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A nurse is assessing a client who received magnesium sulfate to treat preterm labor. Which of the following clinical findings should the nurse identify as an indication of toxicity of magnesium sulfate therapy and report to the provider?
- A. Respiratory depression
- B. Facial flushing
- C. Nausea
- D. Drowsiness
Correct Answer: A
Rationale: The correct answer is A: Respiratory depression. Respiratory depression is a serious sign of magnesium sulfate toxicity as it can progress to respiratory arrest. Magnesium sulfate acts as a central nervous system depressant, leading to muscle weakness and respiratory depression. Facial flushing is a common side effect but not indicative of toxicity. Nausea and drowsiness are common side effects of magnesium sulfate therapy and are not specific signs of toxicity. Reporting respiratory depression promptly is crucial to prevent further complications.
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A nurse is caring for a patient who discloses they are experiencing family violence. What nursing action should the nurse take to support the patient and promote their safety?
- A. Provide a safe environment for the patient to further disclose their experience.
- B. Converse with the patient’s partner and ask why IPV is occurring in their home.
- C. Report the patient’s accusations to other members of the family.
- D. Propose a plan to leave the abuser today.
Correct Answer: A
Rationale: The correct answer is A: Provide a safe environment for the patient to further disclose their experience. This is the most appropriate action as it prioritizes the patient's safety and well-being. By creating a safe space, the nurse can encourage the patient to share more details about the violence they are experiencing. This can help the nurse assess the situation accurately and provide necessary support and resources.
Choices B, C, and D are incorrect:
B: Conversing with the patient's partner and asking why IPV is occurring is inappropriate as it may put the patient at further risk and breach confidentiality.
C: Reporting the patient's accusations to other family members could worsen the situation and further endanger the patient.
D: Proposing a plan to leave the abuser today may not be feasible or safe without proper assessment and planning.
The nurse is assessing a client at 10 weeks' gestation with hyperemesis gravidarum. What is the priority nursing action?
- A. Encourage small, frequent meals.
- B. Monitor for signs of dehydration.
- C. Administer antiemetics as prescribed.
- D. Encourage fluid intake between meals.
Correct Answer: B
Rationale: The correct answer is B: Monitor for signs of dehydration. Dehydration is a serious complication of hyperemesis gravidarum and can lead to electrolyte imbalances and maternal-fetal complications. By monitoring for signs of dehydration, the nurse can intervene promptly to prevent further complications. Encouraging small, frequent meals (choice A) may help manage nausea but does not address the risk of dehydration. Administering antiemetics (choice C) may be necessary, but monitoring for dehydration takes precedence. Encouraging fluid intake between meals (choice D) is important, but assessing for dehydration is more critical in this situation.
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
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.
Which of the following conditions is concerning to The nurse recognizes which as a risk factor for placenta the infant nursery nurse? abruptio? Select all that apply.
- A. An infant who passes a thick, greenish to black
- B. Use of alcohol stool with each bowel movement
- C. Hypertension
- D. Hard, small, white papules on the face of the
Correct Answer: C
Rationale: Correct Answer: C - Hypertension
Rationale:
1. Hypertension is a known risk factor for placental abruption.
2. Hypertension can lead to poor placental perfusion, increasing the risk of abruption.
3. Proper monitoring and management of hypertension are crucial to prevent adverse outcomes.
Summary:
A, B, D are unrelated to placental abruption and not risk factors. Hypertension is directly linked to placental abruption due to its impact on placental perfusion.