Current Issues in Maternal Newborn Nursing

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The nurse is writing an expected outcome for the nursing diagnosis—acute pain related to
tissue trauma, secondary to vaginal birth, as evidenced by patient stating pain of 8 on a scale
of 10. Which expected outcome is correctly stated for this problem?

  • A. Patient will state that pain is a 2 on a scale of 10.
  • B. Patient will have a reduction in pain after administration of the prescribed
  • C. Patient will state an absence of pain 1 hour after administration of the prescribed
  • D. Patient will state that pain is a 2 on a scale of 10, 1 hour after the administration of
Correct Answer: D

Rationale: The correct answer is D because it reflects a specific, measurable, and realistic expected outcome for the nursing diagnosis of acute pain. It includes the patient's subjective pain rating (2 on a scale of 10) and a time frame (1 hour after administration of medication). This outcome is achievable and provides a clear target for evaluating the effectiveness of pain management.

Option A is incorrect as it does not specify a time frame or intervention. Option B is vague and lacks a measurable outcome. Option C is also vague and lacks a clear time frame for evaluation. Overall, option D is the best choice as it aligns with the SMART criteria for expected outcomes in nursing care planning.

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Which body part both protects the pelvic structures and accommodates the growing fetus during pregnancy?

  • A. Perineum
  • B. Bony pelvis
  • C. Vaginal vestibule
  • D. Fourchette
Correct Answer: B

Rationale: The bony pelvis provides protection and support for the growing fetus during pregnancy.

Which contraceptive method best protects against STIs and the HIV?

  • A. Periodic abstinence
  • B. Barrier methods
  • C. Hormonal methods
  • D. Same protection with all methods
Correct Answer: B

Rationale: Barrier methods, such as condoms, protect against STIs and HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods do not offer protection against STIs or HIV.

A nurse is caring for a patient with pyelonephritis. What does the nurse identify as the most common cause?

  • A. Escherichia coli
  • B. Neisseria gonorrhoeae
  • C. Chlamydia trachomatis
  • D. Candida albicans
Correct Answer: A

Rationale: The correct answer is A: Escherichia coli. Step 1: E. coli is the most common causative agent of pyelonephritis due to its ability to ascend from the lower urinary tract to the kidneys. Step 2: E. coli is a common bacteria found in the gut and can easily infect the urinary tract. Step 3: Neisseria gonorrhoeae, Chlamydia trachomatis, and Candida albicans are not commonly associated with pyelonephritis. Thus, the correct choice is A.

What are the most common causes for subinvolution of the uterus?

  • A. Postpartum hemorrhage and infection
  • B. Multiple gestation and postpartum hemorrhage
  • C. Uterine tetany and overproduction of oxytocin
  • D. Retained placental fragments and infection
Correct Answer: D

Rationale: Subinvolution is the failure of the uterus to return to a nonpregnant state. The most common causes are retained placental fragments and infection.

The nurse would advise the patient to report what symptom immediately during a PD-1 (checkpoint inhibitor) infusion?

  • A. nausea
  • B. fatigue
  • C. dizziness
  • D. diarrhea
Correct Answer: C

Rationale: The correct answer is C: dizziness. Dizziness during a PD-1 infusion can indicate a potential serious adverse reaction, such as immune-related neurological toxicity. Prompt reporting is crucial to prevent complications. Nausea, fatigue, and diarrhea are common side effects of PD-1 inhibitors but are typically not considered immediate concerns for infusion reactions. Reporting dizziness ensures timely assessment and intervention to manage any severe adverse effects.

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