A 22-year-old woman visits the clinic requesting birth control. Her medical history includes dysmenorrhea, irregular menstrual cycles, and menorrhagia. She smokes half a pack of cigarettes daily and reports being sexually active with multiple partners. Which birth control method is most appropriate for this client?

Depo-Provera

Contraceptive implant

Combination oral contraceptives

Barrier methods such as female condoms

Answer and Explanation

The Correct Answer is D

A. "Depo-Provera."
Depo-Provera (medroxyprogesterone injection) is effective for contraception, but it may worsen menstrual irregularities and cause bone density loss with long-term use, making it less ideal.

B. "Contraceptive implant."
While progestin-only implants (e.g., Nexplanon) are effective, they do not protect against STIs. Additionally, irregular bleeding is a common side effect, which may not be ideal for someone with menorrhagia and irregular cycles.

C. "Combination oral contraceptives."
Estrogen-containing contraceptives (e.g., combined oral contraceptive pills) are contraindicated in women who smoke and are ≥35 years old due to the increased risk of venous thromboembolism (VTE). While this client is 22 years old, smoking still makes this option less preferable.

D. "Barrier methods such as female condoms."
Barrier methods reduce the risk of sexually transmitted infections (STIs), which is crucial for this client with multiple sexual partners. Additionally, they do not contain hormones, making them safer for smokers.

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Correct Answer is ["A","B"]

Explanation

A. Slurred speech – Slurred speech may indicate systemic absorption of the epidural medication, leading to toxicity or excessive central nervous system depression, which requires immediate intervention.

B. Respiratory depression – A serious complication of epidural anesthesia is respiratory depression, which may result from excessive medication spread, affecting respiratory function. Immediate intervention is required.

C. Decreased sensation in the lower extremities – This is an expected effect of an epidural and does not necessarily require immediate reporting unless it extends beyond expected levels.

D. Sustained fetal heart rate of 150 bpm – This fetal heart rate is within the normal range (110-160 bpm) and does not indicate distress.

E. Blood pressure 108/62 – While hypotension can be a side effect of epidural anesthesia, this blood pressure is within an acceptable range for many clients and does not require immediate intervention unless the client is symptomatic.

A. Discontinue the oxytocin infusion B. Notify the health care provider C. Assist the patient onto her left side D. Administer oxygen at 10L/min via nonrebreather face mask E. Stop the magnesium sulfate F. Assist with a vaginal exam for cord prolapse

Correct Answer is ["B","C"]

Explanation

A. Discontinue the oxytocin infusion The patient is not receiving an oxytocin infusion; therefore, discontinuing it is not applicable. Oxytocin is typically stopped in cases of uterine tachysystole or fetal distress, neither of which is present in this scenario. The fetal heart rate (FHR) is within normal range, and no contractions have been noted.

B. Notify the health care provider: The nurse should notify the healthcare provider because the patient is exhibiting severe hypertension (168/100 mmHg), minimal fetal heart rate variability, and laboratory findings consistent with preeclampsia with severe features (elevated liver enzymes, thrombocytopenia, and proteinuria).

C. Assist the patient onto her left side: Repositioning the patient onto her left side can improve uteroplacental blood flow by reducing pressure on the inferior vena cava, thereby enhancing oxygen delivery to the fetus.

D. Administer oxygen at 10L/min via nonrebreather face mask : Oxygen therapy is typically reserved for cases of acute fetal distress. In this case, the FHR is within the normal range, and there are no signs of immediate fetal compromise requiring supplemental oxygen.

E. Stop the magnesium sulfate: Magnesium sulfate is administered to prevent seizures in preeclampsia with severe features and should not be stopped unless there are signs of magnesium toxicity, such as absent deep tendon reflexes (DTRs), respiratory depression, or altered mental status.

F. Assist with a vaginal exam for cord prolapse: A vaginal examination for cord prolapse is only indicated when there is a sudden, severe fetal bradycardia or variable decelerations, particularly following rupture of membranes.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is monitoring a client in active labor who has an epidural in place. Which of the following findings should be reported to the anesthesiologist immediately? (Select All that Apply.)

Correct Answer is ["A","B"]

Explanation

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) The nurse will implement the following interventions based on the fetal heart rate.(Select All that Apply.)

Correct Answer is ["B","C"]

Explanation

A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

Exhibits Select a condition, the assessment cues, and anticipated solutions for this client.

A nurse is assessing a postpartum client for signs of postpartum depression. Which of the following symptoms is most indicative of postpartum depression rather than normal postpartum adjustment?

A teenager presents to the clinic with complaints of painful lesions, fever, headache, and vaginal discharge. After testing she is diagnosed with Herpes simplex virus type 2. What education should the nurse include in a teaching plan? (Select All that Apply.)

A nurse is caring for a postpartum client who reports feeling anxious, irritable, and unable to sleep despite extreme fatigue. The client also expresses feelings of inadequacy as a mother. Which of the following nursing interventions is the most appropriate?

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) Identify which of the following findings is a priority concern or not for the patient.

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client?