A nurse is caring for a client who is at 38 weeks of gestation and is experiencing continuous abdominal pain and vaginal bleeding. The client has a history of cocaine use. The nurse should identify that the client is likely experiencing which of the following complications?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Abruptio placentae. Abruptio placentae is a serious complication where the placenta detaches from the uterine wall before delivery. The symptoms of abdominal pain and vaginal bleeding in a pregnant woman with a history of cocaine use are indicative of this condition. Cocaine can cause vasoconstriction, leading to decreased blood flow to the placenta, increasing the risk of abruptio placentae. Option B) Hydatidiform mole is incorrect because this condition presents with symptoms such as vaginal bleeding, passage of vesicles, and elevated hCG levels, not continuous abdominal pain. Option C) Preterm labor is unlikely in this case as the symptoms described are more indicative of a placental complication rather than uterine contractions. Option D) Placenta previa typically presents with painless vaginal bleeding in the third trimester, not continuous abdominal pain. Educationally, this question highlights the importance of recognizing the signs and symptoms of various pregnancy complications, understanding how substance use can impact pregnancy outcomes, and the critical role of nurses in identifying and managing such high-risk situations in maternity care.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to take is option A: Encourage the mother to breastfeed the newborn. This is the appropriate choice because breastfeeding is the most natural and effective way to increase the newborn's blood glucose level. Breast milk contains the necessary nutrients and sugars that can help regulate the baby's glucose levels. Option B, gavage feeding 60 mL of glucose water, is incorrect because it introduces an unnecessary intervention that may not align with the infant's actual needs. Providing glucose water may also disrupt the establishment of breastfeeding. Option C, administering 10 mL of D W via IV, is not the first-line intervention for a newborn with low blood glucose levels. Intravenous administration should be reserved for severe cases where oral intake is not feasible or effective. Option D, rechecking the glucose level in 2 hours, is not the most appropriate immediate action when dealing with a newborn with low blood glucose levels. Prompt intervention is crucial to prevent further complications associated with hypoglycemia in neonates. In an educational context, understanding the significance of promoting breastfeeding for newborns is crucial for healthcare professionals working in maternity care. Encouraging breastfeeding not only provides optimal nutrition but also helps establish bonding between the mother and the infant. It is essential for nurses to prioritize evidence-based practices that support the well-being of both the newborn and the mother in maternity care settings.

Correct Answer: A

Rationale: In this scenario, option A, "You should keep the car seat rear-facing until your baby is at least 2 years old," is the correct statement for the nurse to make. This recommendation aligns with current safety guidelines from organizations like the American Academy of Pediatrics (AAP) and the National Highway Traffic Safety Administration (NHTSA). Rear-facing car seats provide the best protection for infants and young children in the event of a crash by supporting the child's head, neck, and spine. Options B, C, and D are incorrect statements. Positioning the retainer clip over the upper part of the baby's abdomen (Option B) can result in serious internal injuries in a crash. Placing the baby in the car seat at a 90-degree angle (Option C) is not necessary and may not be practical in all vehicles. Lastly, placing the shoulder harness straps in the slots above the baby's shoulders (Option D) can lead to improper fit and decreased safety in the event of a crash. Educationally, it is crucial for healthcare providers to provide evidence-based information on car seat safety to parents. By understanding and following the recommended guidelines, parents can significantly reduce the risk of injury to their child in a motor vehicle accident. Nurses play a vital role in educating families on best practices to ensure the safety and well-being of infants and children during car travel.

Correct Answer: C

Rationale: In this scenario, the nurse should prioritize option C, which is to massage the client's fundus. Massaging the fundus helps to stimulate uterine contractions, which can effectively control postpartum bleeding by promoting the expulsion of clots and initiating the process of uterine involution. This intervention is crucial in preventing postpartum hemorrhage, a potentially life-threatening complication. Option A, elevating the client's legs, is not the priority in this situation as it does not address the underlying cause of the excessive bleeding. While elevating the legs can improve venous return and circulation, it is not as directly beneficial as fundal massage in managing postpartum hemorrhage. Inserting an indwelling urinary catheter (option B) is not the priority action because the client's excessive bleeding takes precedence. Monitoring urinary output is essential but can be done after addressing the bleeding. Initiating an infusion of oxytocin (option D) is a valid intervention to help control postpartum bleeding, but it should come after fundal massage. Oxytocin can be administered after ensuring that the uterus is contracting effectively through fundal massage. In an educational context, it is crucial for nurses caring for postpartum clients to understand the significance of fundal massage in managing postpartum hemorrhage. This knowledge ensures they can provide timely and appropriate care to prevent complications and promote maternal well-being.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) "You should expect the test to take about 30 minutes." This statement is important to prepare the client for the duration of the nonstress test, ensuring they know what to expect and can plan their time accordingly. Option A is incorrect because nonstress tests do not typically require medication through an IV. Option C is also incorrect as fasting is not necessary for a nonstress test, so the client should not be advised to avoid eating or drinking before the test. Option D is incorrect because although nonstress tests are important in assessing fetal well-being, they do not specifically determine the maturity of the baby's lungs. From an educational perspective, it is crucial for nurses to provide accurate and relevant information to pregnant clients to alleviate anxiety, promote understanding, and ensure optimal prenatal care. By explaining the purpose and duration of the nonstress test, the nurse can empower the client to actively participate in their maternity care and make informed decisions regarding their health and the health of their baby.