Nokea
Which snack is most appropriate for a pregnant client with nausea?
- A. Dry crackers
- B. Ice cream
- C. Spicy chips
- D. Carbonated soda
Correct Answer: A
Rationale: Dry crackers are bland and easy to digest, helping to alleviate nausea without exacerbating symptoms.
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In the process of preparing the client for discharge after cesarean section, the nurse addresses all of the following areas during discharge education. Which should be the priority advice for the client?
- A. How to manage her incision
- B. Planning for assistance at home
- C. Infant care procedures
- D. Increased need for rest
Correct Answer: B
Rationale: Although the client needs information about incision care, the priority need is for assistance at home so that she can get the rest needed for multiple demands. Because the client has had a surgical procedure, the priority consideration is for the mother to plan for additional assistance at home. Without this assistance, it is difficult for the mother to get the rest she needs for healing, pain control, and appropriate infant care. Infant care is important, but having assistance at home after a surgical procedure is more important. The need for increased rest is important, but she would not be able to obtain adequate rest without assistance at home.
The nurse explained the process of cervical effacement to the client in early labor. Which statement by the client indicates that she understands the information?
- A. “The cervix will widen from less than 1 cm to about 10 cm.”
- B. “The cervix will pull or draw up and become paper-thin.”
- C. “The cervical changes will cause my membranes to rupture.”
- D. “The cervical changes will help my baby to change position.”
Correct Answer: B
Rationale: In cervical effacement, the cervix progressively changes from a thick and long structure, to paper thin. This statement indicates that the client understands the information. Widening of the cervix describes cervical dilation, not effacement. Cervical changes will not cause membranes to rupture. The power of contractions causes cervical changes (effacement and dilation) and, possibly, membrane rupture. Cervical changes will not help the fetus to change position. Fetal descent is thought to occur from the pressure of contractions, especially from the fundus, and from the pressure of the amniotic fluid. Fetal position changes also occur from the fetal head and body adjusting to the maternal pelvis as they descend.
The nurse is reviewing the medication history of the client during preconception counseling. The client reports taking isotretinoin for acne. Which is the nurse’s best response?
- A. “Stop taking isotretinoin now! It can cause serious birth defects if you become pregnant.”
- B. “You need to be on some type of birth control right now. Getting pregnant is not an option.”
- C. “Talk with your HCP about changing isotretinoin before you consider becoming pregnant.”
- D. “Once you are off of isotretinoin for treating acne, you can then safely become pregnant.”
Correct Answer: C
Rationale: The best response is to have the client consult her HCP so another medication can be prescribed. This response indicates that isotretinoin (Accutane) is not safe but that alternative medications can be prescribed. Responding to the client emphatically can create anxiety and fear. Telling the client that getting pregnant is not an option is a paternal response and does not facilitate open communication. Clients must wait one month after cessation of isotretinoin before becoming pregnant.
The nurse is reviewing the laboratory test results of the pregnant client. Which laboratory test findings would require further follow-up from the nurse?
- A. Hemoglobin
- B. 50-g, 1-hour glucose test
- C. Glucosuria
- D. Proteinuria
Correct Answer: A
Rationale: The normal Hgb level should be 12—16 g/dL in the pregnant client. The nurse should encourage iron-rich foods. The 50-g 1-hour glucose test should be less than 140. Values over 140 warrant a 3-hour glucose screen to determine if the client has gestational diabetes. The presence of glucose in the urine (glucosuria) is negative, which is a normal finding. Proteinuria in trace amounts is common in pregnant women, although higher protein concentrations should be evaluated.
The oncoming shift nurse assesses the fundus of the postpartum client 6 hours after a vaginal birth and finds that it is firm. When the nurse then assists the client out of bed for the first time, blood begins to run down the client’s leg. Which action by the nurse in response to the client’s bleeding is correct?
- A. Explain that extra bleeding can occur with initial standing
- B. Immediately assist the client back into bed
- C. Push the emergency call light in the room
- D. Call the HCP to report this increased bleeding
Correct Answer: A
Rationale: Lochia normally pools in the vagina when the postpartum client remains in a recumbent position for any length of time. When the client then stands, gravity causes the blood to flow out. As long as the nurse knows the fundus is firm and not bleeding, a simple explanation to the client is all that is required. There is no reason to return the client to bed; the fundus is firm. There is no reason to push the emergency call light. Increased bleeding is an expected response when standing for the first time. There is no reason to call the HCP.