Nokea
A client is considering the copper IUD. Which of the following statements by the nurse is accurate?
- A. It requires replacement every 6 months.
- B. It is hormone-free and effective for up to 10 years.
- C. It reduces menstrual bleeding.
- D. It prevents ovulation.
Correct Answer: B
Rationale: The copper IUD is hormone-free and effective for up to 10 years. It does not require replacement every 6 months, may increase menstrual bleeding, and does not prevent ovulation.
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When reviewing the prenatal history for a newly delivered neonate, the nurse notes that the mother has neurofibromatosis. The nurse should further assess the neonate for:
- A. Caffé au lait spots.
- B. Port wine nevus.
- C. Strawberry hemangiomas.
Correct Answer: A
Rationale: Neurofibromatosis is associated with café au lait spots, which are a hallmark sign to assess in the neonate.
The nurse is working on a busy labor and delivery unit with other nurses and a licensed practical nurse. Which of the following labor clients would the nurse assign to the licensed practical nurse?
- A. A G 4, P 3 client with a history of gestational diabetes.
- B. A G 3, P 1, Ab 1 client at 35 weeks' gestation.
- C. A G 1, P 0 client with leaking green amniotic fluid.
- D. A G 2, P 1 client with a history of hyperemesis gravidarum.
Correct Answer: D
Rationale: A G 2, P 1 client with a history of hyperemesis gravidarum is low-risk, suitable for an LPN's scope (e.g., vital signs, basic care). Clients with gestational diabetes, preterm labor (35 weeks), or meconium-stained fluid (G 1, P 0) require RN assessment due to higher risk.
On the first postpartum day, the primiparous client reports perineal pain of 5 on a scale of 1 to 10 that was unrelieved by ibuprofen 800 mg given 2 hours ago. The nurse should further assess the client for:
- A. Puerperal infection.
- B. Vaginal lacerations.
- C. History of drug abuse.
- D. Perineal hematoma.
Correct Answer: D
Rationale: Persistent perineal pain unrelieved by ibuprofen suggests a perineal hematoma, which requires further assessment.
A client at 15 weeks' gestation is admitted with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 and fundal height is 19 cm. The nurse should prepare to do which of the following?
- A. Transfer the client to the antenatal unit.
- B. Keep the client NPO for 24 hours.
- C. Administer magnesium sulfate.
- D. Obtain an ultrasound.
Correct Answer: D
Rationale: Ultrasound confirms the diagnosis of a hydatidiform mole.
A nurse is counseling a client about the use of barrier methods. Which of the following client statements indicates a need for further teaching?
- A. I will use a new condom for each act of intercourse.
- B. The diaphragm should be left in place for at least 6 hours after intercourse.
- C. The cervical cap can be used without spermicide.
- D. I will check the condom for tears before use.
Correct Answer: C
Rationale: The cervical cap requires spermicide for effectiveness, indicating a need for further teaching. The other statements are correct regarding condom use and diaphragm care.