A nurse is educating a group of pregnant women about neural tube defects.
Which of the following conditions should the nurse mention as an example of a neural tube defect?
Spina bifida.
Cerebral palsy.
Muscular dystrophy.
Hydrocephalus.
The Correct Answer is A
Choice A rationale
Spina bifida is indeed an example of a neural tube defect. It occurs when the neural tube doesn’t close completely somewhere along the spine during fetal development. This is the correct answer.
Choice B rationale
Cerebral palsy is not a neural tube defect. It is a group of disorders that affect a person’s ability to move and maintain balance and posture.
Choice C rationale
Muscular dystrophy is not a neural tube defect. It is a group of diseases that cause progressive weakness and loss of muscle mass.
Choice D rationale
Hydrocephalus is not a neural tube defect. It is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain.
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Correct Answer is C
Explanation
Choice A rationale
Having the patient void is not the immediate priority. While it is important to ensure the bladder is not distended, which could interfere with labor progress, the vital signs suggest a more urgent concern.
Choice B rationale
Asking the patient if she needs pain medication is important for comfort measures during labor, but it is not the immediate priority. The nurse’s first responsibility is to ensure the safety of the mother and baby.
Choice C rationale
Turning the patient on her side and rechecking the blood pressure is the correct action. The maternal blood pressure is low, which could indicate supine hypotensive syndrome. This occurs when the gravid uterus compresses the inferior vena cava when the woman is supine, reducing venous return to the heart. Turning the woman on her side may relieve this pressure and improve blood pressure.
Choice D rationale
Notifying the healthcare provider of the findings is important, but it is not the first action the nurse should take. The nurse should first address the mother’s hypotension by turning her on her side.
Correct Answer is B
Explanation
Choice A rationale
While it is important to notify the doctor, it is not the first action. The priority is to manage the patient’s symptoms and ensure their safety.
Choice B rationale
Administering diazepam is the correct first action. Delirium tremens is a severe form of alcohol withdrawal that can cause dangerous changes in breathing, blood pressure, and heart rate. Benzodiazepines like diazepam are the first line of treatment.
Choice C rationale
Obtaining a medical history is important, but it is not the first action. The priority is to treat the patient’s symptoms and stabilize their condition.
Choice D rationale
Raising the side rails of the bed is important for patient safety, but it is not the first action. The priority is to treat the patient’s symptoms. Diabetic ketoacidosisDiabetic ketoacidosis Explore
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