Nokea
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.
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A client asks about the differences between the copper IUD and the hormonal IUD. Which of the following responses by the nurse is accurate?
- A. The copper IUD is hormone-free and may increase menstrual bleeding, while the hormonal IUD may reduce bleeding.
- B. Both IUDs require replacement every year.
- C. The copper IUD prevents ovulation, while the hormonal IUD does not.
- D. The hormonal IUD is less effective than the copper IUD.
Correct Answer: A
Rationale: The copper IUD is hormone-free and may increase menstrual bleeding, while the hormonal IUD releases progestin and may reduce bleeding. Both last several years, neither primarily prevents ovulation, and both are highly effective.
A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks' gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breast-feed the neonate. Which of the following instructions about breast-feeding would be most appropriate?
- A. Breast-feeding is not recommended because the neonate needs increased fat in the diet.
- B. Once the neonate no longer needs oxygen and continuous monitoring, breast-feeding can be done.
- C. Breast-feeding is contraindicated because the neonate is preterm.
- D. Gavage feedings using breast milk can be given until the neonate can coordinate sucking and swallowing.
Correct Answer: D
Rationale: Gavage feedings with breast milk allow the neonate to receive the benefits of breast milk while accommodating their immature sucking and swallowing reflexes.
A primigravid client at 36 weeks' gestation with premature rupture of the membranes is to be discharged home on bed rest with follow-up by the home health nurse. After instruction about care while at home, which of the following client statements indicates effective teaching?
- A. "It is permissible to douche if the fluid irritates my vaginal area."
- B. "I can take either a tub bath or a shower when I feel like it."
- C. "I should limit my fluid intake to less than 1 quart daily."
- D. "I should contact the doctor if my temperature is 100.4° F or higher."
Correct Answer: D
Rationale: Contacting the doctor for fever is appropriate.
A 24-year-old client is discussing contraception options with the nurse and expresses interest in an intrauterine device (IUD). Which of the following statements by the client indicates a need for further teaching?
- A. I understand the IUD can remain in place for several years.
- B. The IUD will prevent ovulation each month.
- C. I may experience heavier menstrual periods with the copper IUD.
- D. The IUD does not protect against sexually transmitted infections.
Correct Answer: B
Rationale: The IUD does not primarily prevent ovulation; it works by affecting sperm movement and preventing fertilization (copper IUD) or thinning the uterine lining (hormonal IUD). The other statements are correct, indicating a need for further teaching about its mechanism.
A multiparous client, 72 hours postpartum, reports a sudden gush of lochia rubra. The nurse should suspect:
- A. Normal involution.
- B. Uterine subinvolution.
- C. Cervical laceration.
- D. Retained placental fragments.
Correct Answer: D
Rationale: A sudden gush of lochia rubra after 72 hours suggests retained placental fragments, which can cause hemorrhage.