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A nurse is reinforcing teaching with a client about common discomforts during the first trimester of pregnancy.
Which of the following discomforts should the nurse include in the teaching?
- A. Round ligament pain
- B. Perineal discomfort and pressure
- C. Tingling in the fingers
- D. Urination urgency and frequency
Correct Answer: D
Rationale: Increased urinary urgency and frequency are common in the first trimester due to hormonal changes and uterine pressure on the bladder.
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A nurse is reinforcing discharge teaching about home safety with a client who is postpartum.
In which of the following positions should the nurse instruct the client to place their newborn in the crib?
- A. Right lateral
- B. Supine
- C. Prone
- D. Left lateral
Correct Answer: B
Rationale: The supine position reduces the risk of sudden infant death syndrome (SIDS) by keeping the airway open.
Assessment: Fontanels soft, head molded with caput succedaneum, eyes symmetric, sclera yellow, dry mucous membranes, abdomen soft, bowel sounds present. Vital Signs: HR 154/min, RR 44/min, Temp 36.9°C. Diagnostic Results: Coombs positive, Glucose 50 mg/dL. Nurses' Notes: Term newborn, 39 weeks, Apgar 9/9, breastfeeding 3-4 times/day, voided once, no meconium.
Which of the following findings should the nurse report to the RN? Select all that apply.
- A. Sclera color
- B. Heart rate
- C. Respiratory rate
- D. Glucose level
- E. Coombs test result
- F. Head assessment finding
Correct Answer: A,E,G
Rationale: Yellow sclera, positive Coombs test, infrequent voiding/no meconium, and dry mucous membranes suggest jaundice, hemolysis, and dehydration, requiring reporting.
A nurse is planning to administer Rho(D) immune globulin to a client who is postpartum.
Which of the following actions should the nurse take?
- A. Administer the medication into the client's abdomen.
- B. Administer the medication within 72 h after birth
- C. Verify that the newborn is Rh-negative
- D. Verify that the client's Coombs test is positive
Correct Answer: B
Rationale: Rho(D) immune globulin should be given within 72 hours after delivery to prevent Rh isoimmunization in an Rh-negative mother with an Rh-positive newborn.
A nurse is assisting with the care of a newborn who has neonatal abstinence syndrome.
Which of the following actions should the nurse take first?
- A. Swaddle the newborn in blankets
- B. Determine the newborn's respiratory rate
- C. Auscultate the newborn's bowel sounds.
- D. Weigh the newborn's wet diaper
Correct Answer: B
Rationale: Determining respiratory rate is the priority to assess for distress, as neonatal abstinence syndrome can cause tachypnea.
A nurse is reinforcing teaching about travel with a client who is pregnant.
Which of the following instructions should the nurse include?
- A. Position the lap belt across your navel.
- B. Wear the shoulder harness snug across your stomach.
- C. Take a break and walk at least once every hour during long trips.
- D. Move your car seat forward, close to the steering wheel.
Correct Answer: C
Rationale: Walking every hour during long trips improves circulation and reduces the risk of deep vein thrombosis.