Reproductive
A client has just begun taking an oral contraceptive that contains estrogen and progestin. The nurse should instruct the client to use additional methods of contraception for at least: a) 1 month. b) 2 months. c) 2 weeks. d) 7 days.
7 days. Correct Explanation: Because of the mechanism of action of oral contraceptives, the onset of action is somewhat delayed. Full contraceptive benefits don't occur until an oral contraceptive agent has been taken for at least 7 days.
The nurse is caring for a client on her second postpartum day. The nurse should expect the client's lochia to be: a) red and moderate. b) thin and white. c) continuous with red clots. d) brown and scant.
red and moderate. Explanation: During the first 3 days, the lochia will be red (lochia rubra) with moderate flow. Note, however, that the client shouldn't be soaking more than one pad every hour. A continuous flow of moderately clotted blood from the vagina isn't normal and should be reported. Clots may indicate retained pieces of placenta. Lochia changes to pink or brown (lochia serosa) after 3 to 10 days. By day 10, the lochia should be white (lochia alba) and continue for several weeks
The nurse performs a routine prenatal assessment on a woman at 35 weeks gestation and finds vital signs: blood pressure 138/88 mm Hg, pulse 82/min, respirations 18/min, temperature 99.1° F (37.3°C). Which statement is most appropriate for the nurse to make at this time? a) "You have a slight temperature. Do you feel hot?" b) "Your pulse is low. Do you exercise a lot?" c) "Your vital signs are all normal. I will document them on your chart." d) "Your blood pressure is slightly high. I will check it again before you leave."
"Your blood pressure is slightly high. I will check it again before you leave." Explanation: A blood pressure reading of 138/88 mm Hg is nearing hypertension range and could be a sign of developing gestational hypertension. Conversely, the client may be experiencing "white coat" syndrome or could be anxious during the prenatal visit. In order to obtain an accurate blood pressure reading, the nurse should allow the woman to rest for a period of time and recheck the blood pressure in the same arm and while the woman is in the same position. This blood pressure is considered approaching high. All other vitals are within normal range
A postpartum client calls the nurse and informs the nurse that the client "had a baby 1 week ago and still having a pink discharge." Which of the following is the nurse's best response? a) "This is called lochia serosa and is a normal finding for approximately 3-10 days." b) "By this time you should have lochia alba, which is a white discharge." c) "You should not be having any discharge after the third day." d) "This should be reported immediately to your physician, as it could indicate something serious."
This is called lochia serosa and is a normal finding for approximately 3-10 days." Correct Explanation: Lochia rubra is red in color and occurs from the 1st to the 3rd postpartum day. It is composed of blood, fragments of decidua, and mucus. Lochia serosa is pink in color and occurs from the 3rd through the 10th day and is composed of blood, mucus, and invading leukocytes. Lochia alba is white in color and occurs the 10th through the 14th postpartum day and is composed largely of mucus with a high leukocyte count.
When working the mother-baby unit which client would the nurse anticipate giving Rho(D) immune globulin (human) to: a) the Rh positive baby with an Rh negative mother. b) the Rh negative baby with an Rh positive mother. c) the Rh positive mother with an Rh negative baby. d) the Rh negative mother with an Rh positive baby.
the Rh negative mother with an Rh positive baby. Explanation: Rho (D) immune globulin (human) is give to an Rh negative mother after the birth of an Rh positive baby to prevent the woman from making antibodies that are sensitized to attack foreign Rh positive blood cells in future pregnancies. Rho D is also given during pregnancy to Rh negative mothers at 28 weeks, with invasive procedures, or after any trauma, such as an automobile accident. Rho (D) is not given to Rh positive mothers and is never given to babies.
A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan? a) "Another method of contraception is needed until the sperm count is 0." b) "Vasectomy requires only a yearly follow-up once the procedure is completed." c) "Vasectomy is contraindicated in males with prior history of cardiac disease." d) "Vasectomy is easily reversed if children are desired in the future."
"Another method of contraception is needed until the sperm count is 0." Correct Explanation: Another method of contraception is needed until all sperm has been cleared from the body. The number of ejaculates for this to occur varies with the individual, and laboratory analysis is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males and vasectomy. There is no need for follow-up after verification there is no sperm in the system.
The nurse is caring for a client in labor. The client states she feels like she "has to push." The vaginal exam reveals that the client is 8 cm dilated. Which of the following responses made by the nurse is correct? a) "I will get you some IV pain medication. That will help." b) "Your cervix is dilated 8 cm and it is time to push. Take a deep breath in and let it out. Then, take another breath in and hold it and push." c) "Let me call your healthcare provider. You should not feel like you need to push during this stage of labor." d) "I know you want to push, but your cervix is not dilated enough. Keep breathing through your contractions."
"I know you want to push, but your cervix is not dilated enough. Keep breathing through your contractions." Explanation: Pushing (bearing down) before the cervix is completely dilated may cause edema, tissue damage, and may impede fetal descent. There is no need to call the healthcare provider, as this feeling is natural at this stage of labor. Giving the client IV pain medication at 8 cm can cause fetal respiratory distress.
A client at 37 weeks gestation is at a prenatal visit and states that she sometimes feels dizzy when lying directly on her back. Which of the following is the nurse's best response? a) "This is most likely due to low hemoglobin." b) "This may be due to the uterus putting pressure on a blood vessel." c) "This is a normal occurrence in the third trimester." d) "Do you have a family history of cardiac-related illnesses?"
"This may be due to the uterus putting pressure on a blood vessel." Correct Explanation: During pregnancy, the uterus enlarges, and if the client is lying in a supine position, the uterus may put pressure on the vena cava, causing supine hypotensive syndrome. This pressure on the vena cava causes a decrease in blood flow and a decrease in blood pressure. Often the client will describe symptoms of dizziness, pallor, and clamminess. Instruct the client to lie on her left side to avoid this type of episode. This is not a normal occurrence, but rather a common experience, given the client's description, and warrants discussion. It would be inappropriate to assume that this is due to low hemoglobin. Asking the client of any family cardiac history may imply the nurse's assumption of cardiac complication and may not be the most appropriate response given the client's description of what is being experienced
The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section? a) client at 40 weeks' gestation whose fetus weighs 8 lb (3,630 g) by ultrasound estimate b) client at 32 weeks' gestation with fetus in breech position c) client at 37 weeks' gestation with fetus in ROP position d) client at 38 weeks' gestation with active herpes lesions
client at 38 weeks' gestation with active herpes lesions Explanation: Herpes simplex virus can be transmitted to the infant during a vaginal birth. The neonatal effects of herpes are severe enough that a cesarean birth is warranted if active lesions—primary or secondary—are present. A client with a primary infection during pregnancy sheds the virus for up to 3 months after the lesion has healed. The client carrying an infant weighing 8 lb (3,629 g) will be given a trial of labor before a cesarean. The client with a fetus in the right occiput posterior position will have a slow labor with increased back pain but can give birth vaginally. The fetus in a breech position still has many weeks to change positions before being at term. At 7 months' gestation, the breech position is not a concern.
