Nokea
A client visits the clinic seeking a prescription for oral contraceptives. Which of the following would alert the nurse to further assess the client before the contraceptives are prescribed?
- A. The client has a history of fibrocystic breast disease.
- B. The client has a family history of ovarian cancer.
- C. The client is a smoker and 37 years old.
- D. The client experienced irregular menstrual cycles as an adolescent.
Correct Answer: C
Rationale: Smoking at age 37 is a significant risk factor for cardiovascular complications with combined oral contraceptives, requiring further assessment. Fibrocystic breast disease and irregular cycles are not contraindications, and family history of ovarian cancer is less relevant.
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A laboring client at -2 station has a spontaneous rupture of the membranes and a cord immediately protrudes from the vagina. The nurse should first:
- A. Place gentle pressure upward on the fetal head.
- B. Place the cord back into the vagina to keep it moist.
- C. Begin oxygen by face mask at 8 to 10 L/min.
- D. Turn the client on her left side.
Correct Answer: A
Rationale: Gentle pressure prevents cord compression.
After the nurse teaches a primiparous client planning to return to work in 6 weeks about storing breast milk, which of the following client statements indicates the need for further teaching?
- A. I can let the milk sit out in a bottle for up to 10 hours.
- B. I'll be sure to label the milk with the date, time, and amount.
- C. I can store the milk for 3 days in the refrigerator.
- D. I can keep the milk in a deep-freeze in clean glass bottles for up to 1 year.
Correct Answer: A
Rationale: Breast milk should not be left out for more than 4-6 hours; 10 hours risks spoilage.
A primiparous client asks the nurse about resuming exercise after vaginal delivery. The nurse should advise the client to start low-impact exercises:
- A. Immediately after discharge.
- B. After 2 weeks postpartum.
- C. After 6 weeks postpartum.
- D. When lochia has completely stopped.
Correct Answer: C
Rationale: Low-impact exercises are generally safe after 6 weeks, allowing time for healing and recovery.
A 24-year-old primigravid client who delivers a viable term neonate is ordered to receive the primary effect of the placenta. Which of the following signs would indicate to the nurse that the placenta is about to be delivered?
- A. The cord lengthens outside the vagina.
- B. There is decreased vaginal bleeding.
- C. The uterus cannot be palpated.
- D. Uterus changes to discoid shape.
Correct Answer: A
Rationale: A lengthening umbilical cord outside the vagina indicates placental separation and descent, signaling imminent delivery. Decreased bleeding or a non-palpable uterus are not reliable signs, and the uterus becomes globular, not discoid, after placental delivery.
Assessment of a 23-year-old primigravid client at term who is admitted to the birthing unit in active labor reveals that her cervix is 4 cm dilated and 100% effaced. Contractions are occurring every 4 minutes. The nurse is developing a care plan with the client to relieve pain based on the gate-control theory of pain. The nurse should explain which of the following to the client?
- A. Input from the large sensory fibers opens the gate.
- B. Labor pain is a matter of individual perception.
- C. Slow abdominal breathing can open the gate.
- D. The gating mechanism is in the spinal cord.
Correct Answer: D
Rationale: The gate-control theory posits that pain signals are modulated in the spinal cord, where non-painful stimuli (e.g., touch) can 'close the gate' to pain transmission. Input from large fibers closes the gate, perception varies but is not the mechanism, and slow breathing helps manage pain but does not open the gate.