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The nurse is evaluating the client who delivered vaginally 2 hours ago and is experiencing postpartum pain rated 8 on scale of 1 to 10. The client is a G 4, P 4, breast-feeding mother who would like medication to decrease the pain in her uterus. Which of the medications listed on the orders sheet would be the most appropriate for this client?
- A. Aspirin 1,000 mg P.O. q 4 to 6 hour p.r.n.
- B. Ibuprofen 800 mg P.O. q 6 to 8 hour p.r.n.
- C. Colace 100 mg P.O. b.i.d.
- D. Vicodin 1 to 2 tabs P.O. q 4 to 6 hour p.r.n.
Correct Answer: B
Rationale: Ibuprofen is safe for breastfeeding mothers and effective for uterine cramping pain, unlike aspirin (risk of bleeding), Colace (stool softener), or Vicodin (opioid, less preferred due to sedation risks).
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A nurse is discussing the benefits of the copper IUD with a client. Which of the following statements by the nurse is accurate?
- A. The copper IUD can reduce menstrual bleeding.
- B. The copper IUD is effective for up to 10 years.
- C. The copper IUD requires daily monitoring.
- D. The copper IUD prevents ovulation.
Correct Answer: B
Rationale: The copper IUD is effective for up to 10 years, providing long-term contraception. It may increase menstrual bleeding, does not require daily monitoring, and does not prevent ovulation, working primarily by affecting sperm motility.
A 24-year-old primigravid client who delivers a viable term neonate is ordered to receive the primary effect of the placenta. Which of the following signs would indicate to the nurse that the placenta is about to be delivered?
- A. The cord lengthens outside the vagina.
- B. There is decreased vaginal bleeding.
- C. The uterus cannot be palpated.
- D. Uterus changes to discoid shape.
Correct Answer: A
Rationale: A lengthening umbilical cord outside the vagina indicates placental separation and descent, signaling imminent delivery. Decreased bleeding or a non-palpable uterus are not reliable signs, and the uterus becomes globular, not discoid, after placental delivery.
When developing the initial plan of care for a neonate who was born at 41 weeks' gestation, was diagnosed with meconium aspiration syndrome (MAS), and requires mechanical ventilation, which of the following should the nurse include:
- A. Care of an umbilical arterial line.
- B. Frequent ultrasound scans.
- C. Orogastric feedings as soon as possible.
- D. Assessment for symptoms of hyperglycemia.
Correct Answer: A
Rationale: Care of an umbilical arterial line is necessary for monitoring blood gases and blood pressure in a neonate on mechanical ventilation.
A client is considering permanent contraception. Which of the following statements by the nurse is accurate?
- A. Tubal ligation and vasectomy are considered reversible procedures.
- B. Both tubal ligation and vasectomy require a follow-up to confirm effectiveness.
- C. Tubal ligation affects hormone production.
- D. Vasectomy increases the risk of prostate cancer.
Correct Answer: B
Rationale: Both tubal ligation and vasectomy require follow-up to confirm effectiveness (e.g., sperm count for vasectomy, imaging for tubal ligation). Reversal is not guaranteed, tubal ligation does not affect hormones, and vasectomy is not linked to prostate cancer.
A primigravid client with class II heart disease who is visiting the clinic at 8 weeks' gestation tells the nurse that she has been maintaining a low-sodium, 1,800-calorie diet. Which of the following instructions should the nurse give the client?
- A. Avoid folic acid supplements to prevent megaloblastic anemia.
- B. Severely restrict sodium intake throughout the pregnancy.
- C. Take iron supplements with milk to enhance absorption.
- D. Increase caloric intake to 2,200 calories daily to promote fetal growth.
Correct Answer: D
Rationale: Increased caloric intake supports fetal growth without compromising maternal health.