Nursing Elites

1. 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.

2. A client who is 2 hours postpartum is in the taking-hold phase. Which intervention should the nurse plan to implement during this phase of postpartum behavioral adjustment?

• A. Discuss contraceptive options with the client and her partner.
• B. Repeat information to ensure client understanding.
• C. Listen to the client and her partner as they reflect upon the birth experience.
• D. Demonstrate to the client how to perform a newborn bath.

Correct answer: D

Rationale: During the taking-hold phase of postpartum behavioral adjustment, the new mother starts taking a stronger interest in her new role as a mother. This phase involves the mother focusing on the care of her newborn and acquiring parenting skills. Demonstrating how to perform a newborn bath is an appropriate intervention during this phase as it helps the mother actively engage in caring for her baby, which aligns with the developmental tasks of this phase. Choices A, B, and C are incorrect as they do not specifically address the mother's need to actively engage in caring for her newborn during the taking-hold phase. Discussing contraceptive options, repeating information, and listening to reflections on the birth experience are more relevant to other phases of postpartum adjustment.

3. A nurse concludes that the parent of a newborn is not showing positive indications of parent-infant bonding. The parent appears very anxious and nervous when asked to bring the newborn to the other parent. Which of the following actions should the nurse use to promote parent-infant bonding?

• A. Hand the parent the newborn and suggest that they change the diaper.
• B. Ask the parent why they are so anxious and nervous.
• C. Tell the parent that they will grow accustomed to the newborn.
• D. Provide reinforcement about infant care when the parent is present.

Correct answer: D

Rationale: Providing reinforcement about infant care when the parent is present can help alleviate anxiety and promote positive parent-infant bonding. By offering guidance and support while the parent is interacting with the newborn, the nurse can help build the parent's confidence and strengthen the bond between the parent and the infant. Choice A is not ideal as it does not address the parent's anxiety and may increase stress levels. Choice B focuses on the parent's emotions without providing direct support for bonding. Choice C is dismissive and does not offer practical assistance in fostering bonding between the parent and the infant.

4. A client who is postpartum received methylergonovine. Which of the following findings indicates that the medication was effective?

• A. Increase in blood pressure
• B. Fundus firm to palpation
• C. Increase in lochia
• D. Report of absent breast pain

Correct answer: B

Rationale: Methylergonovine is used to prevent or treat postpartum hemorrhage by contracting the uterus. A firm fundus indicates effective uterine contraction and less bleeding. Therefore, the correct answer is a firm fundus to palpation. The increase in blood pressure (Choice A) is not a typical finding associated with the effectiveness of methylergonovine. Increase in lochia (Choice C) may indicate excessive bleeding rather than the medication's effectiveness. Absence of breast pain (Choice D) is not directly related to the medication's effectiveness in treating postpartum hemorrhage.

5. A client is being cared for 2 hours after a spontaneous vaginal birth and has saturated two perineal pads with blood in a 30-minute period. Which of the following is the priority nursing intervention at this time?

• A. Palpate the client's uterine fundus.
• B. Assist the client to a bedpan to urinate.
• C. Prepare to administer oxytocic medication.
• D. Increase the client's fluid intake.

Correct answer: A

Rationale: The priority nursing intervention in this situation is to palpate the client's uterine fundus. A boggy uterus that is not well contracted may indicate uterine atony, which can lead to postpartum hemorrhage. Palpating the fundus and massaging it if it is boggy helps to promote contractions and reduce bleeding, making it the most critical intervention to address the potential underlying issue. Assisting the client to a bedpan to urinate, preparing to administer oxytocic medication, or increasing the client's fluid intake are not the immediate priorities in this scenario compared to assessing and addressing the uterine fundus status.

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