A nurse is planning care for a pre-term newborn who has a diagnosis of intraventricular hemorrhage (IVH).

Which of the following interventions should the nurse include in the plan?

Monitor vital signs and neurological status frequently

Administer antibiotics as prescribed

Elevate the head of the bed to 30 degrees

Provide supplemental oxygen as needed

Answer and Explanation

The Correct Answer is A

Monitor vital signs and neurological status frequently.

This is because intraventricular hemorrhage (IVH) is a common and serious complication of prematurity that can lead to hydrocephalus, cerebral palsy, and developmental delays. Monitoring vital signs and neurological status can help detect changes in intracranial pressure, bleeding, and infection.

Choice B is wrong because antibiotics are not indicated for IVH unless there is evidence of infection.

Choice C is wrong because elevating the head of the bed to 30 degrees can increase the risk of IVH by reducing cerebral perfusion pressure and causing venous congestion.

Choice D is wrong because supplemental oxygen is not recommended for IVH unless there is hypoxia or respiratory distress. Excessive oxygen can cause oxidative stress and vasoconstriction, which can worsen IVH.

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Correct Answer is C

Explanation

The therapeutic effect of magnesium sulfate is to inhibit uterine contractions and prevent or delay preterm labor.

By assessing uterine activity, the nurse can evaluate if the medication is working or not.

Choice A is wrong because measuring urine output is not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for toxicity and renal function.

Choice B is wrong because checking deep tendon reflexes is also not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for neuromuscular effects and toxicity.

Choice D is wrong because monitoring blood pressure is not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for cardiovascular effects and toxicity.

A. Avoid sexual intercourse until term B. Drink at least 3 L of fluids per day C. Report any increase in vaginal discharge to the provider D. Perform pelvic floor exercises daily

Correct Answer is C

Explanation

Report any increase in vaginal discharge to the provider.This is because an increase in vaginal discharge can indicate an infection, which can trigger preterm labor or cause complications for the mother and the baby.

Choice A is wrong because sexual intercourse is not contraindicated for women who have preterm labor that was successfully stopped with tocolytic therapy, unless they have other risk factors such as placenta previa or ruptured membranes.

Choice B is wrong because drinking at least 3 L of fluids per day is not necessary for women who have preterm labor that was successfully stopped with tocolytic therapy, unless they have dehydration or oligohydramnios.

Choice D is wrong because pelvic floor exercises are not recommended for women who have preterm labor that was successfully stopped with tocolytic therapy, as they can increase uterine activity and cause contractions.

Tocolytic therapy is the use of drugs to delay delivery for a short time (up to 48 hours) if a woman begins labor too early in her pregnancy.

The purpose of tocolytic therapy is to allow time for the administration of corticosteroids or other medicine.

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A nurse is planning care for a pre-term newborn who has a diagnosis of intraventricular hemorrhage (IVH). Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is receiving magnesium sulfate for pre-term labor. Which of the following assessments should the nurse perform to evaluate the therapeutic effect of the medication?

Correct Answer is C

Explanation

A nurse is planning discharge teaching for a client who is at 25 weeks of gestation and has pre-term labor that was successfully stopped with tocolytic therapy. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is providing education to a client who had pre-term labor and was prescribed indomethacin. Which of the following information should the nurse include in the teaching?

A nurse is providing discharge instructions to a client who had pre-term labor at 32 weeks of gestation and was prescribed bed rest at home. Which of the following statements by the client indicates an understanding of the teaching?

A nurse is performing a digital examination on a client who is at 34 weeks of gestation and has pre-term labor. Which of the following findings indicates cervical effacement?

A client at 28 weeks of gestation presents with bleeding from the vagina. Which assessment finding should the nurse prioritize?

A nurse is administering terbutaline to a client who is at 31 weeks of gestation and has pre-term labor. Which of the following findings should the nurse monitor as an adverse effect of this medication?

A nurse is evaluating the fetal heart rate tracing of a client who is in pre-term labor and receiving magnesium sulfate. The nurse should identify that which of the following patterns indicates a potential adverse effect of the medication on the fetus?

A nurse is teaching a client who is at risk for pre-term labor about the signs and symptoms to report to the provider. Which of the following should the nurse include in the teaching?

A nurse is preparing to perform an amniocentesis on a client who is at 27 weeks of gestation and has pre-term labor. Which of the following actions should the nurse take before the procedure?

A nurse is planning care for a pre-term newborn who has a diagnosis of intraventricular hemorrhage (IVH).

Which of the following interventions should the nurse include in the plan?