A nurse is assisting a postpartum person with breastfeeding. What is the most important factor for successful breastfeeding?
- A. frequent breastfeeding
- B. proper latch
- C. positioning
- D. administer oxytocin
Correct Answer: B
Rationale: The correct answer is B: proper latch. A proper latch is crucial for successful breastfeeding as it ensures the baby is effectively extracting milk from the breast, preventing nipple soreness and ensuring an adequate milk supply. Without a proper latch, the baby may not receive enough milk, leading to issues such as poor weight gain and frustration for both the baby and the person breastfeeding. Frequent breastfeeding (choice A) is important, but without a proper latch, it may not be effective. Positioning (choice C) is also important, but proper latch takes precedence. Administering oxytocin (choice D) is not necessary for successful breastfeeding and may have side effects.
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What is the most appropriate nursing action when a laboring person requests pain relief during the first stage of labor?
- A. provide non-pharmacological pain relief
- B. administer epidural analgesia
- C. administer IV analgesics
- D. administer pain medication as requested
Correct Answer: B
Rationale: The correct answer is B: administer epidural analgesia. In the first stage of labor, epidural analgesia is the most appropriate option for pain relief as it provides effective and continuous pain management without compromising maternal and fetal well-being. Epidural analgesia allows the laboring person to remain alert and actively participate in the birthing process. Non-pharmacological pain relief methods may not provide sufficient pain relief during the intense contractions of the first stage of labor. Administering IV analgesics may not effectively manage the pain in the first stage and can have sedative effects on the laboring person and newborn. Administering pain medication as requested without considering the most appropriate option may not provide optimal pain relief and may not be in the best interest of the laboring person and their baby.
A client asks the nurse, “Could you explain how the baby’s blood and my blood separate at delivery?” Which of the following responses is appropriate for the nurse to make?
- A. When the placenta is born, the circulatory systems separate.
- B. When the doctor clamps the cord, the blood stops mixing.
- C. The separation happens after the baby takes the first breath. The baby’s oxygen no longer has to come from you.
- D. The blood actually never mixes. Your blood supply and the baby’s blood supply are completely separate.
Correct Answer: D
Rationale: During pregnancy, the mother's and baby's blood supplies do not mix. The placenta acts as a barrier and facilitates the exchange of nutrients, gases, and waste products between the maternal and fetal bloodstreams without direct mixing. This ensures that each individual maintains their own circulatory system.
What is the primary purpose of assessing cervical dilation during labor?
- A. to assess the progress of labor
- B. to identify the need for interventions
- C. to assess for complications
- D. to monitor fetal position
Correct Answer: A
Rationale: The primary purpose of assessing cervical dilation during labor is to evaluate the progress of labor. Cervical dilation indicates how far the labor has advanced and helps determine if the labor is proceeding normally. Monitoring dilation helps healthcare providers make informed decisions about the timing of interventions and the overall management of labor. It does not directly assess the need for interventions (choice B), complications (choice C), or fetal position (choice D). These factors can be assessed through other means, but the main focus of assessing cervical dilation is to track the progression of labor.
Which vitamin should be avoided in excess during pregnancy?
- A. Vitamin C
- B. Vitamin D
- C. Vitamin B2 (niacin)
- D. Vitamin B12 (cobalamin)
Correct Answer: B
Rationale: Vitamin D in excess can lead to hypercalcemia, which may harm the fetus. Other vitamins listed are generally safe when consumed in recommended amounts.
A nurse is assisting with a vaginal birth and is monitoring for the risk of umbilical cord prolapse. Which is the most appropriate intervention if the cord is prolapsed?
- A. place the person in the knee-chest position
- B. reposition the laboring person
- C. administer oxygen via mask
- D. apply pressure to the cord
Correct Answer: A
Rationale: The correct answer is A: place the person in the knee-chest position. Placing the person in this position helps alleviate pressure on the umbilical cord, reducing the risk of compression and improving fetal oxygenation. Other choices like repositioning the laboring person or administering oxygen via mask do not directly address the issue of cord prolapse. Applying pressure to the cord can further compromise blood flow to the fetus. The knee-chest position is the most appropriate intervention as it helps relieve pressure on the cord and is crucial in managing umbilical cord prolapse effectively.