Nokea
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
- A. Determining cervical dilation and effacement
- B. Monitoring FHR and maternal vital signs
- C. Observing vaginal bleeding or leakage of amniotic fluid
- D. Determining frequency, duration, and intensity of contractions
Correct Answer: A
Rationale: The correct answer is A: Determining cervical dilation and effacement. This assessment is contraindicated for a patient with suspected placenta previa because it can lead to further disruption of the placenta and potentially cause severe bleeding. Monitoring FHR and vital signs (B) is important for assessing fetal well-being and maternal status. Observing vaginal bleeding or amniotic fluid leakage (C) is crucial in identifying complications. Determining the frequency, duration, and intensity of contractions (D) is essential for monitoring labor progression but is not appropriate for a patient with suspected placenta previa due to the risk of placental disruption.
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A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. Which is the immediate nursing action?
- A. Administering oxygen
- B. Elevating the head of the bed
- C. Drawing blood for a hematocrit level
- D. Giving an intramuscular analgesic
Correct Answer: A
Rationale: The correct immediate nursing action is to administer oxygen (Choice A) to ensure adequate oxygenation for both the mother and the fetus. Oxygen is crucial in cases of vaginal bleeding as it helps maintain tissue perfusion and prevent hypoxia. Elevating the head of the bed (Choice B) is not the priority as oxygenation should be addressed first. Drawing blood for a hematocrit level (Choice C) may provide valuable information but does not address the immediate need for oxygen. Giving an intramuscular analgesic (Choice D) is not appropriate without knowing the cause of the pain and bleeding.
A pregnant client with a history of preterm labor is at home on bed rest. Which instruction would be included in this client's teaching plan?
- A. Place blocks under the foot of the bed.
- B. Sit upright with several pillows behind the back.
- C. Lie on the side with the head raised on a small pillow.
- D. Assume the knee-chest position at regular intervals throughout the day.
Correct Answer: C
Rationale: The correct answer is C: Lie on the side with the head raised on a small pillow. This position helps improve circulation to the uterus and placenta, reducing the risk of preterm labor. Lying on the left side also promotes optimal blood flow. Option A is incorrect as elevating the foot of the bed can decrease blood flow to the placenta. Option B may cause discomfort and increase pressure on the cervix. Option D is not suitable for bed rest as it involves being on all fours, which is not conducive to rest and relaxation.
Which position increases cardiac output in the obstetrical client with cardiac disease?
- A. Trendelenburg
- B. Low semi-Fowler
- C. Lateral positioning
- D. Supine with legs elevated
Correct Answer: C
Rationale: The correct answer is C: Lateral positioning. This position increases cardiac output in obstetrical clients with cardiac disease by improving venous return to the heart, reducing pressure on the vena cava, and optimizing uteroplacental perfusion. The other choices are incorrect because Trendelenburg can worsen cardiac function by increasing venous return and intracardiac volume, low semi-Fowler does not optimize venous return and may decrease preload, and supine positioning with legs elevated can compress the vena cava, leading to decreased cardiac output and potential hypotension.
Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage?
- A. 10th and 12th weeks of gestation
- B. 18th and 22nd weeks of gestation
- C. 24th and 28th weeks of gestation
- D. 36th and 40th weeks of gestation
Correct Answer: C
Rationale: The correct answer is C (24th and 28th weeks of gestation) because during the second and third trimesters of pregnancy, insulin needs typically increase due to hormonal changes causing insulin resistance. This is when the placenta produces hormones that interfere with insulin, leading to higher blood sugar levels. Choices A, B, and D are incorrect because they do not align with the typical pattern of insulin dosage adjustments during pregnancy for clients with type 1 diabetes.
What medication is not recommended for hypertension during pregnancy due to teratogenic effects?
- A. lisinopril
- B. nifedipine
- C. labetalol
- D. hydralazine
Correct Answer: A
Rationale: The correct answer is A: lisinopril. Lisinopril is contraindicated in pregnancy due to its teratogenic effects, particularly in the first trimester. It can cause fetal harm, including renal dysfunction and skull hypoplasia. Nifedipine, labetalol, and hydralazine are considered safe options for hypertension during pregnancy with no known teratogenic effects.