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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.
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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.
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 in a provider's office is collecting data from a client who is at 34 weeks of gestation and reports having a sudden gush of vaginal fluid.
Which of the following manifestations is the priority?
- A. Fetal heart tones 98 /min
- B. Foul smelling vaginal discharge
- C. Amniotic fluid with meconium noted
- D. Maternal temperature 38.3°C (101°F)
Correct Answer: A
Rationale: Fetal bradycardia (98/min) indicates distress, requiring immediate intervention due to possible cord prolapse after membrane rupture.
A nurse is reinforcing teaching with a client who is at 10 weeks of gestation regarding the purposes of laboratory tests.
Which of the following statements by the client indicates an understanding of the teaching?
- A. Urine specific gravity identifies my risk for pregnancy-induced hypertension.
- B. White blood cell count is an indicator of anemia.
- C. Platelet count identifies if I am at risk for bleeding.
- D. Sedimentation rate checks for signs of cancer.
Correct Answer: C
Rationale: Platelet count assesses clotting function, identifying bleeding risk in conditions like gestational thrombocytopenia.
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.