Nokea
An antenatal G 2, T 1, P 0, Ab 0, L 1 client is discussing her postpartum plans for birth control with the health care provider. In analyzing the available choices, which of the following factors has the greatest impact on her birth control options?
- A. Satisfaction with prior methods.
- B. Preference of sexual partner.
- C. Breast- or bottle-feeding plan.
- D. History of clotting disease.
Correct Answer: D
Rationale: A history of clotting disease significantly impacts birth control options, as hormonal methods like combined oral contraceptives may increase the risk of thromboembolism, making non-hormonal or progestin-only methods safer choices.
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A primigravid client at 41 weeks' gestation is admitted to the hospital's labor and delivery unit in active labor. After 25 hours of labor with membranes ruptured for 24 hours, the client delivers a healthy neonate vaginally with a midline episiotomy. Which of the following nursing diagnoses should the nurse identify as the priority for the client?
- A. Activity intolerance related to difficult labor process.
- B. Sleep deprivation related to prolonged labor.
- C. Situational low self-esteem related to lengthy labor process.
- D. Risk for infection related to birth trauma and prolonged ruptured membranes.
Correct Answer: D
Rationale: Prolonged rupture of membranes (>24 hours) and episiotomy increase infection risk, making this the priority post-delivery. Activity intolerance, sleep deprivation, and self-esteem are less urgent.
During a scheduled cesarean delivery of a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean delivery tend to have an increased incidence of which of the following?
- A. Congenital anomalies.
- B. Pulmonary hypertension.
- C. Meconium aspiration syndrome.
- D. Respiratory distress syndrome.
Correct Answer: D
Rationale: Cesarean delivery, especially without labor, increases the risk of respiratory distress syndrome due to retained lung fluid. Breech presentation may exacerbate this. Congenital anomalies, pulmonary hypertension, and meconium aspiration are less directly related.
One week after her prenatal visit, a primigravid client at 38 weeks' gestation diagnosed with mild preeclampsia calls the clinic nurse complaining of a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. The nurse should tell the client:
- A. "Take two acetaminophen tablets. They aren't as likely to upset your stomach."
- B. "I think the doctor should see you today. Can you come to the clinic this morning?"
- C. "You need to lie down and rest. Have you tried placing a cool compress over your head?"
- D. "I'll ask the doctor to call in a prescription for aspirin with codeine. What's your pharmacy's number?"
Correct Answer: B
Rationale: Continuous headache and nausea are signs of worsening preeclampsia requiring evaluation.
A primiparous client asks the nurse about resuming exercise after vaginal delivery. The nurse should advise the client to start low-impact exercises:
- A. Immediately after discharge.
- B. After 2 weeks postpartum.
- C. After 6 weeks postpartum.
- D. When lochia has completely stopped.
Correct Answer: C
Rationale: Low-impact exercises are generally safe after 6 weeks, allowing time for healing and recovery.
During an assessment of a neonate born at 33 weeks' gestation, a nurse finds and reports a heart murmur. The neonate is diagnosed with patent ductus arteriosus, for which the neonate received indomethacin. An expected outcome after the administration of indomethacin to a neonate with patent ductus arteriosus is:
- A. Closure of a patent ductus arteriosus.
- B. Decreased bleeding time.
- C. Increased gastrointestinal function.
- D. Increased renal output.
Correct Answer: A
Rationale: Indomethacin promotes closure of the patent ductus arteriosus by inhibiting prostaglandin synthesis.