The nurse is caring for a client in labor with ruptured membranes. What finding suggests umbilical cord prolapse?

Correct Answer: B

Rationale: The correct answer is B: Variable decelerations on the fetal monitor. This finding suggests umbilical cord prolapse because the cord can become compressed during contractions, leading to variable decelerations. It is a serious complication that requires immediate intervention to prevent fetal distress. A: Clear amniotic fluid is a normal finding after rupture of membranes. C: Contractions every 2 minutes may indicate tachysystole, but not specifically cord prolapse. D: Maternal blood pressure is not directly related to cord prolapse.

Correct Answer: B

Rationale: The correct answer is B: Neck. The patch contraception is most effective when applied to a clean, dry, and hairless area of the body. The neck is a suitable site because it is easily accessible, non-occlusive, and less likely to be affected by clothing friction. Placing the patch on the neck also helps avoid skin irritation and allows for optimal absorption of hormones. Choice A: Buttocks - The buttocks may not be an ideal site as it can be covered by clothing and may not allow for proper adherence and absorption. Choice C: Leg - The leg is not typically recommended as a site for the patch due to movement and friction from clothing that may affect patch adhesion and hormone absorption. Choice D: Arm - While the arm is a possible site for the patch, it is not as ideal as the neck because it may be subject to more movement and rubbing against clothing, potentially affecting patch adherence and effectiveness.

Correct Answer: C

Rationale: The correct answer, C, states that excess spermicide should be removed from the vagina within 6 hours to reduce vaginal irritation. This is important as leaving excess spermicide can lead to discomfort and irritation. It is a crucial instruction to ensure the user's comfort and safety. Choice A is incorrect as nonoxynol-9 does not necessarily increase efficacy when used with barrier methods. Choice B is incorrect because while using spermicide with condoms can reduce the risk of STIs, the statement does not specifically address the instructions for use. Choice D is incorrect as placing the spermicide close to the vagina's opening does not guarantee maximal effectiveness and is not a critical instruction for safe use.

Correct Answer: C

Rationale: The correct answer is C because soaking a pad in 2 hours could indicate excessive bleeding, a potential complication after a surgical abortion. This response shows understanding of the education provided by the nurse about when to seek immediate medical attention. Choice A is incorrect because it is not true that there will be no pain after a surgical abortion; pain is a common experience post-procedure. Choice B is incorrect because it does not demonstrate an understanding of the key information provided during education. Choice D is incorrect because contraception counseling should be addressed sooner than 6 months post-abortion to prevent unintended pregnancies.

Correct Answer: A

Rationale: The correct answer is A: Hepatitis B. Newborns typically receive the Hepatitis B vaccine shortly after birth to provide protection against the virus. This is important because newborns are at risk of contracting Hepatitis B from infected mothers during childbirth. The vaccine helps prevent chronic liver infections and liver cancer later in life. Why other choices are incorrect: B: Rotavirus - Rotavirus vaccine is typically given to infants starting at 2 months of age, not immediately after birth. C: Pneumococcal - Pneumococcal vaccines are usually given later in infancy, not right after birth. D: Varicella - Varicella vaccine is typically given around 12-15 months of age, not immediately after birth.