Which of the following statements by the nurse is appropriate when reviewing a client's rubella titer of 1:8 at her second prenatal visit?

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: Spontaneous rupture of membranes indicates labor progression but does not directly guide oxytocin titration. Oxytocin stimulates uterine contractions, and titration depends on contraction strength and frequency, not membrane status. Rupture enhances labor but lacks specificity for adjusting oxytocin, as it does not reflect myometrial response or contraction adequacy.

Choice B reason: A Bishop score of 2 indicates an unfavorable cervix, suggesting the need for cervical ripening, not immediate oxytocin titration. Oxytocin efficacy depends on contraction patterns, not cervical readiness alone. The score assesses dilation and effacement, but titration requires monitoring uterine response, making this finding irrelevant for adjusting the infusion rate.

Choice C reason: Mild contractions indicate inadequate uterine response to 1 milliunit/min of oxytocin, warranting titration to 2 milliunits/min to achieve an expected labor pattern. Oxytocin stimulates myometrial contractions, and mild intensity suggests insufficient stimulation. Increasing the dose enhances contraction strength and frequency, aligning with labor induction protocols to promote effective labor.

Choice D reason: Contractions every 1 minute indicate hyperstimulation, risking fetal distress due to reduced placental perfusion. Oxytocin titration aims for contractions every 2-3 minutes. This frequency suggests excessive uterine activity, requiring a decrease or pause in oxytocin, not an increase, to prevent hypoxia and ensure fetal safety during labor.