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.)

Correct Answer: D

Rationale: The correct answer is D: All of the above. Cholecystitis, hypertension, and migraine headaches are all contraindications to oral contraceptives. Cholecystitis can be exacerbated by oral contraceptives. Hypertension increases the risk of cardiovascular events with oral contraceptives. Migraine headaches, especially with aura, are associated with an increased risk of stroke when combined with oral contraceptives. Therefore, considering these risks, it is crucial to recognize these findings as contraindications to prescribing oral contraceptives.

Correct Answer: B

Rationale: The correct answer is B: Dizziness. Nifedipine is a calcium channel blocker that can cause hypotension, leading to dizziness. This is a common side effect and needs to be monitored to prevent falls or injury. Blood-tinged sputum (A) is not typically associated with nifedipine use. Pallor (C) is not a common manifestation of nifedipine side effects. Somnolence (D) is also not a common side effect of nifedipine. Dizziness is the most relevant and potentially harmful manifestation to monitor for in a client receiving nifedipine for preterm labor.

Correct Answer: B

Rationale: The correct answer is B: Assist the client to the bathroom to void. This action can help promote uterine contractions by relieving bladder distention, which can cause the fundus to be displaced. Voiding can help the uterus return to its normal position and firmness. Placing the client in a side-lying position (A) may be helpful for fundal massage but addressing bladder distention is the priority. Obtaining a prescription for IV oxytocin (C) or administering methylergonovine (D) are not indicated as first-line interventions for a fundus located above the umbilicus postpartum.

Correct Answer: D

Rationale: The correct answer is D: All of the Above. Implantable progestins are hormonal contraceptives known to cause common adverse effects such as nausea, irregular vaginal bleeding, and weight gain. Nausea is a common side effect due to hormonal changes. Irregular vaginal bleeding can occur as a result of hormonal imbalance. Weight gain is a known side effect associated with progestin use. Therefore, all of the listed adverse effects should be included in the client education. Other choices are incorrect because they do not encompass the full range of potential adverse effects associated with implantable progestins.

Correct Answer: A

Rationale: The correct answer is A: Betamethasone. Betamethasone is a corticosteroid used to promote fetal lung maturity in preterm labor. In this scenario, at 32 weeks of gestation with placenta previa and active bleeding, the priority is to promote fetal lung maturity in case of premature delivery due to the risk of maternal hemorrhage. Indomethacin (B) is a nonsteroidal anti-inflammatory drug and not indicated in this situation. Nifedipine (C) is a calcium channel blocker used for preterm labor to delay contractions, not for placenta previa and active bleeding. Methylergonovine (D) is used for postpartum hemorrhage and not indicated in this scenario.

Correct Answer: B

Rationale: The correct answer is B: Lecithin/sphingomyelin (L/S) ratio. This test is used to assess fetal lung maturity by determining the ratio of two substances present in amniotic fluid. An L/S ratio of 2:1 or higher indicates mature fetal lungs, reducing the risk of respiratory distress syndrome in preterm infants. A: Alpha-fetoprotein (AFP) is used to screen for neural tube defects, not fetal lung maturity. C: Kleihauer-Betke test is used to detect fetal-maternal hemorrhage. D: Indirect Coombs' test is used to detect antibodies in maternal blood that may attack fetal red blood cells, not assess fetal lung maturity. In summary, the L/S ratio test is the most appropriate choice to assess fetal lung maturity during preterm labor, as it directly correlates with the development of the fetal lungs.

Correct Answer: D

Rationale: The correct answer is D: Respiratory distress. Hypoglycemia in a late preterm newborn can lead to respiratory distress due to inadequate energy supply to respiratory muscles. Hypertonia (choice A) may indicate other issues such as hypocalcemia. Increased feeding (choice B) is not a typical clinical manifestation of hypoglycemia, as the newborn may have poor feeding due to low energy levels. Hyperthermia (choice C) is not directly related to hypoglycemia but may occur in response to infection or other causes. Thus, respiratory distress is the most indicative of hypoglycemia in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Petechiae over the head. This is because tight nuchal cord can cause pressure on the baby's head during delivery, leading to tiny red or purple spots called petechiae due to capillary rupture. Bruising over the buttocks (A) is more common in breech deliveries, hard nodules on the roof of the mouth (B) could indicate Epstein pearls which are benign and common in newborns, and bilateral periauricular papillomas (D) are not related to nuchal cord compression.

Correct Answer: B

Rationale: The correct answer is B: "I will likely need to use alternative positions for sexual intercourse." At 10 weeks of gestation, the uterus begins to enlarge, potentially causing discomfort in the missionary position. This statement shows an understanding of the physical changes in pregnancy. A is incorrect because the recommended weight gain for a client with normal BMI is 25-35 pounds during pregnancy, not less than 15-20 pounds. C is incorrect as breast size typically increases during pregnancy due to hormonal changes, regardless of prior breast reduction surgery. D is incorrect because stretch marks are common during pregnancy, regardless of skin complexion.