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A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?
- A. Another method of contraception is needed until the sperm count is 0.
- B. Vasectomy is easily reversed if children are desired in the future.
- C. Vasectomy is contraindicated in males with prior history of cardiac disease.
- D. Vasectomy requires only a yearly follow-up once the procedure is completed.
Correct Answer: A
Rationale: After a vasectomy, another contraception method is needed until a follow-up semen analysis confirms a zero sperm count, ensuring sterility.
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A multigravid laboring client has an extensive documented history of drug addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with contractions every 3 minutes of moderate intensity. The physician orders nalbuphine (Nubain) 15 mg slow I.V. push for pain relief followed by an epidural when the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client states she thinks she is going to have her baby now. Of the following drugs available at the time of the delivery, which should the nurse avoid using with this client in this situation?
- A. 1% lidocaine (Xylocaine).
- B. Naloxone hydrochloride (Narcan).
- C. Local anesthetic.
- D. Pudendal block.
Correct Answer: B
Rationale: In a client with recent opioid use, naloxone (Narcan) could precipitate withdrawal symptoms, which is risky during delivery. Lidocaine, local anesthetics, or pudendal blocks are safe for perineal anesthesia and do not interact with the client's history.
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.
The physician determines that the fetus of a multiparous client in active labor is in distress, necessitating a cesarean delivery with general anesthesia. Before the cesarean delivery, the anesthesiologist orders cimetidine (Tagamet) 300 mg PO. After administering the drug, the nurse should assess the client for reduction in which of the following?
- A. Incidence of bronchospasm.
- B. Oral and respiratory secretions.
- C. Acid level of the stomach contents.
- D. Incidence of postoperative gastric ulcer.
Correct Answer: C
Rationale: Cimetidine, an H2-receptor blocker, is given before general anesthesia to reduce gastric acid levels, minimizing the risk of aspiration pneumonitis. It does not affect bronchospasm, secretions, or postoperative ulcers directly.
A neonate has a large amount of secretions. After vigorously suctioning the neonate, the nurse should assess for what possible result?
- A. Bradycardia.
- B. Rapid eye movement.
- C. Sickness.
- D. Tachycardia.
Correct Answer: A
Rationale: Vigorous suctioning can stimulate the vagus nerve, leading to bradycardia in a neonate.
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.