Nokea
Which of the patient health behaviors in the first trimester would the nurse identify as a risk factor in pregnancy?
- A. Sexual intercourse two or three times weekly
- B. Moderate exercise for 30 minutes daily
- C. Working 40 hours a week as a secretary in a travel agency
- D. Relaxing in a hot tub for 30 minutes a day, several days a week
Correct Answer: D
Rationale: The correct answer is D because relaxing in a hot tub for 30 minutes a day, several days a week can increase the body temperature, which is harmful during the first trimester and can lead to birth defects. Choice A is not a risk factor as it promotes a healthy sexual relationship. Choice B is beneficial as moderate exercise is recommended during pregnancy. Choice C is not necessarily a risk factor unless it involves exposure to harmful substances or excessive stress.
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A laboring woman, G4 P3003, who was 6 cm dilated 1 hour ago cries, 'Hurry. I have to go to the bathroom to have a bowel movement.' The nurse notes that there is an increase in bloody show. Which of the following actions by the nurse is appropriate?
- A. Assess cervical dilation.
- B. Help the woman to the bathroom.
- C. Ask the woman if she needs pain medicine.
- D. Check the fetal heart rate.
Correct Answer: A
Rationale: The urge to have a bowel movement and increased bloody show could indicate that the woman is entering the second stage of labor. The nurse should assess cervical dilation to confirm.
The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks' gestation. The nurse determines that the patient understands the teaching when she states that will be collected for the initial screening process?
- A. Urine
- B. Blood
- C. Saliva
- D. Amniotic fluid
Correct Answer: B
Rationale: The correct answer is B: Blood. Alpha-fetoprotein (AFP) screening is a test that measures the level of AFP in the mother's blood to screen for certain fetal abnormalities. AFP is a protein produced by the fetus and can be detected in the mother's blood. Blood is the most appropriate sample for this screening as it directly reflects the fetal AFP levels. Urine (A), saliva (C), and amniotic fluid (D) do not contain AFP in levels that can be accurately measured for this screening, making them incorrect choices. Blood is the standard and most reliable sample for AFP screening due to its direct correlation with fetal AFP levels.
A woman is seeking counseling regarding tubal ligation. Which of the following should the nurse include in her discussion?
- A. The woman will no longer menstruate.
- B. The surgery should be done when the woman is ovulating.
- C. The surgery is easily reversible.
- D. The woman will be under anesthesia during the procedure.
Correct Answer: D
Rationale: Tubal ligation is a permanent form of contraception and requires anesthesia. It does not affect menstruation, and reversal is not guaranteed.
A 42-week-gestation neonate is being assessed. Which of the following findings would the nurse expect to see?
- A. Folded and flat pinnae.
- B. Smooth plantar surfaces.
- C. Loose and peeling skin.
- D. Short pliable fingernails.
Correct Answer: C
Rationale: Post-term neonates often have loose and peeling skin due to prolonged exposure to amniotic fluid.
A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session?
- A. Managed care insures full coverage of health care costs.
- B. Managed care only assumes the financial risk involved.
- C. Managed care allows providers to focus on illness care.
- D. Managed care causes providers to focus on prevention.
Correct Answer: D
Rationale: Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated (fixed amount) payment for each patient enrolled in the program. Therefore, the focus of care shifts from individual illness care to prevention, early intervention, and outpatient care.