A nurse is reviewing the medical record of a client who has preeclampsia prior to administering labetalol.
For which of the following findings should the nurse withhold the medication?

Uric acid 7.5 mg/dL (2.7 to 7.3 mg/dL).

Heart rate 54/min.

FHR 112/min.

BUN 23 mg/dL (10 to 20 mg/dL).

Answer and Explanation

The Correct Answer is B

Choice A rationale

Uric acid levels in preeclampsia can be elevated due to decreased renal clearance and increased production, often exceeding the normal range of 2.7 to 7.3 mg/dL. A value of 7.5 mg/dL is slightly elevated, which is a common finding in preeclampsia and does not typically contraindicate the administration of labetalol, an antihypertensive medication. It reflects disease progression but does not pose an immediate risk regarding medication administration.

Choice B rationale

Labetalol is a beta-blocker that reduces heart rate and blood pressure. A heart rate of 54/min is below the normal adult resting heart rate range (typically 60-100 beats/min) and indicates bradycardia. Administering labetalol to a client with pre-existing bradycardia could further depress the heart rate, potentially leading to symptomatic bradycardia, decreased cardiac output, and inadequate tissue perfusion, thus requiring the nurse to withhold the medication.

Choice C rationale

A fetal heart rate (FHR) of 112/min is within the normal range for a fetus (typically 110-160 beats/min). While labetalol can rarely cause fetal bradycardia, a baseline FHR of 112/min does not contraindicate its administration. The primary concern with labetalol in preeclampsia is the maternal hemodynamic response, and this FHR value does not indicate an immediate fetal distress that would preclude the medication.

Choice D rationale

A BUN level of 23 mg/dL is slightly elevated above the normal range of 10 to 20 mg/dL, often seen in preeclampsia due to impaired renal function. While this indicates renal involvement, it does not contraindicate the administration of labetalol. Labetalol is primarily metabolized by the liver, and while caution is advised in renal impairment, this BUN level alone does not warrant withholding the medication.

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Correct Answer is ["A","C","E"]

Explanation

Choice A rationale: Screening for sexually transmitted infections (STIs) prior to IUD placement is essential to reduce the risk of pelvic inflammatory disease (PID). The insertion process can introduce bacteria from the cervix or vagina into the uterine cavity, increasing infection risk if an STI is present. Guidelines recommend screening high-risk patients or those with recent STI history. Identifying infections before insertion allows treatment, preventing serious reproductive complications, including infertility.

Choice B rationale: Most intrauterine devices (IUDs) have a lifespan longer than 2 years; copper IUDs last up to 10 years, and hormonal IUDs typically last between 3 and 7 years depending on the type. Replacing the device every 2 years is unnecessary and not evidence-based. Premature removal or replacement increases risk of procedure-related complications without added contraceptive benefit.

Choice C rationale: Irregular spotting or breakthrough bleeding during the first few months after IUD insertion is common due to endometrial adjustment to the foreign body and hormonal changes (for hormonal IUDs). This occurs as the endometrial lining remodels, and bleeding usually decreases with time. Patient education about this transient effect improves adherence and reduces anxiety related to unexpected bleeding.

Choice D rationale: There is no contraindication to tampon use while an IUD is in place. Tampons do not interfere with IUD function or position. Although some clinicians advise caution initially post-insertion to prevent infection, scientific evidence does not support a permanent restriction on tampon use during menstruation after proper healing.

Choice E rationale: Signing informed consent before IUD insertion is legally and ethically required. It ensures the client understands benefits, risks, potential complications (such as expulsion or perforation), and alternative contraceptive methods. This process protects patient autonomy and supports shared decision-making, critical components of safe clinical practice.

A. "Begin each feeding with the breast that is most sore, so the newborn spends less time on it.”. B. "Use breast pads with a moisture-proof lining to keep the nipples moist.”. C. "Breastfeed the baby less frequently to give the nipples time to heal.”. D. "Apply colostrum to the nipples after feeding to help them heal.”.

Correct Answer is D

Explanation

Choice A rationale

Initiating feeding on the less sore breast is generally recommended when nipples are sore or cracked. The newborn's initial suck is often the strongest and most vigorous, which can exacerbate pain and damage on an already compromised nipple. Starting on the less sore side allows for a gentler initial latch and flow.

Choice B rationale

Using breast pads with a moisture-proof lining can trap moisture against the nipples, creating a warm, damp environment that promotes bacterial or fungal growth, potentially worsening soreness or leading to infection. Air drying and absorbent, breathable pads are generally preferred for nipple healing.

Choice C rationale

Reducing feeding frequency can lead to breast engorgement, which further complicates breastfeeding and can decrease milk supply. Frequent, shorter feedings are often more comfortable for the mother and help maintain milk production while allowing the nipples to heal gradually.

Choice D rationale

Applying colostrum to the nipples after feeding is beneficial due to its immunological properties and moisturizing effect. Colostrum contains antibodies and growth factors that can promote healing, reduce inflammation, and provide a protective barrier against infection, aiding in the recovery of sore and cracked nipples.

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A nurse is reviewing the medical record of a client who has preeclampsia prior to administering labetalol. For which of the following findings should the nurse withhold the medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a female client regarding an intrauterine device (IUD) in the outpatient clinic. Which of the following statements should the nurse include in the teaching?

Correct Answer is ["A","C","E"]

Explanation

A nurse is caring for a postpartum client who is breastfeeding their newborn and reports that their nipples have become sore and cracked. Which of the following statements should the nurse make?

Correct Answer is D

Explanation

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A nurse is reviewing the medical record of a client who has preeclampsia prior to administering labetalol.
For which of the following findings should the nurse withhold the medication?