Which of the following interventions should a nurse include in the plan of care for a newborn who is to undergo a circumcision using a plastic bell device?

Choice A reason: Weight changes of 4.5 kg do not necessitate a new vaginal contraceptive ring, as its efficacy relies on local hormone release, not body weight. The ring delivers consistent estrogen and progestin doses, preventing ovulation and altering cervical mucus, unaffected by minor weight fluctuations, per contraceptive pharmacology.

Choice B reason: Leaving the ring inserted for 3 weeks followed by a 1-week removal is the correct regimen, allowing hormonal contraception to prevent ovulation and maintain endometrial stability. This cycle mimics the menstrual cycle, ensuring continuous protection while permitting withdrawal bleeding, aligning with the ring’s pharmacokinetic design for effective contraception.

Choice C reason: Washing the ring with soap and water after use is incorrect, as it may degrade the device or reduce efficacy. The ring is disposable or reusable per cycle, and cleaning disrupts its hormonal matrix. Proper hygiene involves handwashing before insertion, not cleaning the ring itself, per manufacturer guidelines.

Choice D reason: Inserting the ring 6 hours before intercourse is incorrect, as the vaginal ring provides continuous contraception, not on-demand use. It requires insertion for 3 weeks to deliver steady hormones, preventing ovulation and altering cervical mucus, unlike barrier methods, making this timing irrelevant to its contraceptive mechanism.

Choice A reason: Early decelerations of the FHR result from head compression during contractions, a benign response reflecting vagal stimulation. They mirror contraction patterns and do not indicate fetal distress. Epidural analgesia may reduce maternal blood pressure, but early decelerations are unrelated to hypoxia, requiring no immediate reporting in this context.

Choice B reason: FHR accelerations of 15 beats/min for 15 seconds indicate fetal well-being, reflecting a responsive autonomic nervous system. They occur with fetal movement or stimulation and are not concerning. Epidural analgesia does not typically cause accelerations, and these findings do not warrant reporting, as they signify normal fetal oxygenation and neurological function.

Choice C reason: An FHR of 150/min is within the normal range (110-160/min) and does not indicate distress. Epidural analgesia may cause maternal hypotension, affecting placental perfusion, but a stable FHR within normal limits reflects adequate fetal oxygenation. This finding does not require immediate reporting, as it aligns with normal fetal physiology.

Choice D reason: Prolonged absent FHR variability suggests fetal compromise, as variability reflects autonomic nervous system function and oxygenation. Epidural analgesia can cause maternal hypotension, reducing placental perfusion and leading to hypoxia, which diminishes variability. This critical finding requires immediate reporting to address potential fetal distress and prevent adverse outcomes like acidosis.