A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take?

Assist the client to void every 3 hr.

Monitor contractions every 30 min.

Place the client into a lithotomy position.

Encourage the client to use a pant-blow breathing pattern.

Answer and Explanation

The Correct Answer is D

Choice D rationale:

During the transition phase of labor, the nurse should encourage the client to use a pant- blow breathing pattern. The transition phase is intense, and pant-blow breathing (a form of controlled breathing) can help the client manage the pain and reduce anxiety. Panting during contractions allows the client to focus on short, shallow breaths, which can be more effective than deep breathing during this stage.

Choice A rationale:

Assisting the client to void every 3 hours is important during labor, but it is not specific to the transition phase. The nurse should encourage the client to void regularly during the entire labor process to prevent bladder distension and facilitate the descent of the baby. However, during the transition phase, the client may be more focused on contractions and may not need reminders to void every 3 hours.

Choice B rationale:

Monitoring contractions every 30 minutes is not appropriate during the transition phase of labor. The transition phase is characterized by frequent and strong contractions, and continuous monitoring of contractions is usually required during this phase to ensure fetal well-being and progress in labor.

Choice C rationale:

Placing the client into a lithotomy position is not appropriate during the transition phase of labor. The lithotomy position, where the client lies on their back with legs raised and supported in stirrups, is often used during the pushing phase. During the transition phase, it is more common for the client to be in an upright or semi-reclining position to facilitate the descent of the baby through the birth canal.

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Correct Answer is ["A","E"]

Explanation

Choice A rationale:

Nulliparity (never having given birth) is a known risk factor for ovarian cancer. Women who have never had children have a higher risk compared to those who have. This is believed to be associated with the number of ovulatory cycles a woman experiences throughout her lifetime.

Choice B rationale:

History of breastfeeding does not have a direct link to ovarian cancer risk. In fact, breastfeeding is associated with a reduced risk of both breast and ovarian cancer due to hormonal changes that occur during lactation.

Choice C rationale:

Previous use of oral contraceptives is associated with a decreased risk of ovarian cancer. Women who have used birth control pills have a lower risk compared to those who have never used them. The protective effect is believed to be due to the suppression of ovulation.

Choice D rationale:

History of breast cancer is not a risk factor for ovarian cancer. Although both cancers are related to the reproductive system, they have distinct risk factors and characteristics.

Choice E rationale:

Hormone replacement therapy (HRT) is a potential risk factor for ovarian cancer, especially long-term use. The hormones used in HRT can affect hormone levels and may increase the risk of ovarian cancer.

A. Hypertonia. B. Jitteriness. C. Acrocyanosis. D. Generalized petechiae.

Correct Answer is B

Explanation

Choice A rationale:

Hypertonia (increased muscle tone) is not a manifestation of hypoglycemia in a newborn. Instead, hypotonia (decreased muscle tone) is more characteristic.

Choice B rationale:

This is the correct choice. Jitteriness is a common sign of hypoglycemia in a newborn. It may be accompanied by other symptoms like poor feeding, tremors, and irritability.

Choice C rationale:

Acrocyanosis (bluish discoloration of the hands and feet) is a normal finding in newborns and is not specifically associated with hypoglycemia.

Choice D rationale:

Generalized petechiae (small red or purple spots on the skin caused by bleeding under the skin) are not indicative of hypoglycemia but may be associated with other medical conditions.

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A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a group of women about risk factors for ovarian cancer. Which of the following risk factors should the nurse include? (Select all that apply.)

Correct Answer is ["A","E"]

Explanation

A nurse is assessing a newborn whose mother had gestational diabetes. Which of the following findings should the nurse identify as a manifestation of hypoglycemia?

Correct Answer is B

Explanation

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