A pregnant patient is at 28 weeks gestation and reports occasional headaches and blurred vision. What is the nurse's priority action?

Correct Answer: A

Rationale: The correct answer is A: Monitor the patient's blood pressure and check for signs of preeclampsia. 1. Headaches and blurred vision are common symptoms of preeclampsia. 2. Preeclampsia is a serious condition that can lead to complications for both the mother and baby. 3. Monitoring blood pressure is crucial in diagnosing preeclampsia and determining the appropriate course of action. 4. Prompt assessment and management of preeclampsia are essential to prevent further complications. Incorrect choices: B: Administering pain relief and encouraging rest does not address the underlying cause of the symptoms, which could be preeclampsia. C: Assessing vision and scheduling an appointment with an eye specialist does not address the urgent need to assess for preeclampsia. D: Encouraging fluid intake and avoiding strenuous activity may be helpful in general, but they do not address the potential seriousness of preeclampsia in this

Correct Answer: A

Rationale: The correct answer is A: oxytocin (Pitocin). Oxytocin is commonly used postpartum to prevent hemorrhage and promote uterine contractions due to its ability to stimulate uterine muscle contractions. Oxytocin plays a crucial role in the physiological process of labor and delivery by helping the uterus contract and reduce bleeding. Fentanyl (B), epinephrine (C), and lorazepam (D) are not uterotonic medications and do not have the same effects on the uterus as oxytocin. Fentanyl is an opioid analgesic, epinephrine is a vasoconstrictor, and lorazepam is a sedative, none of which are indicated for preventing postpartum hemorrhage or promoting uterine contractions.

Correct Answer: A

Rationale: The purpose of Leopold's maneuver in labor and delivery is to assess fetal presentation and position. Step 1 evaluates the fundal grip to determine the fetal part. Step 2 assesses the sides of the abdomen to identify the fetal back. Step 3 determines the presenting part and position. Step 4 confirms the presenting part and its mobility. This systematic approach helps determine the position of the fetus in the uterus. Choices B, C, and D are incorrect as they do not align with the specific purpose of Leopold's maneuver, which is primarily focused on assessing fetal presentation and position.

Correct Answer: B

Rationale: The correct answer is B because the primary purpose of performing a vaginal examination during labor is to assess fetal well-being and progress of labor. By conducting a vaginal exam, healthcare providers can monitor the fetal heart rate, position, and stage of labor. This information helps determine if the labor is progressing normally and if any interventions are needed. Choice A is incorrect because cervical dilation and effacement can be assessed but are not the primary purpose. Choice C is incorrect as fetal distress is typically identified through other methods such as continuous fetal monitoring. Choice D is incorrect as assessing fetal descent and station can be done through vaginal examination but is not the primary purpose.

Correct Answer: A

Rationale: The correct answer is A: bradycardia. Fetal distress is often indicated by a decreased fetal heart rate (bradycardia), which can be a sign of inadequate oxygenation. Bradycardia is a serious concern in labor and requires immediate intervention. Tachycardia (B) is an increased heart rate, which can indicate fetal distress but is not as specific as bradycardia. Late decelerations (C) are associated with uteroplacental insufficiency, not necessarily fetal distress. Variable decelerations (D) are often related to cord compression and can be a sign of fetal distress, but bradycardia is a more direct indicator.