Nokea
The nurse is teaching the pregnant client during her first trimester. The nurse identifies that which decision is most important for her to make first?
- A. Bottle versus breastfeeding
- B. Labor and delivery location
- C. Pain management during labor
- D. Method for delivery of the baby
Correct Answer: B
Rationale: A decision regarding labor and delivery location is the priority for the client in order to properly plan for a home birth versus a hospital birth, HCP availability at the location, and type of labor and delivery settings available at the location. The decision on feeding the newborn can be made up to the time of the first feeding. The decision on pain management can be made early but can be changed up through the early stages of labor. The decision of delivery method should be made early but cannot be determined until the decision is made on labor and delivery location.
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The postpartum client delivered a healthy newborn 36 hours previously. The nurse finds the client crying and asks what is wrong. The client replies, “Nothing, really. I’m not in pain or anything, but I just seem to cry a lot for no reason.” What should be the nurse’s first intervention?
- A. Call the client’s support person to come and sit with her.
- B. Remind her that she has a healthy baby and that she shouldn’t be crying.
- C. Contact the HCP to have the counselor come see the client.
- D. Ask the client to discuss her birth experience.
Correct Answer: D
Rationale: The client’s support person should be given information about postpartum blues before the client is discharged from the hospital. However, contacting that individual should not be the first intervention. Reminding the client that she has a healthy baby is a nontherapeutic communication technique that implies disapproval of the client’s actions. There is no need to notify the HCP, as postpartum blues is a common self-limiting postpartum occurrence. A key feature of postpartum blues is episodic tearfulness without an identifiable reason. Interventions for postpartum blues include allowing the client to relive her birth experience.
The nurse is evaluating the 39-weeks-pregnant client who reports greenish, foul-smelling vaginal discharge. Her temperature is 101.6°F (38.7°C), and the FHR is 120 with minimal variability and no accelerations. The client’s group beta streptococcus (GBS) culture is positive. Which interventions should the nurse plan to implement? Select all that apply.
- A. Prepare for cesarean birth due to chorioamnionitis
- B. Start oxytocin for labor induction
- C. Start antibiotics as directed for the GBS infection
- D. Prepare the client for epidural anesthesia
- E. Notify the neonatologist of the client’s status
- F. Administer a cervical ripening agent
Correct Answer: A,C,D,E
Rationale: Because this client is not in labor and chorioamnionitis is possible, a cesarean birth is indicated. The client should be given antibiotics as prescribed to treat the infection. Because epidural anesthesia offers the least risk to the fetus, preparation for epidural anesthesia should begin. The pediatrician or neonatologist should be notified and available for the impending delivery. Starting oxytocin (Pitocin) would prolong the time to delivery. Administering a cervical ripening agent would prolong the time to delivery.
How early in a pregnancy can the nurse expect to hear the fetal heartbeat using a Doppler device?
- A. 4 to 6 weeks
- B. 8 to 10 weeks
- C. 12 to 14 weeks
- D. 16 to 18 weeks
Correct Answer: C
Rationale: A fetal heartbeat can typically be detected by Doppler around 12-14 weeks, when the fetus is sufficiently developed.
Which intervention is most appropriate for a client experiencing low self-esteem during pregnancy?
- A. Encourage participation in a prenatal support group
- B. Prescribe antidepressants immediately
- C. Advise avoiding social interactions
- D. Ignore the issue as it is common
Correct Answer: A
Rationale: A prenatal support group fosters peer support and boosts self-esteem, addressing the client's emotional needs.
Which dietary adjustment is most appropriate for a pregnant teenager?
- A. Increase caloric intake to 2,500 calories per day.
- B. Drink decaffeinated beverages instead of carbonated ones.
- C. Eat foods that are low in carbohydrates and fats.
- D. Choose nonspicy, easy to digest foods.
Correct Answer: A
Rationale: Pregnant teenagers require about 2,500 calories daily to support their growth and the fetus's development.