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A nurse is teaching a client about using an intrauterine device (IUD) for contraception. Which of the following client statements indicate an understanding of the teaching?
- A. I will need to have the IUD replaced each year.
- B. I will need to apply a spermicide prior to intercourse.
- C. I should expect my periods to stop while I have the IUD.
- D. I should check for the string each month after menstruation.
Correct Answer: D
Rationale: The client should check for the string each month after menstruation to ensure the IUD is in place. Regular checks can help identify any displacement.
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A nurse is teaching a client who is to start using a diaphragm for contraception. Which of the following client statements indicate an understanding of the teaching?
- A. I will leave the diaphragm in place for 4 hours following intercourse.
- B. I will remove the diaphragm by catching the rim below the dome with my finger.
- C. I will place a thin layer of mineral oil on the diaphragm once per week.
- D. I will place 2 teaspoons of spermicide on the inside of the diaphragm before inserting it.
Correct Answer: D
Rationale: The client should place spermicide in the diaphragm before insertion to enhance contraceptive effectiveness. The diaphragm should also be left in place for at least 6 hours after intercourse, but not more than 24 hours.
A pregnant client's last menstrual period was May 4th, 2013. What is this client's estimated delivery date using Naegele's Rule?
- A. January 15, 2014
- B. February 11, 2014
- C. March 3, 2014
- D. December 25, 2013
Correct Answer: B
Rationale: Naegele's rule is a standard way of calculating an estimated delivery date (EDD). It involves subtracting three months from the first day of the last menstrual period (LMP), adding seven days, and then adding one year. In this case, subtracting three months from May 4th, 2013, gives February 4th. Adding seven days results in a due date of February 11th, 2014.
A client is being treated with eclampsia. What is a priority nursing intervention?
- A. Assess for hyperreflexia
- B. Administer oxygen
- C. Monitor blood pressure every 15 minutes
- D. Prepare for delivery
Correct Answer: A
Rationale: Eclampsia is a serious complication of pregnancy characterized by seizures. Hyperreflexia is often a precursor to eclampsia, and assessing for it can help predict and manage the condition before seizures occur.
A nurse is caring for a newborn with hyperbilirubinemia. Which of the following interventions should be taken during phototherapy?
- A. Maintain an eye mask over the newborn's eyes
- B. Feed the newborn every hour
- C. Monitor the newborn's temperature
- D. Administer vitamin K
Correct Answer: A
Rationale: Phototherapy is used to reduce bilirubin levels in newborns with jaundice. However, the intense light can cause damage to the newborn's corneas and retinas. The use of an eye mask protects the infant's eyes while allowing the therapy to proceed. Regular monitoring of the newborn's temperature and hydration status is also important, but the eye mask is a key protective measure.
A nurse is assessing a client who gave birth 1 week ago. The client states, "I don't know what's wrong. I love my baby, but I feel so let down and I seem to cry for no reason." The nurse should identify that the client is experiencing which of the following emotional responses to birth?
- A. Postpartum depression
- B. Taking-in phase
- C. Postpartum blues
- D. Taking-hold phase
Correct Answer: C
Rationale: The client is likely experiencing postpartum blues, which is common and characterized by mood swings, tearfulness, and emotional letdown shortly after delivery.