A nurse is caring for a client who experienced a vaginal delivery 12 hr ago. When palpating the client's abdomen, at which of the following positions should the nurse expect to find the uterine fundus?

Correct Answer: C

Rationale: After a vaginal delivery, the uterus typically undergoes involution, which is the process of the uterus returning to its pre-pregnancy size and position. At 12 hours postpartum, the uterine fundus should be palpated approximately one fingerbreadth above the symphysis pubis. This position indicates proper contraction of the uterus and helps prevent postpartum hemorrhage. As time progresses, the uterine fundus will gradually descend back into the pelvis.

Correct Answer: B

Rationale: A male infant delivered at 28 weeks gestation, as described, would likely have very underdeveloped skin due to the premature birth. The premature skin is often transparent, allowing the prominent blood vessels underneath to be visible, and may also have a reddish hue due to the skin's immaturity. This characteristic appearance is a common finding in premature infants and is a result of their skin being thinner and more fragile than that of full-term infants. The other options, such as a wide, staring eye, an absence of lanugo, and a scrotum with descended testicles, are not specifically associated with premature birth and are not likely to be observed in this scenario.

Correct Answer: A

Rationale: - A. An 18-hour post-term, breast-fed neonate with jaundice would be a good assignment for the pediatric nurse because a neonate with jaundice requires close monitoring of bilirubin levels and feeding patterns. Breastfeeding can also affect jaundice levels, so the nurse can provide education and support to ensure successful breastfeeding and manage jaundice effectively.

Correct Answer: A

Rationale: In the context of a newborn experiencing respiratory distress, the priority nursing intervention is to administer oxygen and properly position the newborn (Option A). This is crucial because respiratory distress can lead to hypoxia, which can be life-threatening in newborns. Providing oxygen helps improve oxygenation and alleviate respiratory distress, while positioning the newborn helps optimize air exchange and lung expansion. Suctioning the airway and providing stimulation (Option B) may be necessary in certain situations to clear the airway, but in a newborn with respiratory distress, ensuring adequate oxygenation takes precedence over airway clearance. Starting IV antibiotics (Option C) is not the priority in this scenario unless there is a confirmed infection contributing to the respiratory distress. Monitoring heart rate and blood pressure (Option D) is important but is not the immediate priority when the newborn is struggling to breathe. In an educational context, understanding the prioritization of nursing interventions in newborn care is crucial for ensuring positive patient outcomes. Nurses need to be able to quickly assess and prioritize care for newborns experiencing respiratory distress to provide timely and effective interventions. This rationale emphasizes the importance of prioritizing oxygenation and positioning in newborns with respiratory distress to support their respiratory function and overall well-being.

Correct Answer: B

Rationale: The most appropriate intervention for a mother with mastitis is to encourage continued breastfeeding (Option B). This is because breastfeeding helps to clear the blocked ducts and promote drainage, which can help alleviate the symptoms of mastitis. Additionally, breastfeeding helps maintain milk production and prevents engorgement, which can worsen the condition. Advising the mother to stop breastfeeding temporarily (Option A) is not the best choice as it can lead to further complications like engorgement and decreased milk supply. Applying cold compresses (Option C) may provide some relief for symptoms like pain and swelling, but it does not address the underlying issue of blocked ducts. Referring the mother to a lactation consultant (Option D) can be helpful in providing support and guidance for proper breastfeeding techniques, but it is not the most immediate or direct intervention needed for mastitis. In an educational context, it is important to understand the physiological benefits of breastfeeding in cases of mastitis. Encouraging continued breastfeeding not only helps in resolving the current issue but also promotes bonding between the mother and baby. It is crucial for healthcare providers to have a good understanding of the management strategies for mastitis to provide optimal care for breastfeeding mothers.