Nursing Elites

1. A healthcare provider is reinforcing teaching with a client about a new prescription for medroxyprogesterone. Which of the following information should the provider include in the teaching? (Select all that apply)

• A. Weight fluctuations can occur.
• B. Irregular vaginal spotting can occur.
• C. You should increase your intake of calcium.
• D. All of the above

Correct answer: D

Rationale: When educating a client about medroxyprogesterone, it is important to include information about potential side effects and recommendations. Weight fluctuations and irregular vaginal spotting are common side effects of medroxyprogesterone. Additionally, increasing calcium intake is often advised to counteract the potential bone density loss associated with this medication. Therefore, all the statements provided are correct, making option D the correct answer. Choices A, B, and C are all essential pieces of information that the healthcare provider should convey to the client regarding medroxyprogesterone.

2. A client in a family planning clinic requests oral contraceptives. Which of the following findings in the client's history should be recognized as contraindications to oral contraceptives? (Select all that apply.)

• A. Cholecystitis
• B. Hypertension
• C. Migraine headaches
• D. All of the above

Correct answer: D

Rationale: Cholecystitis is a correct answer. A history of gallbladder disease, such as cholecystitis, is a contraindication for the use of oral contraceptives. Hypertension is a correct answer. Hypertension is also a contraindication for the use of oral contraceptives due to the increased risk of complications. Migraine headaches are a correct answer. A history of migraine headaches is a contraindication for the use of oral contraceptives, especially for those with aura. Selecting 'All of the above' is correct as all the mentioned conditions (cholecystitis, hypertension, and migraine headaches) are contraindications for oral contraceptives. Human papillomavirus and anxiety disorder are incorrect choices as they are not contraindications for the use of oral contraceptives.

3. A client reports unrelieved episiotomy pain 8 hours following a vaginal birth. Which of the following actions should the nurse take?

• A. Apply an ice pack to the affected area.
• B. Offer a warm sitz bath.
• C. Provide a squeeze bottle of antiseptic solution.
• D. Place a hot pack on the perineum.

Correct answer: A

Rationale: The correct answer is to apply an ice pack to the affected area. Ice packs help reduce swelling, inflammation, and provide pain relief post-episiotomy. Applying heat, as in a hot pack or warm sitz bath, can increase swelling and discomfort. Providing antiseptic solution in a squeeze bottle is not the first-line intervention for managing episiotomy pain, as the priority is pain relief and comfort.

4. A client is to receive oxytocin to augment labor. Which finding contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

• A. Late decelerations
• B. Moderate variability of the FHR
• C. Cessation of uterine dilation
• D. Prolonged active phase of labor

Correct answer: A

Rationale: Late decelerations are indicative of uteroplacental insufficiency, which can be exacerbated by oxytocin administration, potentially compromising fetal well-being. Therefore, detecting late decelerations should prompt immediate reporting to the provider to prevent harm to the fetus. Choices B, C, and D are not contraindications for initiating oxytocin infusion. Moderate variability of the FHR is a reassuring sign of fetal well-being, cessation of uterine dilation may indicate a pause in labor progress but does not contraindicate oxytocin, and prolonged active phase of labor may necessitate oxytocin administration to augment contractions and progress labor.

5. A patient on the labor and delivery unit is having induction of labor with oxytocin administered through a secondary IV line. Uterine contractions occur every 2 minutes, last 90 seconds, and are strong to palpation. The baseline fetal heart rate is 150/min, with uniform decelerations beginning at the peak of the contraction and a return to baseline after the contraction is over. Which of the following actions should the nurse take?

• A. Decrease the rate of infusion of the maintenance IV solution.
• B. Discontinue the infusion of the IV oxytocin.
• C. Increase the rate of infusion of the IV oxytocin.
• D. Slow the client's breathing rate.

Correct answer: B

Rationale: The described pattern suggests late decelerations, indicating uteroplacental insufficiency. Discontinuing the oxytocin infusion helps reduce uterine contractions, improving placental blood flow and fetal oxygenation. This intervention is essential to prevent fetal compromise and potential harm during labor. Choice A is incorrect because decreasing the rate of the maintenance IV solution does not directly address the cause of the late decelerations. Choice C is incorrect because increasing the rate of IV oxytocin can worsen uterine contractions, exacerbating the fetal distress. Choice D is incorrect because slowing the client's breathing rate is not indicated in the management of late decelerations during labor.

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