Nokea
A client is considering the contraceptive patch. Which of the following instructions should the nurse provide?
- A. Apply a new patch daily for three weeks, then skip a week.
- B. Change the patch weekly for three weeks, then have a patch-free week.
- C. Wear the patch for one month, then replace it.
- D. Apply the patch to the genital area for best results.
Correct Answer: B
Rationale: The contraceptive patch is changed weekly for three weeks, followed by a patch-free week to allow for a withdrawal bleed. It is not applied daily, worn for a month, or placed on the genital area.
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A multigravid client is receiving oxytocin (Pitocin) augmentation. When the client's cervix is dilated to 6 cm, her membranes rupture spontaneously with meconium-stained amniotic fluid. Which of the following actions should the nurse do first?
- A. Increase the rate of the oxytocin infusion.
- B. Turn the client to a knee-to-chest position.
- C. Assess cervical dilation and effacement.
- D. Monitor the fetal heart rate continuously.
Correct Answer: D
Rationale: Meconium-stained fluid indicates potential fetal distress, requiring immediate continuous fetal heart rate monitoring to assess for complications like cord compression or hypoxia. Increasing oxytocin, repositioning, or reassessing dilation are secondary.
The nurse is managing care of a primigravida at full term who is in active labor. What should be included in developing the plan of care for this client?
- A. Oxygen saturation monitoring every half hour.
- B. Supine positioning on back, if it is comfortable.
- C. Anesthesia/pain level assessment every 30 minutes.
- D. Vaginal bleeding, ROM assessment every shift.
Correct Answer: C
Rationale: Regular assessment of anesthesia/pain levels is critical to ensure the client's comfort and to adjust pain management strategies as labor progresses. Oxygen saturation monitoring is not typically required every half hour unless specific complications arise. Supine positioning can cause supine hypotensive syndrome and is generally avoided. Vaginal bleeding and rupture of membranes (ROM) assessments are important but typically performed more frequently than every shift during active labor.
A primigravid client at 39 weeks' gestation is admitted in early labor with contractions every 6 minutes. The nurse notes a fetal heart rate of 145 bpm with occasional variable decelerations. What is the nurse's first action?
- A. Notify the physician immediately.
- B. Administer oxygen via non-rebreather mask.
- C. Reposition the client to her left side.
- D. Increase the IV fluid rate.
Correct Answer: C
Rationale: Variable decelerations may indicate umbilical cord compression. Repositioning the client to her left side is the first action to relieve pressure on the cord and improve fetal oxygenation. Notification, oxygen, or increased fluids are considered if decelerations persist.
A primigravid client is admitted as an outpatient for an external cephalic version. The nurse should assess the client for which of the following contraindications for the procedure?
- A. Multiple gestation.
- B. Breech presentation.
- C. Maternal Rh-negative blood type.
- D. History of gestational diabetes.
Correct Answer: A
Rationale: External cephalic version (ECV) is contraindicated in multiple gestation due to the risk of cord entanglement or placental issues. Breech presentation is an indication for ECV, not a contraindication. Rh-negative blood type and gestational diabetes do not preclude ECV.
The physician orders whole blood replacement for a multigravid client with abruptio placentae. Before administering the intravenous blood product, the nurse should first:
- A. Validate client information and the blood product with another nurse.
- B. Check the vital signs before transfusing over 5 to 6 hours.
- C. Ask the client if she has ever had any allergies.
- D. Administer 100 mL of 5% dextrose solution intravenously.
Correct Answer: A
Rationale: Validating client information and blood product is essential to prevent transfusion errors.