Nokea
Which of the following statements about a fetal biophysical profile would be incorporated into the teaching plan for a primigravid client with insulin-dependent diabetes?
- A. It determines fetal lung maturity.
- B. It is noninvasive using real-time ultrasound.
- C. It will correlate with the newborn's Apgar score.
- D. It requires the client to have an empty bladder.
Correct Answer: B
Rationale: Biophysical profiles are noninvasive and use real-time ultrasound.
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A multigravid client is in active labor with twins at 38 weeks' gestation. The nurse should monitor the client closely for symptoms of which of the following?
- A. Pregnancy-induced hypertension.
- B. Urinary tract infection.
- C. Chorioamnionitis.
- D. Precipitous delivery.
Correct Answer: D
Rationale: Twin pregnancies increase the risk of precipitous delivery due to uterine overdistension, which can lead to rapid labor. Hypertension, infections, or chorioamnionitis are possible but less specific to twins.
When developing the plan of care for a multiparous client in active labor who receives an epidural anesthetic, which of the following would the nurse anticipate that the physician will order if the client develops moderate hypotension?
- A. Ephedrine sulfate.
- B. Epinephrine (Adrenalin Chloride).
- C. Methylergonovine (Methergine).
- D. Atropine sulfate.
Correct Answer: A
Rationale: Ephedrine sulfate is commonly used to treat epidural-related hypotension by increasing blood pressure through vasoconstriction and cardiac stimulation. Epinephrine is for emergencies, methylergonovine treats uterine atony, and atropine addresses bradycardia.
A nurse is teaching a client about the use of spermicides. Which of the following instructions should the nurse include?
- A. Spermicides must be applied at least 1 hour before intercourse.
- B. Spermicides are most effective when used alone.
- C. Spermicides should be used with barrier methods for increased effectiveness.
- D. Spermicides provide long-term contraception for up to 24 hours.
Correct Answer: C
Rationale: Spermicides are most effective when used with barrier methods like condoms or diaphragms, as they increase efficacy. They should be applied 10-30 minutes before intercourse, are less effective alone, and are effective for about 1 hour, not 24 hours.
In which of the following maternal locations would the nurse place the ultrasound transducer of the external electronic fetal heart rate monitor if a fetus at 34 weeks' gestation is in the left occipitoanterior(LOA) position?
- A. Near the symphysis pubis.
- B. Two inches above the umbilicus.
- C. Below the umbilicus on the left side.
- D. At the level of the umbilicus.
Correct Answer: C
Rationale: The transducer should be placed below the umbilicus on the left side for LOA position.
A 30-year-old woman, G 4, P 4, has delivered a healthy term female neonate by cesarean delivery due to a nonreassuring fetal heart rate tracing. At 2 hours postpartum, the nurse assesses the client's retention catheter and observes that the client's urine is slightly red tinged. Which of the following should the nurse do next?
- A. Continue to monitor the client's input and output.
- B. Massage the client's fundus gently every 15 minutes.
- C. Assess the placement of the retention catheter.
- D. Contact the client's physician for further orders.
Correct Answer: C
Rationale: Red-tinged urine may indicate catheter trauma or misplacement, requiring assessment of catheter placement.