Nokea
The nurse is counseling a lesbian couple who have decided to have a child. Which considerations doesn't the nurse present with regard to which partner will become pregnant?
- A. Consider the age and health of each partner.
- B. Evaluate each partner's career goals.
- C. Decide which partner has better insurance.
- D. Determine who will be on the birth certificate.
Correct Answer: D
Rationale: The correct answer is D because determining who will be on the birth certificate is not a relevant consideration when a lesbian couple decides which partner will become pregnant. The birth certificate can typically be amended to include both partners as legal parents regardless of who gives birth.
A: Considering the age and health of each partner is important for assessing pregnancy risks.
B: Evaluating career goals may impact decisions around timing and balancing work and parenthood.
C: Deciding which partner has better insurance is relevant for covering prenatal care and delivery costs.
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The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments isn't covered by REEDA?
- A. Perineal coloration
- B. Suture line appearance
- C. Amount of swelling
- D. Description of pain
Correct Answer: D
Rationale: The correct answer is D, Description of pain. The REEDA acronym stands for Redness, Edema, Ecchymosis, Discharge, and Approximation, focusing on physical characteristics. Pain assessment is important but not part of the REEDA visual assessment. Perineal coloration (A), suture line appearance (B), and amount of swelling (C) are all physical aspects covered by REEDA.
A nurse is preparing to perform a fundal assessment on a postpartum client who delivered 12 hours ago. What should the nurse do first?
- A. Lower the head of the bed
- B. Locate the level of the fundus
- C. Assist the woman to the bathroom to empty her bladder
- D. Massage the fundus
Correct Answer: C
Rationale: The correct answer is C: Assist the woman to the bathroom to empty her bladder. This is the first step because a full bladder can displace the uterus, making fundal assessment inaccurate. Emptying the bladder allows for proper fundal assessment by ensuring the uterus is in the correct position. Lowering the head of the bed (choice A) is not necessary before fundal assessment. Locating the level of the fundus (choice B) can be done after ensuring the bladder is empty. Massaging the fundus (choice D) should only be done after fundal assessment to check for firmness.
The nurse on a postpartum unit is focused on providing care that will assist the mother and father in making the transition to parenthood. For which reason does the nurse review the prenatal and labor records?
- A. Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother.
- B. Awareness of prenatal classes that will help identify and focus on learning needs of both parents.
- C. Identification of preexisting maternal conditions that may interfere with parenting transitions.
- D. Knowledge regarding questions and concerns the mother and father may have about neonate issues.
Correct Answer: A
Rationale: The correct answer is A: Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother. Reviewing the prenatal and labor records helps the nurse understand the mother's experiences during pregnancy and childbirth, which can significantly impact her transition to motherhood. By knowing these experiences, the nurse can identify any factors that may enhance or impede the mother's adjustment to motherhood. This information allows the nurse to provide tailored support and interventions to assist the mother in her transition.
Choice B is incorrect because prenatal classes are not directly related to reviewing prenatal and labor records to understand the mother's experiences. Choice C is incorrect as preexisting maternal conditions are not the main focus when reviewing records for the transition to parenthood. Choice D is also incorrect as it focuses on neonate issues, which are not the primary concern when reviewing prenatal and labor records for assisting the mother and father in making the transition to parenthood.
A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with which occurrence?
- A. An increase in oxytocin release related to the newborn suckling
- B. The presence of intense afterbirth pains related to multiparity
- C. An expected response to the daily administration of oxytocin
- D. The efforts of the uterus to return to a prepregnancy condition
Correct Answer: A
Rationale: Rationale for correct answer A:
1. Breastfeeding stimulates the release of oxytocin.
2. Oxytocin causes uterine contractions.
3. Uterine contractions help the uterus return to its pre-pregnancy size.
4. Severe uterine cramps post-delivery are likely due to increased oxytocin release from breastfeeding.
Summary of why other choices are incorrect:
B: Afterbirth pains are typically crampy, but the scenario specifies severe pain on the first day after delivery, which is more likely due to breastfeeding.
C: Daily administration of oxytocin would not lead to sudden severe cramps on the first day post-delivery.
D: Uterus shrinking back to prepregnancy size causes cramping, but the timing and severity described in the scenario point more towards oxytocin release from breastfeeding.
The nurse on a postpartum unit is focused on providing care that will assist the mother and father in making the transition to parenthood. For which reason does the nurse review the prenatal and labor records?
- A. Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother.
- B. Awareness of prenatal classes that will help identify and focus on learning needs of both parents.
- C. Identification of preexisting maternal conditions that may interfere with parenting transitions.
- D. Knowledge regarding questions and concerns the mother and father may have about neonate issues.
Correct Answer: A
Rationale: The correct answer is A because reviewing prenatal and labor records helps the nurse understand the mother's pregnancy and birth experiences, which can influence her transition to motherhood. By knowing these experiences, the nurse can provide tailored support and interventions.
Choice B is incorrect because prenatal classes are not the main focus for reviewing records, although they may be helpful. Choice C is incorrect because preexisting maternal conditions are important but not the main reason for reviewing records in this context. Choice D is incorrect because the focus is on the mother's experiences rather than neonate issues.