A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate?

Correct Answer: D

Rationale: The correct answer is D: "You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks." This response is appropriate because it provides the client with specific guidance on postpartum exercises that are safe and beneficial for her recovery. Kegel exercises help strengthen the pelvic floor muscles, which can be done early postpartum to promote healing. Slowly increasing toning exercises over time is important to prevent injury and allow the body to regain strength gradually. Option A is incorrect because the client does not need to wait until the six-week checkup to start any form of exercise. Option B is incorrect as it limits the client to only Kegel exercises when a gradual return to other exercises is safe. Option C is incorrect because returning to the pre-pregnancy exercise routine immediately postpartum can be too strenuous for the body that is still healing. Educationally, it is important for nurses to provide evidence-based guidance on postpartum exercises to promote the physical well-being and recovery of clients. Understanding the physiological changes that occur during pregnancy and childbirth is crucial in tailoring exercise recommendations to each individual's needs. Encouraging gradual progression in exercise routines can help prevent complications and support the client's overall health and fitness goals postpartum.

Correct Answer: B

Rationale: In this scenario, option B is correct: "The baby may have an uncommon genetic variant of the disease." This answer is correct because cystic fibrosis can result from various genetic mutations, and not all genetic variants associated with the condition may be detectable through standard prenatal testing like amniocentesis. Option A, "Cystic fibrosis cannot be diagnosed by amniocentesis," is incorrect because while amniocentesis can detect certain genetic disorders, it may not identify all possible genetic variations linked to cystic fibrosis. Option C, "The amniocentesis results were likely inaccurate," is incorrect as it assumes a fault in the testing process, which may not necessarily be the case. Amniocentesis results are generally reliable for the conditions they are designed to detect. Option D, "Cystic fibrosis develops after birth and cannot be detected prenatally," is incorrect as cystic fibrosis is a genetic condition that is present from birth, although symptoms may manifest later. Educationally, this question highlights the complexities of genetic testing and the limitations of prenatal screening methods. It underscores the importance of genetic counseling and the need for parents to understand that not all genetic variations may be identified through prenatal testing, emphasizing the value of ongoing medical surveillance and care for infants at risk for genetic conditions like cystic fibrosis.

Correct Answer: B

Rationale: Rationale: The correct answer is B) Schedule an appointment at the clinic for an examination. The client's symptoms of yellow-gray frothy vaginal discharge and itching could indicate a possible infection, such as bacterial vaginosis or trichomoniasis, rather than a yeast infection. It is essential for the client's health and the health of the fetus to have a healthcare provider evaluate and diagnose the condition accurately. Option A) Using an over-the-counter cream for yeast infections is not appropriate in this case because the symptoms described are not typical of a yeast infection. Misdiagnosis and inappropriate treatment could lead to worsening of the condition. Option C) Administering a vinegar douche under low pressure is not recommended as it can disrupt the natural pH balance of the vagina and worsen the symptoms or even lead to further complications. Option D) Preparing for preterm labor and delivery is premature and not indicated based solely on the client's symptoms of vaginal discharge and itching. It is essential to rule out any infections or other underlying issues first before considering preterm labor. In an educational context, this question highlights the importance of accurate assessment and appropriate intervention in perinatal care. Nurses need to be vigilant in recognizing abnormal symptoms in pregnant clients and guiding them to seek proper medical evaluation and treatment to ensure the well-being of both the mother and the baby.

Correct Answer: A

Rationale: In this scenario, option A, "Thin cervix," is the correct answer. When the nurse palpates a thin cervix during a vaginal examination, it indicates cervical dilation. In the given scenario, the client is 5 cm dilated, which aligns with a thin cervix. Option B, "Bulging fetal membranes," is incorrect as this typically occurs when the client's water breaks, and the amniotic sac protrudes into the vaginal canal. Option C, "Head at the pelvic outlet," is incorrect because at station 2, the fetal head is not yet engaged in the pelvis but is still higher up in the birth canal. Option D, "Closed cervix," is incorrect as the scenario states the client is 5 cm dilated, so the cervix is not closed. Educationally, understanding the significance of findings during a vaginal examination in labor is crucial for nurses caring for laboring clients. It helps in assessing the progress of labor, determining the stage of labor, and making informed decisions regarding the client's care and possible interventions. Palpating and interpreting cervical dilation, effacement, and fetal station are key skills for nurses in providing safe and effective care during childbirth.

Correct Answer: C

Rationale: The correct answer is C) She may have a hidden laceration. In this scenario, the client's complaint of severe perineal pain despite receiving ibuprofen and the presence of edema suggest that there may be an underlying issue such as a hidden laceration that is causing the pain. It is crucial for the nurse to consider this possibility and further assess the client to rule out any complications that may require medical intervention. Option A) She should be assessed by her doctor is incorrect because the nurse should first assess the client herself to determine the cause of the pain before involving the doctor unnecessarily. Option B) She should have a sitz bath is incorrect as a sitz bath may provide comfort but it does not address the underlying issue of severe perineal pain that persists despite pain medication. Option D) She needs a narcotic analgesic is incorrect as the first step should be to investigate the cause of the pain rather than automatically escalating to a stronger pain medication. In an educational context, this question highlights the importance of thorough assessment and critical thinking in postpartum care. It emphasizes the need for nurses to consider all possible causes of a client's symptoms and to prioritize appropriate interventions based on assessment findings rather than jumping to conclusions or treatments. This scenario also underscores the significance of vigilance in detecting potential complications following childbirth, especially in cases where the client's symptoms are not improving as expected.