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A client at 28 weeks' gestation in premature labor was placed on ritodrine(Yutopar). To maintain the pregnancy, the physician orders the client to have 10 mg now, 10 mg in 2 hours, and then 20 mg every 4 hours while contractions persist, not to exceed the maximum daily oral dose of 120 mg. At what time will the client have reached the maximum dose if she begins taking the medication at 10:00 a.m. and follows the physician's order?
- A. 10:00 a.m.
- B. 10:00 p.m.
- C. 12:00 a.m.
- D. 2:00 a.m.
Correct Answer: B
Rationale: The client will reach the maximum dose at 10:00 p.m.
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A primigravida admitted to the hospital with a diagnosis of hyperemesis gravidarum is placed on nothing-by-mouth(NPO) status and is receiving intravenous(IV) fluid replacement therapy. In planning this client's care, the nurse should collaborate with the health care provider(HCP) to carry out which of the following?
- A. Withhold oral fluids indefinitely until acidosis is corrected.
- B. Give oral fluids in small quantities whenever the client desires.
- C. Per HCP orders, provide clear liquids by mouth after 24 hours if vomiting subsides.
- D. Withhold oral fluids until total parenteral nutrition replaces lost electrolytes.
Correct Answer: C
Rationale: Gradual reintroduction of oral fluids is appropriate once vomiting subsides.
A nurse is discussing the contraceptive patch with a client. Which of the following side effects should the nurse mention?
- A. Nausea and skin irritation at the application site.
- B. Permanent hair loss.
- C. Guaranteed weight loss.
- D. Increased risk of ovarian cysts.
Correct Answer: A
Rationale: The contraceptive patch may cause nausea and skin irritation at the application site, especially initially. It does not cause permanent hair loss, guarantee weight loss, or significantly increase ovarian cyst risk.
Assessment reveals that the fetus of a multigravid client is at +1 station and 8 cm dilated. Based on these data, the nurse should first:
- A. Ask anesthesia to increase epidural rate.
- B. Assist the client to push if she feels the need to do so.
- C. Encourage the client to breathe through the urge to push.
- D. Support family members in providing comfort measures.
Correct Answer: C
Rationale: At 8 cm dilation and +1 station, the client is in the transition phase but not fully dilated (10 cm). Pushing before full dilation can lead to cervical edema or lacerations. Encouraging the client to breathe through the urge to push helps prevent premature pushing while supporting labor progression. Increasing the epidural rate or assisting with pushing is inappropriate at this stage, and while family support is valuable, it is not the priority.
A nurse is counseling a client about the fertility awareness method. Which of the following client statements indicates a need for further teaching?
- A. I will track my basal body temperature daily.
- B. I will monitor my cervical mucus for changes.
- C. I will avoid intercourse during my fertile days.
- D. I can rely on this method even with irregular cycles.
Correct Answer: D
Rationale: The fertility awareness method is less reliable with irregular cycles, as ovulation is harder to predict. The other statements reflect correct understanding, indicating a need for further teaching about cycle regularity.
Four hours after cesarean delivery of a neonate weighing 4,000 g (8 lb, 13 oz), the primiparous client asks, "If I get pregnant again, will I need to have a cesarean?" When responding to the client, the nurse should base the response to the client about vaginal birth after cesarean delivery (VBAC) on which of the following?
- A. VBAC may be possible if the client has not had a classic uterine incision.
- B. A history of rapid labor is a necessary criterion for VBAC.
- C. A low transverse incision contraindicates the possibility for VBAC.
- D. VBAC is not possible because the neonate was large for gestational age.
Correct Answer: A
Rationale: VBAC is often possible with a low transverse incision, unlike a classic vertical incision.