Nokea
A client is considering the fertility awareness method. Which of the following client statements indicates understanding?
- A. I will track my basal body temperature daily.
- B. I can use this method with irregular cycles.
- C. I will monitor ovulation with a pregnancy test.
- D. I will avoid intercourse throughout the cycle.
Correct Answer: A
Rationale: Tracking basal body temperature daily is a key component of the fertility awareness method. It is less reliable with irregular cycles, pregnancy tests do not monitor ovulation, and intercourse is avoided only during fertile periods.
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A primigravid client at 37 weeks' gestation has been hospitalized for several days with severe pregnancy-induced hypertension. While caring for the client, the nurse observes that the client is beginning to have a seizure. Which of the following actions should the nurse do first?
- A. Pad the side rails of the client's bed.
- B. Turn the client to the right side.
- C. Insert a padded tongue blade into the client's mouth.
- D. Call for immediate assistance in the client's room.
Correct Answer: D
Rationale: A seizure in pregnancy-induced hypertension (eclampsia) is a medical emergency. Calling for immediate assistance ensures rapid intervention (e.g., magnesium sulfate). Padding rails, repositioning, or inserting a tongue blade (which is outdated) are secondary.
Which of the following would be the priority when the form of primigravid client whose exercise is dilated at 6 cm when the fetus is at 1+ station and the client has had no analgesia or anesthesia?
- A. Giving frequent sips of water.
- B. Applying extra blankets for warmth.
- C. Providing frequent perineal cleansing.
- D. Offering encouragement and support.
Correct Answer: D
Rationale: At 6 cm dilation without analgesia, the client is likely experiencing significant pain and anxiety. Offering encouragement and support is the priority to help her cope emotionally and physically. Hydration, warmth, and perineal cleansing are secondary concerns.
After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least which of the following time spans?
- A. 6 months.
- B. 12 months.
- C. 18 months.
- D. 24 months.
Correct Answer: B
Rationale: Waiting 12 months allows for monitoring for choriocarcinoma.
After instruction of a primigravid client at 8 weeks' gestation diagnosed with class I heart disease about self-care during pregnancy, which of the following client statements would indicate the need for additional teaching?
- A. "I should avoid being near people who have a cold."
- B. "I may be given antibiotics during my pregnancy."
- C. "I should reduce my intake of protein in my diet."
- D. "I should limit my salt intake at meals."
Correct Answer: C
Rationale: Reducing protein intake is not recommended for clients with heart disease.
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.