Nokea
As a nurse begins her shift on the obstetrical unit, there are several new admissions. The client with which of the following conditions would be a candidate for induction?
- A. Pregnancy-induced hypertension (PIH).
- B. Active herpes.
- C. Face presentation.
- D. Fetus with late decelerations.
Correct Answer: A
Rationale: Pregnancy-induced hypertension (PIH) is an indication for induction to prevent maternal-fetal complications. Active herpes, face presentation, or late decelerations are contraindications due to risks of infection, dystocia, or fetal distress.
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Four hours after cesarean delivery of a neonate weighing 4,000 g (8 lb, 13 oz), the primiparous client asks, "If I get pregnant again, will I need to have a cesarean?" When responding to the client, the nurse should base the response to the client about vaginal birth after cesarean delivery (VBAC) on which of the following?
- A. VBAC may be possible if the client has not had a classic uterine incision.
- B. A history of rapid labor is a necessary criterion for VBAC.
- C. A low transverse incision contraindicates the possibility for VBAC.
- D. VBAC is not possible because the neonate was large for gestational age.
Correct Answer: A
Rationale: VBAC is often possible with a low transverse incision, unlike a classic vertical incision.
A 25-year-old primiparous client who delivered a viable neonate 2 hours ago has decided to breast-feed her neonate. Which of the following instructions should the nurse address as the highest priority in the teaching plan about preventing nipple soreness?
- A. Keeping plastic liners in the brassiere to keep the nipple drier.
- B. Placing as much of the areola as possible into the baby's mouth.
- C. Smoothly pulling the nipple out of the mouth after 10 minutes.
- D. Removing any remaining milk left on the nipple with a soft washcloth.
Correct Answer: B
Rationale: Proper latch with the areola in the baby's mouth prevents nipple soreness by reducing trauma.
A nurse is counseling a client about the use of a diaphragm. Which of the following client statements indicates a need for further teaching?
- A. I need to use spermicide with the diaphragm.
- B. I can insert the diaphragm up to 6 hours before intercourse.
- C. I should leave the diaphragm in place for at least 6 hours after intercourse.
- D. I can reuse the diaphragm without cleaning it.
Correct Answer: D
Rationale: The diaphragm must be cleaned after each use to maintain hygiene and effectiveness. The other statements are correct, indicating a need for further teaching about cleaning.
A primigravid client at 36 weeks' gestation with premature rupture of the membranes is to be discharged home on bed rest with follow-up by the home health nurse. After instruction about care while at home, which of the following client statements indicates effective teaching?
- A. "It is permissible to douche if the fluid irritates my vaginal area."
- B. "I can take either a tub bath or a shower when I feel like it."
- C. "I should limit my fluid intake to less than 1 quart daily."
- D. "I should contact the doctor if my temperature is 100.4° F or higher."
Correct Answer: D
Rationale: Contacting the doctor for fever is appropriate.
A breast-feeding primiparous client with a midline episiotomy is prescribed ibuprofen 200 mg orally. The nurse instructs the client to take the medication:
- A. Before going to bed.
- B. Midway between feedings.
- C. Immediately after a feeding.
- D. When providing supplemental formula.
Correct Answer: C
Rationale: Taking ibuprofen after feeding minimizes the amount of medication in breast milk during the next feeding.