Nokea
Two weeks after a breast-feeding primiparous client is discharged, she calls the birthing center and says that she is afraid she is "losing my breast milk. The baby had been nursing every 4 hours, but now she's crying to be fed every 2 hours." The nurse interprets the neonate's behavior as most likely caused by which of the following?
- A. Lack of adequate intake to meet maternal nutritional needs.
- B. The mother's fears about the baby's weight gain.
- C. Preventing the neonate from sucking long enough with each feeding.
- D. The neonate's temporary growth spurt, which requires more feedings.
Correct Answer: D
Rationale: Increased feeding frequency at 2 weeks is typical of a growth spurt, requiring more frequent nursing.
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A primigravid client who has had a prolonged labor but now is completely dilated has received epidural anesthesia. Which of the following should the nurse include in the teaching plan about pushing?
- A. The client needs to push for at least 1 to 3 minutes.
- B. Pushing is most effective when the client holds her breath.
- C. The client should be urged to push with an open glottis.
- D. Pushing is limited to times when she feels the urge.
Correct Answer: C
Rationale: Pushing with an open glottis (exhaling during effort) is effective and reduces the risk of Valsalva maneuver complications. Prolonged pushing (1–3 minutes) is unrealistic, holding breath is discouraged, and with epidurals, the urge to push may be diminished.
A nurse is discussing the contraceptive injection with a client. Which of the following side effects should the nurse mention?
- A. Guaranteed regular periods.
- B. Irregular bleeding and potential weight gain.
- C. Permanent infertility.
- D. Increased risk of breast cancer.
Correct Answer: B
Rationale: The contraceptive injection may cause irregular bleeding and potential weight gain. It does not guarantee regular periods, cause permanent infertility, or significantly increase breast cancer risk.
A client is considering the cervical cap. Which of the following statements by the nurse is accurate?
- A. The cervical cap can be left in place for up to 72 hours.
- B. The cervical cap does not require spermicide.
- C. The cervical cap requires a prescription and fitting.
- D. The cervical cap is highly effective for women who have given birth.
Correct Answer: C
Rationale: The cervical cap requires a prescription and fitting by a healthcare provider for proper use. It can be left in place for up to 48 hours, requires spermicide, and is less effective for women who have given birth.
A 24-year-old primigravid client in active labor requests use of the jet hydrotherapy tub to aid in pain relief. The nurse bases the response on the understanding that this therapy is commonly contraindicated for clients with which of the following?
- A. A required membranes.
- B. Multifetal gestation.
- C. Diabetes mellitus.
- D. Hypotonic labor patterns.
Correct Answer: A
Rationale: Jet hydrotherapy (e.g., whirlpool tubs) is contraindicated with ruptured membranes due to the risk of infection from water entering the vaginal canal. Multifetal gestation, diabetes, and hypotonic labor are not absolute contraindications unless other complications are present.
A breast-feeding primiparous client with a midline episiotomy is prescribed ibuprofen 200 mg orally. The nurse instructs the client to take the medication:
- A. Before going to bed.
- B. Midway between feedings.
- C. Immediately after a feeding.
- D. When providing supplemental formula.
Correct Answer: C
Rationale: Taking ibuprofen after feeding minimizes the amount of medication in breast milk during the next feeding.