Nokea
The nurse should be cognizant of which postpartum physiologic alteration?
- A. Cardiac output, pulse rate, and stroke volume all return to prepregnancy normal values within 48 hours of childbirth.
- B. Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth.
- C. Lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections.
- D. Hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth.
Correct Answer: B
Rationale: Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth.
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Many communities now offer the availability of free-standing birth centers to provide care for low-risk women during pregnancy, birth, and postpartum. When counseling the newly pregnant patient regarding this option, the nurse should be aware that this type of care setting includes which advantages? (Select all that apply.)
- A. Staffing by lay midwives
- B. Equipped for obstetric emergencies
- C. Less expensive than acute care hospitals
- D. Safe, homelike births in a familiar setting
Correct Answer: B
Rationale: B. Equipped for obstetric emergencies: Free-standing birth centers are equipped to handle any obstetric emergencies that may arise during labor and birth. They have the necessary equipment and trained staff to respond quickly and effectively to emergencies to ensure the safety of both the mother and baby.
The nurse is assessing a 33-year-old female patient who comes to the family practice clinic with complaints of excessive menstrual bleeding with bleeding between periods for the past 6 months. The health care provider has performed an endometrial biopsy and has discontinued the patient's oral contraceptives. What is the rationale for this treatment?
- A. This condition is often associated with use of oral contraceptives and may subside upon discontinuation.
- B. This condition is often associated with type 2 diabetes and must be controlled with a different type of birth control.
- C. This condition is often associated with hyperplasia of the endometrial tissue, which is exacerbated with oral contraceptives.
- D. This condition is often associated with ovarian cysts, which are exacerbated with the use of oral contraceptives.
Correct Answer: C
Rationale: The correct rationale for discontinuing the oral contraceptives in a patient with excessive menstrual bleeding and bleeding between periods is that this condition is often associated with hyperplasia of the endometrial tissue, which can be exacerbated with the use of oral contraceptives. Endometrial hyperplasia is a condition characterized by the abnormal thickening of the lining of the uterus, which can lead to heavy or prolonged menstrual bleeding. Estrogen contained in oral contraceptives can contribute to this thickening of the endometrial tissue, potentially worsening the patient's symptoms. By discontinuing the oral contraceptives, the provider aims to reduce the estrogen levels in the body, which may help alleviate the symptoms associated with endometrial hyperplasia. An endometrial biopsy is also important in this case to further investigate the underlying cause of the abnormal bleeding.
Which response by the nurse is the most therapeutic when the patient states, “I’m so afraid to N R I G B.C M U S N T O have a cesarean birth”?
- A. “Everything will be OK.”
- B. “Don’t worry about it. It will be over soon.”
- C. “What concerns you most about a cesarean birth?”
- D. “The physician will be in later and you can talk to him.”
Correct Answer: C
Rationale: The most therapeutic response by the nurse when the patient expresses fear about having a cesarean birth is to offer an open-ended question that explores the patient's concerns further. By asking, "What concerns you most about a cesarean birth?" the nurse acknowledges the patient's fears, encourages communication, and allows the patient to express her feelings and fears in more detail. This response shows empathy and enables the nurse to better address the specific worries and anxieties the patient may have about the procedure. The other options do not effectively address the patient's fears and do not promote therapeutic communication.
A health care provider performs a clinical breast examination on a woman diagnosed with fibroadenomHow would the nurse explain the defining characteristics of a fibroadenoma?
- A. Inflammation of the milk ducts and glands behind the nipples
- B. Thick, sticky discharge from the nipple of the affected breast
- C. Lumpiness in both breasts that develops 1 week before menstruation
- D. Single lump in one breast that can be expected to shrink as the woman ages
Correct Answer: D
Rationale: Fibroadenomas are usually solitary lumps that shrink as the woman ages. They are benign and distinct from other conditions like mammary duct ectasia or fibrocystic changes.
A primipara patient asks about possible support options for her during the labor process. She is apprehensive that her family members will not be prepared to assist her during this time. Which option would be most effective for this patient?
- A. Reassure the patient that the labor and birth staff consists of highly trained nurses who are well educated to take care of laboring patients so that should be sufficient.
- B. Encourage the patient to take prepared childbirth classes with her husband because that should provide the best support by a family member.
- C. Provide information to the patient about obtaining a doula during the labor process.
- D. Tell the patient that this is a normal feeling based on fear of the unknown and that it will subside once she starts the labor process.
Correct Answer: C
Rationale: Providing information to the patient about obtaining a doula during the labor process is the most effective option in this scenario. A doula is a trained professional who provides physical, emotional, and informational support to the mother before, during, and after childbirth. They can help the mother feel supported and empowered during labor, especially if family members are unavailable or unprepared to offer the necessary support. Doulas can also help in communication with the medical staff, advocate for the mother's preferences, and provide comfort measures. Therefore, recommending the option of obtaining a doula would help address the patient's concerns about support during labor.