Nokea
In preparation for discharge, the nurse discusses sexual issues with a primiparous client who had a routine vaginal delivery with a midline episiotomy. The nurse should instruct the client that she can resume sexual intercourse:
- A. In 6 weeks when the episiotomy is completely healed.
- B. After a postpartum check by the health care provider.
- C. Whenever the client is feeling amorous and desirable.
- D. When lochia flow and episiotomy pain have stopped.
Correct Answer: D
Rationale: Resuming sexual intercourse is safe when lochia has stopped and episiotomy pain has resolved, indicating healing.
You may also like to solve these questions
The nurse makes a home visit to a 3-day-old full-term neonate who weighed 3,912 grams (8 lb, 10 oz) at birth. Today the neonate, who is being bottle-fed, weighs 1,350 grams (7 lb, 14 oz).Which of the following instructions should the nurse give to the mother?
- A. Continue feeding every 3 to 4 hours since the weight loss is normal.
- B. Contact the physician if the weight loss continues over the next few days.
- C. Switch to a soy-based formula because the current one seems inadequate.
- D. Change to a higher-calorie formula to prevent further weight loss.
Correct Answer: A
Rationale: The weight loss from 3,912 g to 3,550 g (7 lb, 14 oz) is approximately 9%, which is within the normal range of up to 10% for newborns in the first few days. Continuing regular feedings is appropriate.
A nurse is giving a shift report about a client in labor. Which of the following information is the least important to include to complete the report at the change of shift?
- A. Gravida, term, preterm, abortion, living.
- B. Cervical effacement, dilation, station.
- C. Support persons with the client.
- D. Bottle- or breast-feeding preference.
Correct Answer: D
Rationale: Feeding preference is less critical during labor compared to obstetric history and labor progress.
A nurse is reviewing a client's maternal prenatal record and notes that the mother used narcotics during her pregnancy. A primary nursing intervention when caring for a drug-exposed neonate is to:
- A. Assess vital signs including blood pressure every hour.
- B. Minimize environmental stimuli.
- C. Place the infant in a well-lighted area for observation.
- D. Provide stimulation to increase adaptation to the environment.
Correct Answer: B
Rationale: Minimizing environmental stimuli reduces stress and overstimulation in drug-exposed neonates, who are often hypersensitive.
A primiparous client, 24 hours post-cesarean, reports incisional pain rated 6/10. The nurse should first:
- A. Administer prescribed analgesics.
- B. Encourage deep breathing exercises.
- C. Apply a warm compress to the incision.
- D. Assess the incision for signs of infection.
Correct Answer: A
Rationale: Administering analgesics addresses pain promptly, promoting comfort and mobility.
The labor and delivery nurse is assigned to triage for the day. There are four clients already in rooms and the following reports have been received about each of these clients. To provide the safest care and best manage time, the nurse should plan to see which client first?
- A. A primipara in active labor at 5 cm asking to be admitted and wanting an epidural.
- B. A primipara who is 100% effaced, 8 cm dilated, and ready to push.
- C. A multipara who thinks her water broke 2 hours ago.
- D. A multipara with contractions every 5 minutes who is 3 cm dilated.
Correct Answer: B
Rationale: A primipara at 8 cm, 100% effaced, and ready to push is in the second stage of labor, requiring immediate attention to prepare for delivery. Other clients are in earlier stages or need assessment but are less urgent.