A nurse is caring for a client who is at 40 weeks of gestation and is in early labor. The client has a platelet count of 75,000/mm3 and is requesting pain relief. Which of the following treatment modalities should the nurse anticipate?

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Question 1 of 5

A nurse is caring for a client who is at 40 weeks of gestation and is in early labor. The client has a platelet count of 75,000/mm3 and is requesting pain relief. Which of the following treatment modalities should the nurse anticipate?

Correct Answer: C

Rationale: The correct answer is C: Attention-focusing. At 40 weeks gestation with a platelet count of 75,000/mm3, epidural analgesia is contraindicated due to the risk of epidural hematoma. Naloxone hydrochloride is an opioid antagonist used for opioid overdose, not for labor pain relief. Pudendal nerve block is used for local anesthesia during the second stage of labor, not for early labor pain relief. Attention-focusing techniques can help the client manage pain without pharmacological interventions, ensuring safety for both the client and the baby.

Question 2 of 5

A full-term newborn is being assessed by a nurse 15 minutes after birth. Which of the following findings requires intervention by the nurse?

Correct Answer: B

Rationale: Correct Answer: B (Respiratory rate 18/min) Rationale: A normal respiratory rate for a newborn is 30-60 breaths/min. A rate of 18/min is below the normal range, indicating potential respiratory distress requiring immediate intervention to ensure adequate oxygenation. Summary of other choices: A: Heart rate 168/min - Normal range for a newborn is 120-160/min. C: Tremors - Common in newborns due to immature nervous system, usually self-resolving. D: Fine crackles - May be present due to residual amniotic fluid and typically resolve without intervention.

Question 3 of 5

A client who is at 36 weeks of gestation and has a prescription for a nonstress test is being taught by a nurse. Which of the following statements should the nurse include in the teaching?

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.

Question 4 of 5

What is the most appropriate statement for a nurse to make to a client who has recently experienced a perinatal death?

Correct Answer: B

Rationale: The correct answer is B: "I'm sad for you." This response shows empathy and acknowledges the client's feelings without making assumptions or providing false reassurance. It validates the client's emotions and offers support. Incorrect choices: A: This statement assumes the client's feelings and may not be comforting. C: This statement is insensitive and can cause unnecessary guilt or blame. D: While well-intentioned, this statement may not align with the client's beliefs and can be dismissive of their grief.

Question 5 of 5

A client who is at 24 weeks of gestation and reports daily mild headaches is being cared for by a nurse. Which of the following instructions should the nurse include in the plan of care?

Correct Answer: B

Rationale: The correct answer is B: Recommend that the client perform conscious relaxation techniques daily. Headaches during pregnancy can be common due to hormonal changes and increased blood volume. The nurse should recommend non-pharmacological interventions like relaxation techniques to manage headaches safely without medication. Conscious relaxation techniques can help reduce stress and tension, potentially alleviating headaches. Ibuprofen (choice A) is not recommended during pregnancy due to potential harm to the fetus. Ginseng tea (choice C) is not safe for pregnant women as it may lead to complications. Soaking in a hot bath (choice D) with a water temperature of 105°F can raise the body temperature, which is not advised during pregnancy as it may harm the baby.

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