A client who is in the second trimester of pregnancy tells the nurse that she wants to use herbal therapy. Which response is best for the nurse to provide?

Correct Answer: D

Rationale: The correct response, "D) It is important that you want to take part in your care," is the most appropriate because it acknowledges the client's autonomy and decision-making in their healthcare. In the context of maternity care, empowering the client to actively participate in their care can lead to better outcomes and increased satisfaction. By recognizing and supporting the client's desire to explore herbal therapy, the nurse promotes a collaborative and patient-centered approach. Option A is incorrect as it generalizes the use of herbs without considering individual circumstances or potential risks during pregnancy. Option B is not directly addressing the client's interest in herbal therapy. Option C is incorrect because while healthcare providers should guide treatment options, it is essential to involve the client in decision-making regarding their care to promote shared decision-making and patient autonomy. Educationally, this question highlights the importance of respecting the client's autonomy and involving them in decision-making processes, especially in the context of maternal healthcare where individual preferences and beliefs can significantly impact the care provided. Nurses need to communicate effectively, support informed decision-making, and collaborate with clients to ensure a holistic and personalized approach to care.

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take immediately is option D, which is to call the healthcare provider to question the prescription of Methergine 0.2 mg IM. This is the appropriate response because the client's symptoms indicate a potential complication such as postpartum hemorrhage or retained placental fragments, which could be exacerbated by the use of Methergine. It is crucial for the nurse to seek clarification from the provider to ensure the safety and well-being of the client. Option A is incorrect because administering Methergine without addressing the underlying cause of the increased bleeding and boggy fundus could be harmful to the client. Option B is also incorrect as breastfeeding does not directly address the client's clinical presentation of increased bleeding and boggy fundus. Option C is not the priority action as the client's symptoms suggest a more urgent need for medical intervention rather than bladder emptying and fundal massage. From an educational perspective, this question highlights the importance of critical thinking and prompt action in responding to postpartum complications. Nurses must be able to recognize abnormal postpartum signs and symptoms, prioritize interventions based on client needs, and advocate for appropriate care by collaborating with healthcare providers. This case underscores the significance of timely communication and seeking clarification when faced with a prescription that may not align with the client's clinical presentation.

Correct Answer: B

Rationale: In the context of a client suspected of abruptio placentae, the charge nurse should expect findings that are indicative of this serious obstetric emergency. Lower back pain (option B) is not typically associated with abruptio placentae. A) Dark, red vaginal bleeding is a common sign of abruptio placentae due to the separation of the placenta from the uterine wall. C) A rigid abdomen may be present due to the uterine contractions and potential blood accumulation behind the placenta. D) Increased uterine irritability is expected as the uterus tries to expel the separated placenta. Educationally, understanding the signs and symptoms of abruptio placentae is crucial for nurses working in labor and delivery units to provide timely and appropriate care in emergency situations. Recognizing these signs promptly can lead to quick interventions that can potentially save both the mother and baby's lives.

Correct Answer: B

Rationale: The correct answer is B) It is difficult to consume 18 mg of additional iron by diet alone. During pregnancy, a woman's iron requirements increase significantly to support the growing fetus and changes in her own body. It is challenging to meet this increased demand through diet alone, as the body's ability to absorb iron from food is limited. Therefore, supplementary iron in the form of tablets is often prescribed to ensure that the mother and the developing baby receive an adequate amount of iron. Option A is incorrect because while supplementary iron is important during pregnancy, the efficiency of its utilization is not the primary reason for prescribing it. Option C is incorrect because iron absorption is actually increased in the GI tract during pregnancy to help meet the higher demand. Option D is incorrect because iron is primarily needed to prevent iron-deficiency anemia, not megaloblastic anemia, in pregnancy. In an educational context, it is crucial for healthcare providers to understand the specific nutritional needs of pregnant women and the rationale behind prescribing supplements like iron. This knowledge enables them to provide evidence-based care and support the health and well-being of both the mother and the baby. By explaining the challenges of meeting increased iron requirements through diet alone, nurses can empower pregnant women to adhere to their prescribed supplements and optimize their health outcomes.

Correct Answer: B

Rationale: In this scenario, option B is the most appropriate maternal behavior when a new mother receives her infant for the first time. This choice reflects a gentle and nurturing approach as the mother traces the infant's profile with her fingertips, showing a sense of care, tenderness, and bonding with the newborn. Option A is incorrect as it describes a more clinical and detached approach to examining the infant, lacking the emotional connection and gentleness seen in the correct response. Option C is incorrect because simply cuddling the infant to her own body does not demonstrate the same level of attentiveness and delicacy as tracing the infant's profile with her fingertips. Option D is also incorrect as it focuses more on holding the infant close without the added element of gentle touch and exploration shown in option B. By choosing option B, the nurse is likely to witness a mother's instinctual and affectionate response to her newborn, fostering early bonding and attachment, which are vital for the infant's emotional and social development. This understanding is crucial for nurses working in maternity care to promote positive parent-infant relationships and support healthy early interactions.