A 25-year-old female, with no prenatal care, is brought into your LAD unit by ambulance with vagina bleeding Based upon what she thinks in her LMP, she is suspected of being 26 weeks of gestation. The patients combative, yelling at staff, and refuses to change into a patient gown. The nurse suspects possible drug use and history of psychological disorders. She has had no prenatal care. What is not an appropriate nursing action at this time?

Ensure that the patient's external environment is free from excessive stimuli.

Ask her what drugs she has taken and when was the last time.

Administer prescribed sedatives.

Perform a vaginal exam.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Ensuring a calm environment by minimizing excessive stimuli is important for the safety and well-being of the patient.

B. Asking about drug use is essential to understand potential risks and provide appropriate care.

C. Administering sedatives to a combative patient without assessing the situation further could be dangerous. It could harm the patient and fetus, especially if drug use or psychological disorders are suspected.

D. Performing a vaginal exam is necessary to assess bleeding and determine if there are any signs of preterm labor or other complications.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is ["A","C","D","F"]

Explanation

A. Tachysystole refers to excessive uterine contractions, which can cause fetal distress and indicates a category 3 strip.

B. Tachycardia with minimal variability does not qualify as a category 3 pattern; it is concerning but not as severe as category 3.

C. Late decelerations with absent variability are highly concerning for fetal compromise, making the strip category 3.

D. A sinusoidal pattern indicates severe fetal distress and categorizes the strip as category 3.

E. Absent variability with no periodic changes may suggest a non-reassuring pattern but is not categorized as a category 3 strip unless other signs of fetal distress are present.

F. Bradycardia with absent variability is another critical pattern, indicating poor fetal oxygenation and requiring intervention, categorizing it as a category 3 strip.

G. Late decelerations with moderate variability indicate a category 2 strip, not category 3.

H. Variable decelerations with absent variability can be concerning, but it doesn't automatically classify as category 3 without further complications.

A. 3 lbs per week for each week of pregnancy B. 35-40 lbs throughout the entire pregnancy C. 15-20 lbs throughout the entire pregnancy D. Less than a 1lb per week for each week of pregnancy.

Correct Answer is C

Explanation

A. 3 lbs per week is too high for someone with a BMI of 16 and could lead to excessive weight gain.

B. 35-40 lbs is too broad and may not be suitable for this patient's low BMI, which typically requires a more controlled approach.

C. For a patient with a BMI of 16 (underweight), the recommended weight gain during pregnancy is generally between 28-40 pounds, but given the patient's lower weight, 15-20 lbs is a realistic goal for weight gain, allowing for healthy fetal development.

D. Less than 1lb per week could be too slow, potentially leading to insufficient fetal growth.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Select the four criteria below that would indicate a category 3 fetal monitor strip.

Correct Answer is ["A","C","D","F"]

Explanation

A patient has a BMI 16 and weighs 96lbs and asks what the appropriate amount of weight she should gain with har pregnancy. Which of the following would be the best answer

Correct Answer is C

Explanation

A patient comes to the clinic to be tested for Gonorrhea. Which of the following is true of this particular STD? Select all that apply

A woman is 12 weeks pregnant. She has a 5 year old son born at 38 weeks and 3 year old twin daughters that were born at 36 weeks gestation. She had one other pregnancy that terminated spontaneously at 8 weeks. You would document this as

A. A blood pressure of 94/60 is low but not typically a contraindication for Terbutaline administration.

Temp 98.6 (O) Sp02 98% on RA FHR 155 with minimal variability Exhibits Which of the following will you recommend for this patient? (Select all that apply)

A nurse is developing a care plan for a patient with a medical diagnosis of endometriosis. Based upon her predicted symptoms, what is the priority nursing diagnosis?

59. When a women is being evaluated for her pregnancy, there are a number of tests and procedures that are performed from the beginning of the pregnancy to the end. Please put the test and procedure the order that they are supposed to occur in the normal pregnancy.

The nurse is evaluating the effectiveness of breastfeeding of a neonate prior to discharge. Which of the following would be included in the LATCH score? (Select all that apply).