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A nurse is reviewing the chart of a client who is 2 days postpartum following a vaginal delivery and reports constipation. Which of the following findings should the nurse identify as a contraindication to the use of a suppository?
- A. Vaginal candidiasis
- B. Abdominal distention
- C. Afterpains
- D. Third-degree perineal laceration
Correct Answer: D
Rationale: The correct answer is D: Third-degree perineal laceration. Using a suppository in a client with a third-degree perineal laceration can increase the risk of infection or further trauma to the area. It is crucial to allow the laceration to heal properly without introducing any foreign substances.
A: Vaginal candidiasis - This is not a contraindication to using a suppository for constipation.
B: Abdominal distention - This is not a contraindication to using a suppository for constipation.
C: Afterpains - This is not a contraindication to using a suppository for constipation.
In summary, the other choices do not directly impact the safety or effectiveness of using a suppository for constipation postpartum, making them incorrect options.
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A nurse is caring for a client who is at 36 weeks of gestation and has methicillin-resistant Staphylococcus aureus. Which of the following types of isolation precautions should the nurse initiate?
- A. Droplet
- B. Contact
- C. Protective environment
- D. Airborne
Correct Answer: B
Rationale: The correct answer is B: Contact precautions. Methicillin-resistant Staphylococcus aureus (MRSA) is typically spread through direct contact with an infected person or contaminated surfaces. Therefore, initiating contact precautions is essential to prevent the spread of the infection to other individuals. This includes wearing gloves and gowns when providing care to the client, ensuring proper hand hygiene, and properly cleaning and disinfecting the environment.
The other choices are incorrect:
A: Droplet precautions are used for infections spread through respiratory droplets (e.g., influenza, pertussis), not MRSA.
C: Protective environment precautions are used for clients with compromised immune systems to protect them from environmental pathogens, not for MRSA.
D: Airborne precautions are used for infections spread through airborne particles (e.g., tuberculosis, chickenpox), not MRSA.
A nurse is assessing a newborn who was born postterm. Which of the following findings should the nurse expect?
- A. Large deposits of subcutaneous fat
- B. Thin covering of fine hair on shoulders and back
- C. Nails extending over tips of fingers
- D. Pale, translucent skin
Correct Answer: C
Rationale: The correct answer is C: Nails extending over tips of fingers. Postterm newborns have longer nails due to their prolonged growth in utero. This is a common finding in babies born after 42 weeks gestation. Large deposits of subcutaneous fat (choice A) are typically seen in term or postterm newborns, not specific to postterm. Thin covering of fine hair on shoulders and back (choice B) is known as lanugo, which is present in premature infants, not postterm. Pale, translucent skin (choice D) is more common in premature infants, not postterm.
A nurse is providing teaching about increasing dietary fiber to an antepartum client who reports constipation. Which of the following food selections has the highest fiber content per cup?
- A. Oatmeal
- B. Cabbage
- C. Asparagus
- D. Lentils
Correct Answer: D
Rationale: The correct answer is D: Lentils. Lentils have a high fiber content of around 15.6 grams per cup, making them an excellent choice for relieving constipation. Fiber helps soften stool and promote regular bowel movements. Oatmeal, while a good source of fiber, typically contains around 4 grams per cup. Cabbage and asparagus have lower fiber content compared to lentils. In summary, lentils have the highest fiber content per cup among the options provided, making them the most suitable choice to help alleviate constipation in the antepartum client.
The nurse is teaching the client about postpartum depression. The nurse should encourage the client to----------------- and ----------------- to help prevent postpartum depression.
- A. Engage in regular physical activity
- B. Maintain a strong support system
- C. Get adequate rest and sleep
- D. Eat a well-balanced diet
- E. exercise 30 min per day
Correct Answer: B,E
Rationale: The correct answers are B and E. Maintaining a strong support system is crucial in preventing postpartum depression as it provides emotional support. Exercise for 30 minutes per day can help release endorphins, reduce stress, and improve mood. Engaging in regular physical activity (choice A) is beneficial but not as specific as the 30-minute exercise recommendation. Getting adequate rest and sleep (choice C) is important but may not solely prevent postpartum depression. Eating a well-balanced diet (choice D) is essential for overall health but does not directly address the prevention of postpartum depression.
A nurse is calculating the estimated date of delivery for a client who reports that the first day of her last menstrual period was August 10. Using Nägele’s Rule, which of the following is the client’s estimated date of delivery?
- A. May 13
- B. May 17
- C. May 3
- D. May 20
Correct Answer: B
Rationale: The correct answer is B: May 17. Nägele's Rule involves adding 7 days to the first day of the last menstrual period, subtracting 3 months, and adding 1 year. In this case, August 10 + 7 days = August 17, subtracting 3 months gives May 17. This calculation estimates the date of delivery. Choice A (May 13) is incorrect as it doesn't account for the full calculation process. Choice C (May 3) is incorrect as it doesn't consider adding 7 days. Choice D (May 20) is incorrect as it doesn't involve subtracting 3 months.