Nokea
A primigravid client in the second stage of labor feels the urge to push. The client has had no analgesia or anesthesia. Anatomically, which of the following would be the best position for the client to assume?
- A. Dorsal recumbent.
- B. Lithotomy.
- C. Hands and knees.
- D. Squatting.
Correct Answer: D
Rationale: Squatting is anatomically optimal for pushing in the second stage as it widens the pelvic outlet, aligns the fetus with the birth canal, and uses gravity to aid descent. Dorsal recumbent and lithotomy positions restrict pelvic mobility, and hands and knees, while helpful for back pain, is less effective for pushing.
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A multiparous client, 72 hours postpartum, reports a sudden gush of lochia rubra. The nurse should suspect:
- A. Normal involution.
- B. Uterine subinvolution.
- C. Cervical laceration.
- D. Retained placental fragments.
Correct Answer: D
Rationale: A sudden gush of lochia rubra after 72 hours suggests retained placental fragments, which can cause hemorrhage.
The nurse is caring for a primiparous client and her neonate immediately after delivery. The neonate was born at 41 weeks' gestation and weighs 4,082 g (9 lb). Assessing for signs and symptoms of which of the following conditions should be a priority in the neonate?
- A. Anemia.
- B. Hypoglycemia.
- C. Delayed meconium.
- D. Elevated bilirubin.
Correct Answer: B
Rationale: Large-for-gestational-age neonates (e.g., 4,082 g) are at risk for hypoglycemia due to increased metabolic demand and potential maternal diabetes. Hypoglycemia screening is a priority. Anemia, delayed meconium, or hyperbilirubinemia are less immediate.
A primigravida admitted to the hospital with a diagnosis of hyperemesis gravidarum is placed on nothing-by-mouth(NPO) status and is receiving intravenous(IV) fluid replacement therapy. In planning this client's care, the nurse should collaborate with the health care provider(HCP) to carry out which of the following?
- A. Withhold oral fluids indefinitely until acidosis is corrected.
- B. Give oral fluids in small quantities whenever the client desires.
- C. Per HCP orders, provide clear liquids by mouth after 24 hours if vomiting subsides.
- D. Withhold oral fluids until total parenteral nutrition replaces lost electrolytes.
Correct Answer: C
Rationale: Gradual reintroduction of oral fluids is appropriate once vomiting subsides.
A breast-feeding primiparous client with a midline episiotomy is prescribed ibuprofen 200 mg orally. The nurse instructs the client to take the medication:
- A. Before going to bed.
- B. Midway between feedings.
- C. Immediately after a feeding.
- D. When providing supplemental formula.
Correct Answer: C
Rationale: Taking ibuprofen after feeding minimizes the amount of medication in breast milk during the next feeding.
A nurse is counseling a client about the use of a diaphragm. Which of the following client statements indicates a need for further teaching?
- A. I need to use spermicide with the diaphragm.
- B. I can insert the diaphragm up to 6 hours before intercourse.
- C. I should leave the diaphragm in place for at least 6 hours after intercourse.
- D. I can reuse the diaphragm without cleaning it.
Correct Answer: D
Rationale: The diaphragm must be cleaned after each use to maintain hygiene and effectiveness. The other statements are correct, indicating a need for further teaching about cleaning.