MC Remediation

A woman reports night sweats, sleep disturbances, and weight gain. Upon diagnosis, the woman has low levels of estrogen and is given hormonal therapy. Which nursing interventions would be beneficial to the client? Select all that apply.

Encourage physical activity Advise the client to take oral forms of estradiol with food Provide the client with instructions on self-administration The nurse should encourage the client to perform physical activities to reduce her weight. Taking oral forms of estradiol with food helps to minimize gastrointestinal upset. The nurse should provide instructions on self-administration of the drug for safety purposes. The nurse should not recommend long-term use of estradiol because of the potential toxic effects. The client should take estradiol at the same time every day so that effective hormone serum levels are maintained.

A client is prescribed uterine stimulants to augment labor. Which condition should be assessed in the client before initiating therapy?

PID Labor-inducing drugs are contraindicated in women who have pelvic inflammatory disease. Ovarian stimulants are contraindicated in women who have liver disease and pituitary tumors. Abortifacient drugs are contraindicated in women who have intrauterine devices.

Early in the ninth month of pregnancy a client experiences painless vaginal bleeding and is admitted to the hospital. What should the client's plan of care include?

Placing the client in the semi-Fowler position to increase cervical pressure Placing the client in the semi-Fowler position forces the heavy uterus to put pressure on the blood vessels at the site of the separating placenta, controlling bleeding to some extent. There is no indication that the clotting mechanism is disturbed. Performing a rectal examination is contraindicated with placenta previa; it may further dislodge the placenta. Enemas are contraindicated in any client admitted with vaginal bleeding.

After a vaginal hysterectomy and an anterior and posterior repair of the vaginal wall a client is returned to her room. Which action does the nurse include in the plan of care for this client?

Check vaginal packing. Vaginal packing supports the repair and provides slight pressure to prevent bleeding; the packing should be checked for bleeding. Elevating the legs is unnecessary; leg exercises and a gradual increase in ambulation are encouraged to prevent pulmonary emboli. There is no dressing, only vaginal packing and a sanitary pad. Sitz baths are not instituted until the packing is removed; an ice pack, heat lamp, or both may be used to promote comfort.

A client was administered oxytocin to induce labor, but the client was not responsive to the treatment. Which oral uterine stimulant is the next choice in this condition?

Misoprostol Misoprostol is an oral uterine stimulant that helps in inducing labor when the uterus is insensitive to oxytocin. Mifepristone can induce elective abortion. Dinoprostone induces the uterine contractions but is only available for vaginal use. Methylergonovine helps to prevent postpartum hemorrhage.

A lactating woman has developed thromboembolism. Which drug should be prescribed if she wishes to continue breast-feeding?

Heparin Heparin is the drug of choice to treat thromboembolism in a lactating woman because it is not absorbed in the breast milk. Aspirin may cause severe bleeding so is not preferred. Dicumarol may cause a hemorrhage and therefore is not preferred. Phenindione may cause a bruising effect and therefore is not the drug of choice.

A client at 40 weeks' gestation visits the prenatal clinic after finding a lump in her breast. Which clinical finding by the nurse requires further assessment?

Nodularity in an outer quadrant Although nodularity of the breasts may occur during pregnancy as a response to increased hormone levels, the greatest number of malignant tumors is located in the tail of Spence area, and further assessment is needed. An increased level of melanotropin, secreted by the anterior pituitary gland, causes darkening of the nipple areolae in all pregnant women. High levels of luteal and placental hormones stimulate the production of colostrum, and there may be leakage from one or both nipples at the end of pregnancy; it is a benign occurrence. There is an increased blood supply to the breasts causing vein engorgement; these blood vessels become visible as pregnancy progresses.

A registered nurse teaches a nursing student about caring a client who is prescribed estradiol to treat low estrogen levels. Which statement of the nursing student indicates a need for additional learning?

"I should avoid covering the medication with clothing after it is dried." Covering the medication with clothing after it is dried helps to prevent the transfer of the medication to other individuals. The nurse should instruct the client to apply the emulsion once a day on the thighs. The nurse should educate the client about the pharmacokinetic properties of the drug to ensure the drug's safe and effective administration. The nurse should advise the client to not apply sunscreen products at the same time because this action may reduce the absorption of estradiol.

A nurse teaches a client about side effects that will necessitate discontinuation of an oral contraceptive. Which statement made by the client indicates that the teaching is understood?

"I'll stop taking the pills if I have chest pain." Oral contraceptives should be discontinued with any symptom that may be related to a pulmonary embolus. Fluid retention is a common side effect of increased estrogen and progestin; discontinuation of the contraceptive is unnecessary. Leukorrhea may be a sign of infection, not a side effect of oral contraceptives. Abdominal pain in the middle of the menstrual cycle is not expected while an oral contraceptive is being taken. Abdominal pain in the area of an ovary that occurs midway during the menstrual cycle (mittelschmerz) usually indicates ovulation.

A client is found to have pelvic inflammatory disease, and the primary healthcare provider prescribes 2 g of intravenous cefotetan twice a day. The instructions on the vial of cefotetan say to reconstitute 20 mL of diluent to yield 1 g/10.5 mL. How much solution (mL) should the nurse add to the 100-mL bag of 0.9% sodium chloride? Record your answer using a whole number. ___ mL

21 - The prescribed dose is 2 g. The available concentration is 1 g in 10.5 mL. Use the dimensional analysis and/or ratio and proportions methods to determine how many milliliters the nurse should to the IVPB bag. Dimensional Analysis: 2 g x (10.5 mL / 1 g) = 21 mL

Which hormone levels do not need to be monitored during the administration of menotropins for infertility?

Gonadotropin-releasing hormone Menotropins that are administered for infertility act at the pituitary level. Gonadotropin-releasing hormones act at the hypothalamic level; therefore, this hormone does not need to be monitored. Menotropin is a standardized mixture of follicle-stimulating hormone and luteinizing hormone; these hormones should be monitored. Also, estrogen levels need to be monitored because the luteinizing hormone indirectly stimulates the production of estrogen.

The nurse is teaching a prenatal breathing and relaxation class. What intervention does the nurse suggest to ease back discomfort during labor?

Having support persons use back massage techniques The fetus exerts pressure against the spine during labor; back massage provides counterpressure, which eases the discomfort. The back-lying position is contraindicated because the weight of the fetus compresses the vena cava, decreasing the flow of blood to the placenta. Although abdominal effleurage can serve as a distraction during labor, it will not relieve back discomfort. The knee-chest position will also not relieve back pain during labor.

A client presents to the clinic with complaints of nausea and amenorrhea and reports that she obtained a positive result on a home pregnancy test. Which component of the history is most indicative of pregnancy?

Her urine immunoassay test is positive. A positive result on a urine pregnancy test is a probable sign of pregnancy because the test, based on the presence of human chorionic gonadotropin (hCG) in the urine, is 95% accurate in detecting pregnancy. Menses a week late is a presumptive sign of pregnancy; there are many other causes of amenorrhea. Urinary frequency is a presumptive sign of pregnancy; there are other causes of frequency, such as urinary tract infection. Nausea each morning, which may occur during the first trimester because of the secretion of hCG, is a presumptive sign of pregnancy; there are many causes of nausea other than the hormones secreted in early pregnancy.

A client undergoing treatment for a medical condition gave birth to a baby with renal failure as a result of the teratogenic effect of the medications. Which medical condition is the client likely getting treated for?

Hypertension Angiotensin-converting enzyme inhibitors used for treating hypertension may cause renal failure as a teratogenic effect. Treatment of cancer may cause central nervous system malformations. Treatment of epilepsy may cause growth delay. Antimicrobials may cause heart defects.

A client undergoing chemotherapy for cancer gave birth to a newborn with limb malformations. Which medication may have caused the limb malformations in this neonate?

Methotrexate When taken during pregnancy, methotrexate (MTX) may cause limb malformations. Because MTX is a folate antagonist and folate is required for healthy DNA and protein synthesis, it can affect limb formation and other things in a developing fetus. MTX has Pregnancy Category D status. Nitrofurantoin is a wide-spectrum antibiotic commonly given for a urinary tract infection; it has Pregnancy Category B status. Carbamazepine is an antiepileptic drug that may cause neural tube defects but not limb malformations; it has Pregnancy Category D status. Dexamethasone is a glucocorticoid medication used to treat the adrenal suppression commonly caused by cancer chemotherapy and it can cause fetal masculinization but not limb malformations; it has a Pregnancy Category C status.

A woman is exposed to indomethacin during the third trimester of pregnancy. Which teratogenic effect of the medication is expected in the newborn?

Premature closure of the ductus arteriosus Indomethacin is a nonsteroidal antiinflammatory drug that may cause premature closure of the ductus arteriosus in newborns receiving long-term maternal dosing. Neural tube defects cannot be expected since the medication is taken in the third trimester. Neonatal hypoglycemia is caused only by oral hypoglycemic drugs. Cleft lip with cleft palate is expected by the medications administered within 8 weeks of gestation.

A fetal monitor is applied to a client in labor. The nurse should take immediate action in response to which fetal heart rate?

Repeatedly drops abruptly to 90 beats/min unrelated to contractions This fetal heart rate change is known as variable-type decelerations. This is indicative of umbilical cord compression that, if left uncorrected, may lead to fetal compromise; interventions are directed at improving umbilical circulation. A fetal heart rate that remains at 140 beats/min during contractions is not an unusual finding and therefore does not require nursing intervention. Uniform drops to 120 beats/min are recurrent early decelerations, a result of fetal head compression during a contraction. They are a benign reflex response requiring no immediate intervention. Fluctuation from 130 to 140 beats/min unrelated to contractions is an expected variation of the fetal heart rate reflecting a well-oxygenated fetal nervous system.

Which points should be included when counseling a woman who is on hormonal therapy? Select all that apply.

The client should use appropriate sun protection. The client should monitor any deviations in body weight. The client should take oral medication at the same time every day. Appropriate sun protection should be used because hormones make people sensitive to sunlight. The client's body weight should be monitored during hormonal therapy because abnormal bleeding can lead to weight loss and serious complications. Oral drugs should be administered at the same time every day to maintain the appropriate concentration of serum drug levels. Hormonal drugs should be taken with food to reduce gastrointestinal upset. The client should report any side effects to the primary healthcare provider and seek his advice. Hormonal therapy should never be discontinued without the knowledge of the primary healthcare provider.

A newborn is Rh positive, and the mother is Rh negative. The infant is to receive an exchange transfusion. When the parents ask why their baby will receive Rh-negative blood, what explanation does the nurse provide?

The red blood cells will not be destroyed by maternal anti-Rh antibodies. Giving Rh-positive cells will lead to further hemolysis; Rh-negative cells are not attacked by maternal antibodies in the infant's blood. Rh-negative blood is not neutral; it provides a temporary safeguard from further hemolysis. A reaction to other antigens in the crossmatched blood may occur. The choice of Rh-positive or Rh-negative blood is not determined by blood availability.