Nokea
The Gravida 7 Para 6 client delivered a 9-pound 4-ounce infant two (2) hours ago. Which intervention is priority for the nurse to implement?
- A. Assess the client’s fundus every hour.
- B. Assess the client’s voiding pattern every shift.
- C. Discuss birth control options with the client.
- D. Discuss breastfeeding methods with the client.
Correct Answer: A
Rationale: Fundal assessment every hour post-delivery prevents postpartum hemorrhage, a life-threatening risk in high-parity clients with large infants. Voiding, birth control, and breastfeeding are secondary.
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When counseling a female client with a new diagnosis of genital herpes, which statement by the nurse is accurate?
- A. Have a Pap test done at least every 6 months.
- B. Avoid having vaginal intercourse for at least 6 months.
- C. If you take your medicine, you will not infect anyone else.
- D. Your infection provides immunity for any future children.
Correct Answer: D
Rationale: Genital herpes infection may confer some immunity to neonates via maternal antibodies, reducing severe neonatal herpes risk.
The nurse is discharging a client diagnosed with pelvic inflammatory disease (PID). Which statement by the client indicates an understanding of the discharge instructions?
- A. I should expect pelvic pain after intercourse.'
- B. I need to douche every day to prevent PID.'
- C. I will have a vaginal examination every two (2) years.'
- D. My partner should use a condom if he is infectious.'
Correct Answer: D
Rationale: Condom use by an infectious partner prevents PID reinfection. Pain post-intercourse is abnormal, douching increases PID risk, and exams every 2 years are insufficient.
The nurse is discussing pelvic floor exercises with a client. Which information should the nurse teach?
- A. Perform the exercises four (4) times per day.
- B. The exercises will prevent stress incontinence.
- C. Contract the perineal muscles and hold for 10 seconds.
- D. Contract the abdominal and buttock muscles to increase strength.
Correct Answer: C
Rationale: Kegel exercises involve contracting perineal muscles for 10 seconds to strengthen the pelvic floor. Frequency varies, they reduce but don’t prevent incontinence, and abdominal/buttock contraction is incorrect.
The nurse in the gynecology clinic is assessing the 50-year-old client who has had four (4) children and is complaining of having lower abdominal pressure and fatigue along with some urinary incontinence. Which instruction should the nurse teach the client?
- A. Wear a peri-pad to keep from having an accident.
- B. Try not to laugh or sneeze unless at home.
- C. Discuss the pros and cons of a vaginal hysterectomy.
- D. Instruct to perform Kegel exercises.
Correct Answer: D
Rationale: Kegel exercises strengthen pelvic floor muscles, reducing stress incontinence and pelvic pressure from multiparity. Peri-pads are palliative, avoiding laughter/sneezing is impractical, and hysterectomy is premature.
The nurse is planning the care of a client diagnosed with pelvic inflammatory disease secondary to an STD. Which collaborative diagnosis is appropriate for this client?
- A. Risk for infertility.
- B. Knowledge deficit.
- C. Fluid volume deficit.
- D. Noncompliance.
Correct Answer: A
Rationale: PID from STDs increases infertility risk due to scarring. Knowledge deficit, fluid volume deficit, and noncompliance are less specific without evidence.