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A nurse is teaching a client about the lactational amenorrhea method. Which of the following instructions should the nurse include?
- A. Exclusively breastfeed and remain amenorrheic for up to 6 months postpartum.
- B. Breastfeed at least once daily for up to 12 months.
- C. Use this method if your periods have returned.
- D. Supplement with formula for flexibility.
Correct Answer: A
Rationale: The lactational amenorrhea method requires exclusive breastfeeding, amenorrhea, and being less than 6 months postpartum to suppress ovulation effectively. The other options reduce its reliability.
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A nurse and an LPN are working in the labor and delivery unit. Of the following assessments and interventions that must be done immediately, which should the nurse assign to the LPN?
- A. Complete an initial assessment on a client.
- B. Increase the oxytocin (Pitocin) rate on a laboring client.
- C. Perform a straight catheterization for protein analysis.
- D. Assess a laboring client for a change in labor pattern.
Correct Answer: C
Rationale: An LPN can perform a straight catheterization for protein analysis, a technical task within their scope. Initial assessments, oxytocin adjustments, and labor pattern assessments require RN judgment and expertise.
One-half hour after vaginal delivery of a term neonate, the nurse palpates the fundus of a primigravid client, noting several large clots and a small trickle of bright red vaginal bleeding. The client's blood pressure is 136/92 mm Hg. Which of the following would the nurse do first?
- A. Continue to monitor the client's fundus every 15 minutes.
- B. Ask the physician for an order for methylergonovine (Methergine).
- C. Immediately notify the physician of the client's symptoms.
- D. Change the client's perineal pads every 15 minutes.
Correct Answer: C
Rationale: Large clots and bright red bleeding post-delivery suggest possible uterine atony or retained placental fragments, requiring immediate physician notification for intervention. Monitoring, requesting medication, or changing pads are secondary actions.
A primiparous client who delivered a viable neonate 8 hours ago tells the nurse that she gained 26 lb during pregnancy and asks how long it will take to return to her normal prepregnant weight. The nurse should tell the client that the usual time frame for returning to prepregnant weight is:
- A. 4 weeks.
- B. 6 weeks.
- C. 8 weeks.
- D. 12 weeks.
Correct Answer: D
Rationale: Returning to prepregnant weight typically takes about 12 weeks with proper diet and exercise.
A multigravid client at 40 weeks' gestation with a history of previous cesarean delivery is admitted for a trial of labor. The fetal monitor shows late decelerations. Which interventions should the nurse perform? Select all that apply.
- A. Administer oxygen at 8–10 L/min via mask.
- B. Stop the oxytocin infusion.
- C. Reposition the client to her right side.
- D. Increase the IV fluid rate.
- E. Apply a fetal scalp electrode.
Correct Answer: A,B,D
Rationale: Late decelerations suggest uteroplacental insufficiency. Administering oxygen, stopping oxytocin (if running), and increasing IV fluids improve fetal oxygenation and uterine perfusion. Right-side repositioning is less effective than left-side, and scalp electrodes are not the first step.
Which of the following best identifies the reason for assessing a neonate weighing 1,500 g at 32 weeks' gestation for retinopathy of prematurity (ROP)?
- A. The neonate is at risk because of multiple factors.
- B. Oxygen is being administered at a level of $21%.
- C. The neonate was alkalotic immediately after birth.
- D. Phototherapy is likely to be ordered by the pediatrician.
Correct Answer: A
Rationale: Preterm neonates, especially those with low birth weight and receiving oxygen, are at risk for ROP due to immature retinal development.