A client in the first stage of labor reports severe lower back pain. What intervention is most effective?

Correct Answer: B

Rationale: In the context of pharmacology and maternal newborn care, the most effective intervention for a client in the first stage of labor experiencing severe lower back pain is to encourage frequent position changes (Option B). This intervention is based on the principles of optimizing fetal oxygenation and blood flow by relieving pressure on the mother's blood vessels and enhancing comfort during labor. Encouraging position changes helps to alleviate the intensity of back pain by redistributing the pressure on the lower back and promoting better fetal positioning for labor progression. It also assists in enhancing maternal blood circulation and reducing the risk of fetal distress. This non-pharmacological approach aligns with the goal of promoting physiologic birth and minimizing unnecessary medical interventions during labor. Administering an epidural block (Option A) may be effective for pain relief but is not the first-line option for addressing lower back pain in the initial stage of labor. Epidural blocks carry risks such as hypotension and prolonged labor, and should be reserved for cases where non-pharmacological interventions are ineffective. Applying a heating pad (Option C) may provide temporary relief for muscle tension but does not address the underlying causes of lower back pain in labor. Moreover, the use of heat modalities during labor should be monitored closely to prevent overheating and potential harm to the fetus. Performing a sterile vaginal exam (Option D) is not indicated for managing lower back pain in labor. Vaginal exams are typically conducted to assess cervical dilation and fetal descent, not for pain management purposes. In conclusion, understanding the rationale behind each intervention in the context of maternal newborn care is crucial for providing safe and effective care to laboring clients. Encouraging frequent position changes is the optimal choice to address severe lower back pain in the first stage of labor, promoting comfort, optimal fetal positioning, and minimizing the need for pharmacological interventions.

Correct Answer: A

Rationale: In the context of maternal health during pregnancy, anemia is a common concern due to the increased demands on the mother's body for adequate blood supply to support both her and the developing fetus. The correct answer, option A, states a hemoglobin level of 10 g/dL, which supports the diagnosis of anemia. Hemoglobin is a protein found in red blood cells responsible for carrying oxygen throughout the body. During pregnancy, a hemoglobin level below 11 g/dL is considered indicative of anemia due to the expansion of plasma volume, which can dilute the concentration of red blood cells. Therefore, a hemoglobin level of 10 g/dL at 20 weeks' gestation raises suspicion for anemia. Analyzing the incorrect options: B) Platelet count of 150,000 mm3: Platelets are involved in blood clotting, not in diagnosing anemia. C) Hematocrit of 40%: While hematocrit measures the proportion of red blood cells in the blood, a specific hemoglobin level is more indicative of anemia. D) White blood cell count of 8,000 mm3: White blood cells are part of the immune system and are not directly related to diagnosing anemia. Educationally, understanding the importance of interpreting lab values in the context of pregnancy helps nurses provide optimal care to both the mother and the fetus. Recognizing the significance of hemoglobin levels in assessing for anemia during pregnancy is crucial for timely intervention and management to promote positive maternal and neonatal outcomes.

Correct Answer: B

Rationale: In the context of pharmacology and maternal newborn care, the priority intervention when assessing a client in labor with variable decelerations on the fetal monitor is to reposition the client (Option B). Repositioning the client, specifically onto their left side, helps to alleviate pressure on the vena cava, improving fetal oxygenation and potentially resolving the decelerations. Increasing the oxytocin infusion (Option A) can actually worsen variable decelerations by intensifying contractions, further compromising fetal oxygenation. Administering oxygen at 10 L/min (Option C) is generally a good intervention, but repositioning takes precedence in this scenario. Notifying the healthcare provider (Option D) is important, but it is not the immediate priority over repositioning the client to address the variable decelerations. Educationally, this rationale highlights the critical thinking skills needed in pharmacology and maternal newborn care. Understanding the physiological effects of different interventions is crucial in prioritizing care for both the mother and the unborn baby. By repositioning the client, nurses can actively contribute to improving fetal well-being during labor and delivery.

Correct Answer: A

Rationale: In the context of maternal fetal health, educating clients about kick counts is crucial for monitoring fetal well-being. The correct answer is A) Fewer than 10 movements in 2 hours because it aligns with the standard recommendation of feeling at least 10 movements within a 2-hour period. This frequency indicates adequate fetal activity and suggests a healthy baby. Contacting the healthcare provider in this scenario allows for prompt evaluation and intervention if needed. Option B) Fewer than 5 movements in 1 hour sets a threshold that is too low and may lead to unnecessary anxiety and frequent calls to the healthcare provider. It does not align with the standard kick count recommendations. Option C) No movements after drinking juice is not a reliable indicator of fetal well-being. Fetal movements can vary based on various factors, and the response to ingesting juice may not always be immediate or consistent. Option D) No movements for 12 hours is too long to wait before seeking medical attention. Delaying contact with the healthcare provider in such a situation could pose risks to the fetus if there is an issue with decreased fetal movement. Educationally, understanding the significance of kick counts empowers pregnant individuals to actively participate in monitoring their baby's health. By providing accurate information on when to contact the healthcare provider, nurses can help ensure timely interventions and promote positive maternal and newborn outcomes.

Correct Answer: B

Rationale: In the context of pharmacology and maternal-newborn care, it is crucial for nurses to understand the effects of medications like oxytocin on both the mother and the fetus during labor induction. The correct answer, B) Fetal heart rate of 100 beats/minute, requires the nurse to stop the infusion because a fetal heart rate of 100 beats/minute is considered bradycardia, which is a concerning sign indicating fetal distress. This situation necessitates immediate intervention to ensure the safety of the fetus. Option A) Contractions every 2 minutes may indicate hyperstimulation of the uterus, which can lead to fetal distress but does not explicitly mandate stopping the infusion. Option C) Maternal blood pressure of 120/80 mmHg is within the normal range and does not require stopping the oxytocin infusion. Option D) Client reports mild back pain is a common side effect of labor and not a reason to discontinue the oxytocin infusion. Educationally, this scenario highlights the importance of vigilant monitoring and prompt recognition of adverse effects during oxytocin administration for labor induction. Nurses should prioritize fetal well-being by closely assessing fetal heart rate patterns and being prepared to intervene promptly if signs of distress arise.