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

True labor contractions cause cervical dilation and effacement.

This means that the cervix opens up and thins out to prepare for the baby’s passage through the birth canal.

Cervical changes can be measured by a pelvic exam.

Choice A is wrong because true labor contractions are regular and do not subside with rest.False labor contractions are irregular and may stop when you change position or activity level.

Choice B is wrong because false labor contractions are usually felt in the front of the abdomen, not in the lower back.True labor contractions may start in the back and radiate to the abdomen.

Choice D is wrong because false labor contractions do not increase in intensity with ambulation.True labor contractions may become stronger and closer together when you walk.

Normal ranges for cervical dilation and effacement vary depending on the stage of labor, but generally, full dilation is 10 cm and full effacement is 100%.

A. “This medication will help prevent seizures in case I develop preeclampsia.” B. “This medication will help mature my baby’s lungs in case he is born early.” C. “This medication will help relax my uterus and stop contractions.” D. “This medication will help lower my blood pressure in case it gets too high.”

Correct Answer is C

Explanation

This medication will help relax my uterus and stop contractions.

Magnesium sulfate is a tocolytic, a medication used to suppress uterine contractions and delay preterm delivery.The exact mechanism through which magnesium sulfate inhibits contractions is unknown, but researchers believe it likely works by lowering calcium levels in the uterine muscles.

Choice A is wrong because magnesium sulfate is not used to prevent seizures in case of preeclampsia.

Preeclampsia is a condition characterized by high blood pressure and protein in the urine during pregnancy.Magnesium sulfate may be used to treat seizures if they occur with eclampsia, which is a severe complication of preeclampsia.

Choice B is wrong because magnesium sulfate does not help mature the baby’s lungs in case of preterm birth.

Magnesium sulfate may have some neuroprotective effects for the baby, but it does not affect lung development.Steroids are usually given to pregnant women at risk of preterm delivery to help accelerate fetal lung maturation.

Choice D is wrong because magnesium sulfate does not lower blood pressure in case it gets too high.

Magnesium sulfate may have some vasodilatory effects, but it is not used as an antihypertensive agent.Other medications, such as hydralazine or labetalol, are used to treat high blood pressure during pregnancy.

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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 teaching a client who is at 27 weeks of gestation and has pre-term labor about the signs and symptoms of true labor versus false labor. Which of the following information should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is teaching a client who is at 25 weeks of gestation and has pre-term labor about the purpose and side effects of magnesium sulfate therapy. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

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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?