Nokea
A nurse is discussing the contraceptive ring with a client. Which of the following client statements indicates understanding?
- A. I can remove the ring for up to 3 hours if needed.
- B. The ring is replaced every week.
- C. The ring requires daily insertion.
- D. The ring provides long-term contraception for 5 years.
Correct Answer: A
Rationale: The vaginal contraceptive ring can be removed for up to 3 hours if needed without losing effectiveness. It is replaced every 3 weeks (not weekly), not inserted daily, and provides contraception for one cycle, not 5 years.
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A client asks about the side effects of oral contraceptives. Which of the following would the nurse include in the response?
- A. Weight loss is a common side effect.
- B. Nausea and breast tenderness may occur initially.
- C. Hair loss is frequently reported.
- D. Oral contraceptives decrease the risk of breast cancer.
Correct Answer: B
Rationale: Nausea and breast tenderness are common initial side effects of oral contraceptives, which often subside. Weight gain, not loss, may occur, hair loss is not typical, and oral contraceptives do not significantly reduce breast cancer risk.
A client asks about the risks of the contraceptive injection. Which of the following would the nurse include?
- A. Increased risk of blood clots.
- B. Decreased bone density with long-term use.
- C. Permanent weight loss.
- D. Guaranteed regular periods.
Correct Answer: B
Rationale: The contraceptive injection may decrease bone density with long-term use, which is a significant risk. It does not significantly increase blood clot risk, cause permanent weight loss, or guarantee regular periods.
On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The client's blood pressure is 70/50 mm Hg and her pulse rate is 120 bpm. The nurse notifies the physician immediately because of the possibility of:
- A. Ectopic pregnancy.
- B. Abruptio placentae.
- C. Gestational trophoblastic disease.
- D. Complete abortion.
Correct Answer: A
Rationale: Severe pain and hypotension suggest ectopic pregnancy.
For the past 8 hours, a 20-year-old primigravid client in active labor with intact membranes has been experiencing regular contractions. The fetal heart rate is 136 bpm with good variability. After determining that the client is still in the latent phase of labor, the nurse should observe the client for:
- A. Exhaustion.
- B. Chills and fever.
- C. Fluid overload.
- D. Meconium-stained fluid.
Correct Answer: A
Rationale: Prolonged latent phase (8 hours) in a primigravid client can lead to maternal exhaustion due to sustained effort and lack of progress, impacting labor stamina. Chills/fever, fluid overload, or meconium-stained fluid are less likely without specific risk factors.
Which of the following subjects should the nurse include when teaching the mother of a neonate diagnosed with retinopathy of prematurity (ROP) about possible treatment for complications?
- A. Laser therapy.
- B. Common medium (Intal) eye drops.
- C. Frequent testing for glaucoma.
- D. Corneal transplants.
Correct Answer: A
Rationale: Laser therapy is a common treatment for severe ROP to prevent retinal detachment.