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The client, who is 20 days postpartum, telephones the perinatal clinic to tell the nurse that she is having heavy, bright red bleeding since hospital discharge 18 days ago. Which instruction to the client is correct?
- A. “You need to come to the clinic immediately.”
- B. “Decrease physical activity until the bleeding stops.”
- C. “There is no need for concern; this is expected after birth.”
- D. “Call next week if the bleeding has not stopped by then.”
Correct Answer: A
Rationale: Lochia rubra that persists for longer than 2 weeks is suggestive of subinvolution of the uterus, which is the most common cause of delayed postpartum hemorrhage. The client should be seen in the clinic immediately to determine what is causing her abnormal lochial discharge. Increased physical activity can lead to increased lochial discharge, but the client is reporting continuous lochia rubra, which is abnormal. Lochia rubra is expected to last for up to 3 days after birth, not 20 days. Waiting until next week to be seen only delays determining the cause for her abnormal bleeding and increases the risk of the client for other complications.
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The nurse is caring for multiple clients. The nurse determines that which client would be a candidate for intermittent fetal monitoring during labor?
- A. The client with a previous cesarean birth
- B. The primigravida client at 41 weeks
- C. The client with preeclampsia
- D. The client with gestational diabetes
Correct Answer: B
Rationale: The client who is overdue by 7 days but has a reassuring FHR pattern is able to have intermittent fetal monitoring. Women with a previous cesarean birth are at an increased risk for uterine rupture. Women with preeclampsia are at an increased risk for placental insufficiency and need continuous monitoring during labor. Women with gestational diabetes are at an increased risk for placental insufficiency and need continuous monitoring during labor.
Which explanation by the nurse accurately identifies the recommended weight gain for a pregnant client who has a normal prepregnancy weight?
- A. Less than 15 pounds (<6.8 kg)
- B. 15 to 20 pounds (6.8 to 9 kg)
- C. 25 to 35 pounds (11.3 to 15.9 kg)
- D. No more than 40 pounds (≤18.1 kg)
Correct Answer: C
Rationale: For a woman with normal prepregnancy weight, the recommended weight gain is 25-35 pounds to support fetal development.
The nurse explains that true labor contractions are characterized by which feature?
- A. Irregular timing
- B. Increasing intensity and frequency
- C. Relief with walking
- D. Occurrence only at night
Correct Answer: B
Rationale: True labor contractions increase in intensity and frequency, distinguishing them from false labor.
The RN and the student nurse are caring for the postpartum client who is 16 hours postdelivery. The RN evaluates that the student needs more education about uterine assessment when the student is observed doing which activity?
- A. Elevating the client’s head 30 degrees before doing the assessment
- B. Supporting the lower uterine segment during the assessment
- C. Gently palpating the uterine fundus for firmness and location
- D. Observing the abdomen before beginning palpation
Correct Answer: A
Rationale: For uterine assessment, the client should be positioned in a supine position so the height of the uterus is not influenced by an elevated position. When beginning the assessment, one hand should be placed at the base of the uterus just above the symphysis pubis to support the lower uterine segment. This prevents the inadvertent inversion of the uterus during palpation. Once the lower hand is in place, the fundus of the uterus can be gently palpated. The abdomen should be observed prior to palpation for contour to detect distention and for the appearance of striae or a diastasis.
The client tells the nurse that she is using cocoa butter on her abdomen to prevent stretch marks. Which is the most accurate response from the nurse?
- A. “That is wonderful. If you continue to use cocoa butter daily, you should have no stretch marks after delivery.”
- B. “The cocoa butter will not prevent stretch marks completely, but it will help to reduce their number.”
- C. “The cocoa butter will not prevent stretch marks but will decrease the appearance of the linea nigra.”
- D. “Cocoa butter does not prevent stretch marks, but it soothes itching that occurs as your abdomen enlarges.”
Correct Answer: D
Rationale: Cocoa butter is an emollient and provides moisture to the skin, thereby decreasing the itching associated with stretching of the skin as the abdomen enlarges. Cocoa butter does not prevent striae gravidarum. Cocoa butter does not decrease the incidence of striae gravidarum. Cocoa butter does not prevent the appearance of linea nigra.