The nurse is discussing travel with a pregnant client. The client is in good
health and the fetus is developing normally. The nurse is correct to provide
which recommendation?
A. Stop to walk every hour during car travel
B. Receive MMR vaccine prior to foreign travel
C. Avoid airport security checkpoints
D. Do not travel long distances during pregnancy - CORRECT ANSWERS-A.
Stop to walk every hour during car travel
It is generally safe for women to travel during low-risk pregnancies. During
car travel, the client should stop every hour and walk to prevent blood clots.
Which condition should the nurse recognize as a contraindication to tocolytic
therapy?
A. Cardiac disease
B. Tachypnea
C. Hypotension
D. Decreased vaginal bleeding - CORRECT ANSWERS-A. Cardiac disease
Tocolytics are medications given to stop uterine contractions and impending
delivery of a fetus. The nurse should recognize cardiac disease as a
contraindication to tocolysis.
The nurse assesses a pregnant client who has received oxytocin. Upon
assessment, the nurse finds uterine tachysystole with nonreassuring fetal
heart rhythm. Which action should the nurse take first?
A. Stop the oxytocin
B. Administer 1000ml IV bolus of NS
C. Reposition the client in semi-fowler's position
D. Prepare the client to deliver - CORRECT ANSWERS-A. Stop the oxytocin
Uterine tachysystole is a condition of excessive uterine contractions and is
considered an emergency causing potential to the fetus and an increase risk
of uterine rupture. The first priority for the nurse is to reduce uterine
contractions by stopping the oxytocin infusion.
,Which type of visual impairment is corrected by increasing visual stimulation
to the weaker eye, by patching the stronger eye?
A. Myectopia
B. Strabismus
C. Ophritis
D. Anisometropia - CORRECT ANSWERS-B. Strabismus
Strabismus is a result of muscle imbalance or paralysis causing a deviation in
the visual axes. By patching the stronger vision eye, the outcome goal is to
strengthen the muscles of the weaker eye.
A child with cataracts has an increased risk for developing which condition?
A. Amblyopia
B. Glaucoma
C. Hyperopia
D. Myopia - CORRECT ANSWERS-A. Amblyopia
Amblyopia results when one eye does not receive sufficient stimulation.
Eventually, the brain no longer responds to visual stimuli and permanent loss
of vision may occur in the involved eye. If left untreated, cataracts in
children may lead to severe and permanent loss of vision due to amblyopia.
The nurse is educating client who has been diagnosed with pregnancy-
induced hypertension (PIH) and placed on a sodium restriction. Which
statement by the client indicates that the teaching has been effective?
A. "I should avoid eating potato chips."
B. "I should limit sodium intake to correct my hypotension."
C. "Too much sodium can cause central nervous system malformations."
D. "Consuming canned foods will help reduce my sodium levels." - CORRECT
ANSWERS-A. "I should avoid eating potato chips."
Sodium restriction is often not necessary for pregnant clients, unless they
are at an increase risk of pregnancy-induced hypertension (PIH). Teaching
has been effective when the client states that she should avoid potato chips,
which are high in sodium and low in nutrients.
The nurse is discussing risks associated with urinary changes during
pregnancy with a group of nursing students. Which information should the
nurse share with the students?
A. Increased urinary stagnation causes urinary tract infections
B. Increased urinary frequency causes sodium depletion
Clients will experience urinary changes throughout pregnancy. Stagnation of
urine due to anatomical changes due to the enlarging uterus placing
pressure on the bladder increases maternal risk of urinary tract infections.
The nurse is caring for a pregnant client who also has a school-age child. The
client is concerned about preparing the child to be an older sibling. Which
should the nurse recognize as the most effective strategy for helping the
older sibling adapt?
A. Show the child where and how to touch the baby
B. Involve the child in bringing the baby home
C. Encourage the child to interact with the baby
D. Feed the baby separately from the child - CORRECT ANSWERS-A. Show
the child where and how to touch the baby
The school-age child generally takes a more specific, or clinical interest in
the mother's pregnancy. Showing the child where and how to touch the baby
is one way to help the older child adapt to the new sibling.
The nurse is examining a client who believes she is pregnant. Which
presumptive sign should the nurse recognize as a possible indication of
pregnancy?
A. Urinary frequency
B. Breast changes
C. Amenorrhea
D. Quickening - CORRECT ANSWERS-A. Urinary frequency
Presumptive signs of pregnancy include quickening, amenorrhea, breast
changes, and urinary frequency. The nurse should recognize that urinary
frequency can be a sign of pregnancy because the hCG hormone increases
the blood flow to the kidneys during pregnancy and the pressure of the
enlarging uterus on the bladder during the first trimester.
The nurse has administered Rh immune globulin to a client. The nurse should
report which adverse effect of this medication to the health care
immediately?
A. Muscle pain
B. Insomnia
C. Bradycardia
D. Hypertension - CORRECT ANSWERS-D. Hypertension
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