HEALTH PROMOTION

A client in labor is attached to an electronic fetal monitor (EFM). Which finding by an EFM indicates adequate uteroplacental and fetal perfusion? fetal heart rate variability within 5 to 10 beats/minute persistent fetal bradycardia late decelerations variable decelerations and sinusoidal pattern

Fetal heart rate variability most reliably indicates uteroplacental and fetal perfusion; an average variability of 5 to 10 beats per minute is considered normal. Persistent fetal bradycardia may signal hypoxia, arrhythmias, or fetal cord compression. Late decelerations indicate decreased blood flow and oxygen to the intervillous spaces during uterine contractions — an abnormal pattern. Variable decelerations suggest umbilical cord compression; a sinusoidal pattern signals severe fetal anemia or asphyxiation.

The inability of an 18-month-old child to perform what activity would cause the nurse to be concerned? copying a circle playing with pull toys playing tag with other children building a tower of eight blocks

Playing with pull toys is a typical task of a normally developed 18-month-old child. Inability of the toddler to do so would be a concern.Copying a circle and building a tower of eight or more blocks is a behavior typical of a 3-year-old child.Playing tag with other children requires cooperative play and the ability to follow rules; this behavior develops at about age 5 years.

The parents of a 9-month-old bring the infant to the clinic for a regular checkup. The infant has received no immunizations. Which vaccine if prescribed would the nurse question? diphtheria, tetanus, and acellular pertussis (DTaP) Haemophilus influenzae type B (Hib) measles, mumps, and rubella (MMR) inactivated influenza (Flu)

The MMR is a live vaccine. Neither the American Academy of Pediatrics nor the Public Health Agency of Canada recommends routine vaccination with the MMR (either alone or combined with the varicella vaccine) to children younger than 12 months. The DTaP, Hib, and Influenza are all indicated.

A nurse can auscultate for heart sounds more easily if the client is supine. on his right side. holding his breath. leaning forward.

The nurse can best auscultate for heart sounds by asking the client to lean forward and exhale forcefully. This position enables the nurse to listen for heart sounds without the sound of expiration interfering. Using the supine position to visually inspect the precordium allows the nurse to observe the chest wall for movement, pulsations, and exaggerated lifts or strong outward thrusts over the chest during systole. Placing the client in a left lateral decubitus position may make it easier for the nurse to hear low-pitched sounds related to atrioventricular valve problems.

The nurse is developing an educational program about prostate cancer. The nurse should provide information about which topic? The Prostate-Specific Antigen (PSA) test is reliable for detecting the presence of prostate cancer. For all men, age 50 and older, the American and Canadian Cancer Societies recommend an annual rectal examination. Men over 50 should have a colonoscopy. Regular sexual activity promotes health of the prostate gland to prevent cancer.

Most cases of prostate cancer are adenocarcinomas. An adenocarcinoma is palpable on rectal examination because it arises from the posterior portion of the gland. Although the PSA is not a perfect screening test, the American Cancer Society and the Canadian Cancer Society recommend an annual rectal examination and blood PSA level for all men age 50 years and older, or starting at age 40 years if the client is of African descent, or if there is family history of prostate cancer. A colonoscopy is performed to diagnose colon cancer, not prostate cancer. Regular sexual activity does not prevent cancer of the prostate.

Which client statement indicates effective teaching about burping a breastfed neonate? "Breastfed babies who are burped frequently will take more on each breast." "If I supplement the baby with formula, I will rarely have to burp him." "I will breastfeed my baby every 3 hours so I won't have to burp him." "When I switch to the other breast, I'll burp the baby."

Breastfed neonates do not swallow as much air as bottle-fed neonates, but they still need to be burped. Good times to burp the neonate are when the mother switches from one breast to the other and at the end of the breastfeeding session. Neonates do not eat more if they are burped frequently. Breastfeeding mothers are advised not to supplement the feedings with formula because this may cause nipple confusion and decrease milk production. If supplements are given, the baby still needs to be burped. Neonates who are fed every 3 hours still need to be burped.

The mother of a neonate expresses concern about how to continue breastfeeding when she returns to work in 6 weeks. How should the nurse respond? "It's a challenge now, but you'll be an expert at breastfeeding by then!" "If things get difficult, don't feel guilty if you need to supplement with formula." "Speak to your employer to see if they'll allow you time to express milk while you're at work." "You can develop and practice a plan now for expressing milk and feeding so you're ready."

Telling the mother she will be an expert in 6 weeks is dismissive of the client's concern. Breastfeeding should continue for at least 6 months after birth, if possible, for maximum benefits, so the nurse should not encourage the client to use formula if she requests breastfeeding support. Breast milk can be pumped before and during work to give to the neonate. The nurse should inform the client that laws require time be provided for mothers to pump at work, so the employer cannot refuse the request. Pumping will also support continuous milk production. Developing a plan and practicing it prior to going back to work will help the mother feel more confident and worry less during the transition time

Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate? Provide all needed teaching in one extended session. Validate the client's understanding of the material frequently. Conduct a one-on-one session with the client. Use video clips to reinforce the material as needed.

Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehension frequently. Because the client's ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videos.

During a preparation for parenting class, one of the participants asks the nurse, "How will I know if I am really in labor?" What should the nurse tell the participant about true labor contractions? "Walking around helps to decrease true contractions." "True labor contractions may disappear with rest or sleep." "The duration and frequency of true labor contractions remain the same." "True labor contractions are felt first in the lower back, then the abdomen."

With true labor, the contractions are felt first in the lower back and then the abdomen. They gradually increase in frequency and duration and do not disappear with ambulation, rest, or sleep. In true labor, the cervix dilates and effaces. Walking tends to increase true contractions. False labor contractions disappear with ambulation, rest, or sleep. False labor contractions commonly remain the same in duration and frequency. Clients who are experiencing false labor may have pain, even though the contractions are not very effective.

During a scheduled cesarean birth for a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean birth tend to have an increased incidence of which problem? congenital anomalies pulmonary hypertension meconium aspiration syndrome respiratory distress syndrome

Respiratory distress syndrome is more common in neonates born by cesarean section than in those born vaginally. During a vaginal birth, pressure is exerted on the fetal chest, which aids in the fetal inhalation and exhalation of air and lung expansion. This pressure is not exerted on the fetus with a cesarean birth. Congenital anomalies are not more common with cesarean birth. Pulmonary hypertension occurs more commonly in infants with meconium aspiration syndrome, congenital diaphragmatic hernia, respiratory distress syndrome, or neonatal sepsis, not with cesarean birth. Meconium aspiration syndrome occurs more commonly with vaginal birth, postterm neonate, and prolonged labor, not with cesarean birth.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise for 30 minutes. Which exercise frequency would meet the goals of planned exercise? at least once per week at least three times per week at least five times per week every day

Clients with diabetes must exercise at least 150 minutes per week to meet the goals of planned exercise — lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Thirty minutes five times a week would meet the minimum amount of exercise recommended. Exercising once or even three times per week wouldn't achieve these goals. While exercising every day may be beneficial, it is not required to meet the 150 minutes per week recommendation.