A patient with severe preeclampsia is on magnesium sulfate. Which initial action by the nurse would be most appropriate for a magnesium sulfate level of 7 mEq/L?

Correct Answer: B

Rationale: In this scenario, option B is the correct choice. When a patient with severe preeclampsia is on magnesium sulfate and the level reaches 7 mEq/L, it is crucial to contact the healthcare provider and report the level. This is because a magnesium level of 7 mEq/L is above the therapeutic range, increasing the risk of magnesium toxicity. Option A is incorrect because a level of 7 mEq/L is not within the therapeutic range, so simply monitoring the patient would be inadequate. Option C is incorrect as administering calcium gluconate is not the initial action for high magnesium levels; it is used to counteract the effects of magnesium toxicity. Option D is also incorrect as turning the patient and administering oxygen are not appropriate interventions for high magnesium levels. In an educational context, understanding the implications of magnesium sulfate levels in patients with preeclampsia is essential for nurses caring for these individuals. Recognizing the signs of magnesium toxicity and knowing the appropriate actions to take can prevent serious complications. This question highlights the importance of prompt communication with healthcare providers when abnormal lab values are identified, emphasizing the critical role of nursing assessment and intervention in ensuring patient safety.

Correct Answer: A

Rationale: In the scenario of a 33-year-old client experiencing 'back labor' during active labor, the most effective nursing intervention would be option A) Counterpressure against the sacrum. This technique involves applying firm pressure on the sacrum to alleviate the intense lower back pain commonly experienced during back labor. Counterpressure against the sacrum helps relieve the pressure on the lower back by stabilizing and supporting the sacrum, thereby reducing the discomfort associated with back labor. This technique is particularly effective as it targets the specific area of pain and provides physical support to the client during labor. Regarding why the other options are less effective: - Option B) Pant-blow breathing techniques may help manage pain and provide relaxation but may not directly address the intense lower back pain experienced during back labor. - Option C) Effleurage, a light stroking massage technique, may offer some comfort but may not provide the necessary pressure and support to alleviate the specific lower back pain in back labor. - Option D) Conscious relaxation or guided imagery can be beneficial for pain management in labor, but in the case of intense lower back pain like back labor, direct physical interventions like counterpressure against the sacrum are more effective. In an educational context, it is crucial for nursing students to understand the various techniques available to manage labor pain effectively. By learning about specific interventions like counterpressure against the sacrum for back labor, students can develop comprehensive skills to support clients during childbirth and enhance their overall nursing care delivery in obstetric settings.

Correct Answer: C

Rationale: The correct answer is C) A newborn lacks appropriate intestinal flora to synthesize vitamin K. This answer reflects an understanding of the physiological reason behind why newborns are administered vitamin K injections shortly after birth. This is because newborns have sterile intestines at birth and do not have the necessary gut bacteria to produce vitamin K through synthesis. Vitamin K is crucial for blood clotting, and a deficiency in newborns can lead to a rare but serious bleeding disorder called vitamin K deficiency bleeding (VKDB). Option A is incorrect because vitamin K does not directly increase platelets but rather helps in the clotting process. Option B is incorrect because while it is true that newborns have decreased levels of vitamin K due to the immaturity of their liver, the primary reason for the deficiency is the lack of gut flora. Option D is incorrect as vitamin K is not produced in the bone marrow but mainly in the gut. Educationally, understanding the rationale behind administering vitamin K to newborns is essential for healthcare professionals working with neonates to ensure the best outcomes and prevent complications related to vitamin K deficiency. This knowledge underscores the importance of evidence-based practices in newborn care.

Correct Answer: C

Rationale: In this scenario, the best contraception method for a 39-year-old patient who smokes one pack of cigarettes per day and has used combined hormonal contraceptives in the past is option C, contraceptives that contain progestin only. The rationale behind this choice lies in the increased risk of cardiovascular complications associated with the use of combined hormonal contraceptives, especially in individuals who smoke. Progestin-only contraceptives are considered safer for women with risk factors like smoking, as they do not carry the same thrombotic risks as estrogen-containing contraceptives. Option A, combined hormonal contraceptives, would not be the best choice due to the patient's smoking history, which increases the risk of cardiovascular events with estrogen-containing methods. Option B, a levonorgestrel intrauterine system, may not be the most suitable choice as it does not address the patient's need to avoid estrogen. Option D, levonorgestrel (systemic) progestin, is not as specific as progestin-only contraceptives and may not provide the same level of safety for this patient. Educationally, this question highlights the importance of considering individual patient factors, such as smoking history, when selecting an appropriate contraceptive method. It also emphasizes the need to understand the specific risks and benefits associated with different types of contraceptives to make informed decisions in clinical practice.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer because sexual development does not begin immediately upon initiation of androgen therapy. It takes time for the body to respond to hormonal changes, and significant changes in sexual development would not occur instantaneously. Option A is incorrect because a trial of androgen therapy for hypogonadism is typically long-term rather than a short 4- to 6-month period followed by rest. This therapy is usually continued unless there are adverse effects or lack of efficacy. Option C is incorrect because dosages of androgen therapy are adjusted based on clinical response and symptom improvement rather than solely relying on periodic plasma testosterone levels. Option D is incorrect because growth monitoring by radiography is not typically necessary for androgen therapy for hypogonadism unless there are specific concerns about bone health or growth patterns. From an educational perspective, understanding the timing and expectations of treatment outcomes in hormone therapy is crucial for healthcare providers to effectively educate patients and manage their expectations. It is important for nurses to provide accurate information to patients to ensure they have a clear understanding of their treatment plan and potential outcomes.