Nokea
A nurse is teaching a client about the use of condoms for contraception. Which of the following statements by the client indicates understanding of the teaching?
- A. Condoms must be stored in a hot, humid environment.
- B. Condoms can be reused if washed thoroughly.
- C. Condoms provide some protection against STIs.
- D. Condoms are 100% effective in preventing pregnancy.
Correct Answer: C
Rationale: Condoms provide some protection against sexually transmitted infections, which is a key benefit. They should be stored in a cool, dry place, cannot be reused, and are not 100% effective in preventing pregnancy.
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A primigravid client at 37 weeks' gestation has been hospitalized for several days with severe pregnancy-induced hypertension. While caring for the client, the nurse observes that the client is beginning to have a seizure. Which of the following actions should the nurse do first?
- A. Pad the side rails of the client's bed.
- B. Turn the client to the right side.
- C. Insert a padded tongue blade into the client's mouth.
- D. Call for immediate assistance in the client's room.
Correct Answer: D
Rationale: A seizure in pregnancy-induced hypertension (eclampsia) is a medical emergency. Calling for immediate assistance ensures rapid intervention (e.g., magnesium sulfate). Padding rails, repositioning, or inserting a tongue blade (which is outdated) are secondary.
When caring for a multigravid client admitted to the hospital with vaginal bleeding at 38 weeks' gestation, which of the following would the nurse anticipate administering intravenously if the client develops disseminated intravascular coagulation(DIC)?
- A. Ringer's lactate solution.
- B. Fresh frozen platelets.
- C. 5% dextrose solution.
- D. Warfarin sodium(Coumadin).
Correct Answer: B
Rationale: Fresh frozen platelets are used to manage bleeding in DIC.
A primiparous client who delivered vaginally 8 hours ago desires to take a shower. The nurse anticipates remaining nearby the client to assess for which of the following?
- A. Fatigue.
- B. Fainting.
- C. Diuresis.
- D. Hygiene needs.
Correct Answer: B
Rationale: Fainting is a risk during the first shower postpartum due to potential orthostatic hypotension or fatigue, requiring close monitoring.
A client at 36 weeks' gestation with eclampsia begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:
- A. Abruptio placentae.
- B. Transverse lie.
- C. Placenta accreta.
- D. Uterine atony.
Correct Answer: A
Rationale: Abruptio placentae is a complication associated with eclampsia.
The labor and delivery unit is short-staffed, and the charge nurse must prioritize assignments. Which client should the registered nurse personally assess first?
- A. A primigravida at 4 cm dilation requesting pain relief.
- B. A multigravida at 8 cm dilation with a history of rapid labors.
- C. A primigravida with stable vital signs post-epidural.
- D. A multigravida at 6 cm dilation with a reassuring fetal monitor.
Correct Answer: B
Rationale: A multigravida at 8 cm dilation with a history of rapid labors is at risk for precipitous delivery, requiring immediate RN assessment to prepare for birth. Other clients are less urgent, as they are earlier in labor or stable.