Nokea
A charge nurse is discussing risk factors for postpartum hemorrhage with a newly licensed nurse.
Which of the following conditions should the nurse include as a risk factor?
- A. Urinary tract infection
- B. Breech presentation
- C. Oligohydramnios
- D. Retained placental fragments
Correct Answer: D
Rationale: Retained placental fragments prevent effective uterine contraction, leading to postpartum hemorrhage.
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A nurse is reinforcing teaching with a client who is at 24 weeks of gestation and has opioid use disorder.
Which of the following statements should the nurse make?
- A. You will be prescribed diazepam.
- B. You will be prescribed naloxone.
- C. You will be prescribed aripiprazole.
- D. You will be prescribed methadone.
Correct Answer: D
Rationale: Methadone is the standard treatment for opioid use disorder in pregnancy because it stabilizes opioid levels, preventing withdrawal symptoms and reducing cravings, minimizing risks of fetal distress, miscarriage, and preterm labor.
Vital Signs: Blood pressure 132/82 mm Hg, Heart rate 82/min, Respiratory rate 16/min, Temperature 37.1°C (98.8°F), Oxygen saturation 98% on room air. Nurses' Notes: Client reports, 'My baby is not moving as much as usual.' Fetal heart rate 142/min with minimal variability, no accelerations noted in 20 min. External fetal monitor applied, uterine contractions every 5 to 7 min lasting 50 to 60 sec, moderate intensity.
Which of the following actions should the nurse take next? Select all that apply.
- A. Assist the client to a lateral position
- B. Increase the rate of maintenance IV fluid.
- C. Palpate uterine tone to assess for tachysystole
- D. Initiate oxytocin intravenously.
- E. Perform a vaginal exam.
Correct Answer: A,B,C
Rationale: Repositioning to a lateral position improves uteroplacental blood flow, increasing IV fluid enhances perfusion, and palpating uterine tone checks for tachysystole, all addressing fetal heart rate deceleration.
A nurse is assisting with the admission of a client who has hyperemesis gravidarum.
Which of the following laboratory tests is the priority to complete?
- A. CBC
- B. Serum bilirubin
- C. Urinalysis of ketones
- D. Liver enzymes
Correct Answer: C
Rationale: Urinalysis for ketones is the priority as it indicates ketosis from prolonged vomiting, guiding the need for IV fluids and nutritional support in hyperemesis gravidarum.
A nurse in an obstetric clinic is caring for four clients.
The nurse should identify that an intrauterine device is contraindicated for which of the following clients?
- A. A client who has a positive pregnancy test
- B. A client who smokes one pack of cigarettes per day
- C. A client who has a history of gallbladder disease
- D. A client who is nulliparous
Correct Answer: A
Rationale: An IUD is contraindicated in pregnancy due to risks of miscarriage, infection, and preterm labor.
Medical History: 24-year-old with type 1 diabetes, gravida 1 para 1, vaginal birth at 37 weeks, newborn 4.1 kg, third-degree laceration. Vital Signs: Temp 37.3°C, BP 128/82 mm Hg, HR 84/min, RR 18/min. Nurses' Notes: Fundus firm, moderate lochia, diaphoretic, clammy, weak, nauseous at 1500. Diagnostic Results: Blood glucose 120 mg/dL at 1300.
The nurse should plan to ___ and ___
- A. Draw blood for culture and sensitivity
- B. Implement seizure precautions
- C. Administer an IV bolus of dextrose 5% in water
- D. Check deep tendon reflexes
- E. Have the client drink 4 oz of regular soda
- F. Check the client's blood glucose level
Correct Answer: F,E
Rationale: Diaphoresis, weakness, and nausea suggest hypoglycemia in a diabetic client. Checking blood glucose confirms the diagnosis, and drinking soda provides fast-acting carbohydrates for a conscious client.