not the immediate priority. Choice C, positioning the client on the left side, is not as urgent as fluid replacement. Choice D, preop teaching for surgery, is not relevant in this post-operative scenario.
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A nurse is performing a vaginal exam on a client who is in active labor. The nurse notes the umbilical cord protruding through the cervix. Which of the following actions should the nurse take?
- A. Administer oxytocin to the client via intravenous infusion.
- B. Apply oxygen at 2 L/min via nasal cannula.
- C. Prepare for insertion of an intrauterine pressure catheter.
- D. Assist the client into the knee-chest position.
Correct Answer: D
Rationale: The correct answer is D: Assist the client into the knee-chest position. This position helps relieve pressure on the umbilical cord, preventing compression and potential harm to the fetus. By positioning the client in knee-chest, gravity can aid in moving the fetus off the cord. Administering oxytocin (choice A) is not appropriate as the priority is to relieve pressure on the cord. Applying oxygen (choice B) does not address the immediate risk posed by the cord prolapse. Insertion of an intrauterine pressure catheter (choice C) is not indicated when the priority is to alleviate cord compression.
The nurse is teaching a client about preterm labor prevention. What instruction is most appropriate?
- A. Drink at least 8–10 glasses of water daily.
- B. Avoid lying down during the day.
- C. Increase physical activity levels.
- D. Reduce protein intake.
Correct Answer: A
Rationale: The correct answer is A because adequate hydration helps prevent preterm labor by maintaining amniotic fluid levels and preventing dehydration-induced contractions. Drinking 8-10 glasses of water daily ensures proper hydration.
B is incorrect because lying down during the day does not have a direct impact on preterm labor prevention.
C is incorrect as excessive physical activity can sometimes trigger preterm labor instead of preventing it.
D is incorrect as protein intake is important for fetal development and reducing it can lead to nutritional deficiencies, but it is not a direct factor in preventing preterm labor.
What does intimate partner violence refer to?
- A. violence that occurs in public spaces, such as streets or parks, between acquaintances or strangers
- B. violence or abuse that occurs within a relationship, involving physical assault, sexual violence, emotional or psychologic abuse, controlling behaviors, and economic abuse
- C. violence primarily directed toward children by their parents or guardians
- D. violence that is limited to verbal arguments and does not involve physical harm
Correct Answer: B
Rationale: The correct answer is B because intimate partner violence refers to violence or abuse that occurs within a relationship, involving various forms of abuse like physical assault, sexual violence, emotional or psychological abuse, controlling behaviors, and economic abuse. This definition specifically highlights the nature of violence within the context of intimate relationships, distinguishing it from violence that occurs in public spaces (choice A), violence directed toward children (choice C), or limited to verbal arguments without physical harm (choice D). Choice A is incorrect as it focuses on violence between acquaintances or strangers in public spaces. Choice C is incorrect as it refers to violence toward children. Choice D is incorrect as it excludes physical harm, which is often a significant aspect of intimate partner violence.
A nurse is a prenatal clinic is completing a skin assessment for a pregnant client in the second trimester. Which clinical findings should the nurse expect (select all that apply)?
- A. Eczema
- B. Psoriasis C.Linea nigra
- C. Chloasma
- D. Striae gravidarum C, D, E
Correct Answer: C
Rationale: The correct answer is C: Linea nigra. During the second trimester of pregnancy, hormonal changes can lead to the development of Linea nigra, a dark vertical line that appears on the abdomen. This is a common skin change in pregnant women.
Explanation:
1. Eczema (choice A) and Psoriasis (choice B) are chronic skin conditions that are not typically associated with pregnancy. These conditions are not expected findings during the second trimester.
2. Chloasma (choice C) is also known as the "mask of pregnancy" and presents as dark patches on the face. This is a common skin change during pregnancy, especially in the second trimester.
3. Striae gravidarum (choice D) are stretch marks that may develop on the abdomen, breasts, and thighs during pregnancy. While this is a common skin change in pregnancy, it is not one of the expected findings in the second trimester according to the question.
In summary, the correct
Which is a disadvantage of the progesterone-only contraception pill?
- A. Side effects could be increased for persons who are underweight.
- B. There could be a decrease in bone mineral density over time.
- C. They may cause irregular bleeding and spotting.
- D. Return to fertility after discontinuing the pill may take several months.
Correct Answer: B
Rationale: The correct answer is B: There could be a decrease in bone mineral density over time. Progesterone-only pills have been associated with a potential decrease in bone density, especially with long-term use. This is because progesterone can have a negative impact on calcium absorption, leading to bone weakening.
A: Side effects could be increased for persons who are underweight - This is not a specific disadvantage of progesterone-only pills and can apply to any contraceptive method.
C: They may cause irregular bleeding and spotting - This is a common side effect of progesterone-only pills but not a significant disadvantage compared to bone density issues.
D: Return to fertility after discontinuing the pill may take several months - This is a temporary effect and not a long-term disadvantage like decreased bone density.