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When up to the bathroom for the first time after a vaginal delivery, the client states, “A friend told me that I’m going to have trouble with urinary incontinence now that I have had a baby.” Which is the best response by the nurse?
- A. “That’s not true. You won’t need to worry about this until menopause.”
- B. “I will teach you how to do Kegel exercises to strengthen your muscles.”
- C. “Wearing a pad similar to a sanitary pad will help contain the incontinence.”
- D. “If this occurs, notify your HCP to have surgery to correct urinary incontinence.”
Correct Answer: B
Rationale: Women of any life stage can experience urinary incontinence. Kegel exercises strengthen muscles surrounding the vagina and urinary meatus, preventing urinary incontinence for many women. To perform Kegel exercise, contract the muscles around the vagina and hold for 10 seconds, then rest for 10 seconds. This should be repeated 30 or more times each day. The nurse should educate the client about ways in which to prevent urinary incontinence, not just offer information about how to manage the condition if it should occur. Surgical repair only occurs in the most extreme circumstances, after less invasive interventions have been unsuccessful.
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The laboring client in the first stage of labor is talking and laughing with her husband. The nurse should conclude that the client is probably in what phase?
- A. Transition
- B. Active
- C. Active pushing
- D. Latent
Correct Answer: D
Rationale: During the latent phase (1—3 cm), the client is usually happy and talkative. During the transition phase (8—10 cm), the client is usually more restless, irritable, and more likely to lose control. During the active phase (4—7 cm), the client may become more anxious and fatigued and needs to concentrate on breathing techniques to cope with the increasingly stronger contractions. The client who is actively pushing is focusing on how effective she is in the descent of the fetus and concentrating on how she is coping with contractions. She is usually not expressing happiness or laughter, and is not talkative.
The nurse is counseling the client who has SLE. The client tells the nurse that she plans to become pregnant in the next year. Which response by the nurse is correct?
- A. “It is best to plan for your pregnancy when you have been in remission for 6 months.”
- B. “Having systemic lupus erythematosus will not impact your pregnancy in any way.”
- C. “Your chances of having an infant with congenital malformations are increased with SLE.”
- D. “You will need to be scheduled for a cesarean delivery to prevent disease transmission.”
Correct Answer: A
Rationale: Planning for pregnancy with SLE when in remission for 6 months is correct. Pregnancy planned during periods of inactive or stable disease often results in giving birth to a healthy full-term baby without increased risks of pregnancy complications. Exacerbations of SLE can occur during pregnancy and impact pregnancy outcomes. There is no risk of congenital malformations associated with maternal SLE. However, the risk for spontaneous abortion, preterm labor and birth, and neonatal death is increased. SLE is not a transmissible disease, and there is no reason for a cesarean delivery.
Which statement by the client indicates a need for further psychosocial support?
- A. I feel ready to bond with my baby.
- B. I am excited about becoming a mother.
- C. I feel worthless and overwhelmed daily.
- D. I have a great support system at home.
Correct Answer: C
Rationale: Feeling worthless and overwhelmed daily suggests potential depression, indicating a need for additional psychosocial support.
When teaching the class about varicose veins, which symptom should the nurse instruct clients to report immediately?
- A. The appearance of additional varicose veins
- B. Varicose veins that are purple in color
- C. Legs that begin to ache and feel heavy
- D. Calves that become red, tender, and warm
Correct Answer: D
Rationale: Red, tender, warm calves may indicate deep vein thrombosis, a serious condition requiring immediate reporting.
The postpartum client tells the nurse that she has pain when she breastfeeds. The nurse identifies that the infant has poor latch during breastfeeding. Which breast appearance shows that the client is experiencing symptoms associated with poor latch?
- A. Normal breasts
- B. Left breast with mastitis
- C. Engorged breasts
- D. Breasts with reddened, cracked nipples
Correct Answer: D
Rationale: This graphic shows normal breasts. This graphic shows the left breast with mastitis. Mastitis frequently presents as redness, warmth, and tenderness of the breast tissue, rather than the nipple. This graphic shows engorged breasts. This graphic shows breasts that have reddened nipples, one of which is cracked. If proper latch is not obtained during breastfeeding, the newborn’s sucking may cause nipple cracking, blistering, and bleeding.