Nokea
The pregnant client is experiencing low back pain. After determining that the client is not in labor, the nurse instructs the client to perform which exercises to increase comfort and decrease the incidence of the low back pain? Select all that apply.
- A. Kegel exercises
- B. Pelvic tilt exercises
- C. Leg raises
- D. Back stretch
- E. Stepping
Correct Answer: B,C,D
Rationale: Pelvic tilt exercises strengthen and stretch the abdominal and back muscles to relieve pain. Leg raises strengthen and stretch leg and abdominal muscles to relieve pain. Back stretch relieves pain from the back muscles caused by lordosis. Kegel exercises strengthen the pubococcygeal muscle, decreasing urinary leakage, but do not relieve back pain. Stepping provides aerobic exercise, which is good for circulation but is not recommended to decrease low back pain.
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The laboring client is requesting IV pain medication instead of epidural anesthesia. The nurse determines that which factor would most definitely contraindicate the administration of nalbuphine hydrochloride?
- A. Completely dilated and 100 percent effaced
- B. Fetal heart rate (FHR) of 120 beats per minute
- C. Reassuring FHR variability and accelerations
- D. Variable decelerations with reassuring FHR
Correct Answer: A
Rationale: Systemic medications, such as nalbuphine hydrochloride (Nubain), should not be administered when advanced dilation is present (transition stage of labor) because its use can lead to respiratory depression if given too close to the time of delivery. An FHR of 120 bpm is within normal parameters of 120 to 160 bpm. Reassuring FHR variability and accelerations are interpreted as adequate placental oxygenation and do not contraindicate administration of nalbuphine hydrochloride. If mild variable decelerations are present but the FHR pattern remains reassuring, nalbuphine hydrochloride can still be administered.
The primiparous client, who is bottle feeding her infant, asks the nurse when she can expect to start having her menstrual cycle again. Which response by the nurse is most accurate?
- A. “Most women who bottle feed can expect their period within 6 to 10 weeks after birth.”
- B. “Your period should return a few days after your lochial discharge stops.”
- C. “Your lochia will change from pink to white; when white, your period should return.”
- D. “Bottle feeding delays the return of a normal menstrual cycle until 6 months postbirth.”
Correct Answer: A
Rationale: In nonlactating women, the average time to first ovulation is 45 days, and the return of menstruation usually happens within 6 to 10 weeks postbirth. Most women can expect to have lochial discharge for up to 24 days. However, the cessation of discharge is not related to the return of menstruation. The change in lochial color is not related to the return of menstruation. The return of ovulation and menstruation is associated with a rise in serum progesterone levels. Bottle feeding does not affect when this change occurs in the client’s body.
The nurse correctly explains to the group that the most important condition related to frequent urination during pregnancy is related to what factor?
- A. Loss of bladder tone in the mother
- B. The presence of a urinary tract infection
- C. The enlarging uterus exerting pressure on the bladder
- D. The growing fetus excreting increased amounts of waste
Correct Answer: C
Rationale: The enlarging uterus presses on the bladder, causing frequent urination, especially in early and late pregnancy.
While assessing the prenatal client, the nurse found a number of concerning problems. Place the concerning problems in the sequence that they should be addressed by the nurse.
- A. Currently bleeding and cramping
- B. Previous varicella infection
- C. Currently using tobacco
- D. Has intense pelvic pain
Correct Answer: D,A,C,B
Rationale: Has intense pelvic pain is most concerning and should be addressed first by the nurse. It could be a symptom of a serious medical condition, such as a miscarriage, ectopic pregnancy, or appendicitis. This symptom represents a possible pathology that could warrant immediate surgical intervention. Currently bleeding and cramping should be addressed next. It could be associated with the pelvic pain and could be a symptom of a serious medical condition, such as a miscarriage or ectopic pregnancy. Currently using tobacco can put the client at risk for multiple adverse outcomes and should be addressed, although it is not an immediately concerning factor. Previous varicella infection is important to document but poses no risk to the client or the fetus, so it is the least important to address.
The nurse advises the client to clean the newborn's umbilical cord with which substance?
- A. Alcohol or antiseptic as prescribed
- B. Soap and water
- C. Hydrogen peroxide
- D. No cleaning needed
Correct Answer: A
Rationale: Cleaning with alcohol or antiseptic as prescribed prevents infection until the cord stump falls off.