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After a lengthy labor process, a primigravid client delivers a healthy newborn boy with a moderate amount of skull molding. Which of the following would the nurse include when explaining to the parents about this condition?
- A. It is typically seen with breech deliveries.
- B. It usually lasts a day or two before resolving.
- C. It is unusual when the brow is the presenting part.
- D. Surgical intervention may be necessary to alleviate pressure.
Correct Answer: B
Rationale: Skull molding, a common result of vaginal delivery due to cranial bones overlapping, typically resolves within a few days as the head reshapes. It is not specific to breech or brow presentations, and surgical intervention is rarely needed.
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While caring for the neonate of a human immunodeficiency virus-positive mother, the nurse prepares to administer an ordered hepatitis B intramuscular injection at 4 hours after birth. Which of the following actions should the nurse do first?
- A. Bathe the neonate with an antibacterial soap.
- B. Place the neonate under a radiant warmer.
- C. Wash the injection site with povidone-iodine (Betadine) solution.
- D. Apply clean gloves before administering the medication.
Correct Answer: D
Rationale: Applying clean gloves ensures infection control and safety during the administration of the injection.
A multigravid laboring client has an extensive documented history of drug addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with contractions every 3 minutes of moderate intensity. The physician orders nalbuphine (Nubain) 15 mg slow I.V. push for pain relief followed by an epidural when the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client states she thinks she is going to have her baby now. Of the following drugs available at the time of the delivery, which should the nurse avoid using with this client in this situation?
- A. 1% lidocaine (Xylocaine).
- B. Naloxone hydrochloride (Narcan).
- C. Local anesthetic.
- D. Pudendal block.
Correct Answer: B
Rationale: In a client with recent opioid use, naloxone (Narcan) could precipitate withdrawal symptoms, which is risky during delivery. Lidocaine, local anesthetics, or pudendal blocks are safe for perineal anesthesia and do not interact with the client's history.
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.
After teaching the multiparous mother about hemolytic disease of the newborn and Rh sensitization, the nurse determines that the client understands why she was not sensitized during her other pregnancy when she says which of the following?
- A. My other baby had a different father.'
- B. Like most women, I have immunity against the Rh factor.'
- C. Antibodies are not usually formed until after exposure to an antigen.'
- D. My blood couldn't neutralize antibodies formed from my first pregnancy.'
Correct Answer: C
Rationale: Antibodies form after exposure to an Rh-positive fetus, typically not during the first pregnancy, explaining why sensitization did not occur previously.
A client asks the nurse about the effectiveness of natural family planning methods. Which of the following responses by the nurse is most accurate?
- A. Natural family planning is as effective as oral contraceptives when used correctly.
- B. The effectiveness of natural family planning depends on consistent monitoring and abstinence during fertile periods.
- C. Natural family planning is less effective than barrier methods likeå®çŸ³
- D. Natural family planning requires no special equipment or cost.
Correct Answer: B
Rationale: The effectiveness of natural family planning depends on consistent monitoring and abstinence during fertile periods. It is less effective than oral contraceptives or barrier methods due to variability in ovulation and user adherence.