A charge nurse on the postpartum unit is observing a newly licensed nurse who is preparing to administer pain medication to a client. The charge nurse should intervene when the newly licensed nurse uses which of the following secondary identifiers to identify the client?

Correct Answer: A

Rationale: The correct answer is A: The client's room number. Using the client's room number as a secondary identifier is not appropriate as it does not uniquely identify the client and can lead to errors. The room number may change, or there could be multiple clients in the same room. Telephone number, birth date, and medical record number are more reliable secondary identifiers as they are unique to the client and less likely to be confused with another individual. It is essential to use accurate and reliable identifiers to ensure patient safety and prevent medication errors.

Correct Answer: D

Rationale: Step 1: Betamethasone is a corticosteroid that promotes fetal lung maturity by stimulating the production of surfactant, essential for lung function. Step 2: At 32 weeks, the fetus may benefit from accelerated lung development to reduce respiratory distress. Step 3: Calcium gluconate is used for hypocalcemia, not for fetal lung maturity. Step 4: Indomethacin is a nonsteroidal anti-inflammatory drug used to delay preterm labor, not for lung maturity. Step 5: Nifedipine is a calcium channel blocker to prevent preterm labor, not for fetal lung maturity.

Correct Answer: C

Rationale: The correct answer is C: This is due to the weight of the uterus on the vena cava. Maternal hypotension during pregnancy can occur when the growing uterus compresses the vena cava, reducing blood flow back to the heart and causing a drop in blood pressure. This compression can lead to decreased blood flow to the brain and other vital organs, resulting in symptoms of hypotension. The other choices are incorrect because: A: An increase in blood volume during pregnancy typically leads to an increase in blood pressure, not hypotension. B: Pressure from the uterus on the diaphragm may cause discomfort or shortness of breath but is not the primary cause of maternal hypotension. D: Increased cardiac output is a normal adaptation in pregnancy to meet the demands of the growing fetus and placenta, but it does not directly cause maternal hypotension.

Correct Answer: B

Rationale: The correct answer is B: Lecithin/sphingomyelin (L/S) ratio. This test is used to assess fetal lung maturity by determining the ratio of two substances present in amniotic fluid. An L/S ratio of 2:1 or higher indicates mature fetal lungs, reducing the risk of respiratory distress syndrome in preterm infants. A: Alpha-fetoprotein (AFP) is used to screen for neural tube defects, not fetal lung maturity. C: Kleihauer-Betke test is used to detect fetal-maternal hemorrhage. D: Indirect Coombs' test is used to detect antibodies in maternal blood that may attack fetal red blood cells, not assess fetal lung maturity. In summary, the L/S ratio test is the most appropriate choice to assess fetal lung maturity during preterm labor, as it directly correlates with the development of the fetal lungs.

Correct Answer: C

Rationale: The correct answer is C: A blood glucose of 130 to 140 mg/dL is considered a positive screening result. This statement is the correct teaching point because for a 1-hour glucose tolerance test during pregnancy, a blood glucose level of 130-140 mg/dL is considered elevated and may indicate gestational diabetes. The other choices are incorrect: A is wrong because the glucose solution is typically consumed one hour before the test, not prior to the test itself. B is incorrect as limiting carbohydrate intake is not necessary for this test. D is also incorrect because fasting for 8 hours is not required for a 1-hour glucose tolerance test.

Correct Answer: D

Rationale: The correct answer is D: All of the above. Cholecystitis, hypertension, and migraine headaches are all contraindications to oral contraceptives. Cholecystitis can be exacerbated by oral contraceptives. Hypertension increases the risk of cardiovascular events with oral contraceptives. Migraine headaches, especially with aura, are associated with an increased risk of stroke when combined with oral contraceptives. Therefore, considering these risks, it is crucial to recognize these findings as contraindications to prescribing oral contraceptives.

Correct Answer: C

Rationale: The correct answer is C: "You will be offered orange juice to drink during the test." This statement is correct because providing orange juice to the client during the nonstress test can stimulate fetal movement, making it easier to monitor the baby's heart rate. This can help in obtaining a more accurate assessment of the baby's well-being. Incorrect options: A: IV fluid administration is not typically required for a nonstress test, so this statement is incorrect. B: The procedure can actually take longer than 10 to 15 minutes, depending on various factors, so this statement is inaccurate. D: Informed consent is usually obtained once, not before each test, so this statement is not necessary for the client to know in this context.

Correct Answer: C

Rationale: To calculate the mL/hr for the IV infusion pump, we need to use the formula: (Desired dose in mg/hr * Volume of solution in mL) / Concentration of solution in mg/mL. Given: Desired dose = 2 g/hr = 2000 mg/hr Volume of solution = 500 mL Concentration of solution = 20 g in 500 mL = 20,000 mg in 500 mL = 40 mg/mL Now, plug these values into the formula: (2000 mg/hr * 500 mL) / 40 mg/mL = 25,000 mL/hr Round this to the nearest whole number, which is 25,000 mL/hr ≈ 50 mL/hr. Therefore, the IV infusion pump should be set to administer 50 mL/hr, making choice C the correct answer. Option A (60 mL/hr) and Option D (80 mL/hr) are incorrect as they do not match the calculated value. Option

Correct Answer: B

Rationale: The correct answer is B because verifying the newborn's identification ensures the right baby is in the nursery. It is crucial for patient safety and prevents mix-ups. Confirming identification (choice A) is important but comes after verification. Administering vitamin K (choice C) is a necessary procedure but not the first priority. Determining obstetrical risk factors (choice D) is important but not as immediate as verifying identification. Thus, verifying the newborn's identification should be done first to prevent errors and ensure proper care.