A nurse is caring for a postpartum person who is experiencing a headache. What is the most likely cause of a postpartum headache?

Correct Answer: B

Rationale: The correct answer is B: Spinal headache. Postpartum spinal headaches are commonly caused by leakage of cerebrospinal fluid due to accidental dural puncture during epidural anesthesia. This can lead to severe headaches that worsen when sitting or standing. Eclampsia (A) presents with hypertension and seizures, not just headaches. Tension headaches (C) are typically stress-related and not specific to the postpartum period. Cluster headaches (D) are characterized by severe pain around the eye and are not commonly associated with childbirth.

Correct Answer: B

Rationale: The correct answer is B: assist with vacuum extraction. This intervention is appropriate when prolonged pushing has not resulted in progress during labor. Vacuum extraction helps facilitate the delivery of the baby by applying suction to the baby's head to assist with pulling them out. It is less invasive than a cesarean section and forceps delivery, making it a safer option in this scenario. Performing a cesarean section (choices A and C) would be considered if vacuum extraction is unsuccessful or contraindicated due to specific factors. Forceps delivery (choice D) is another option but is generally considered more invasive and carries higher risks compared to vacuum extraction.

Correct Answer: A

Rationale: The correct answer is A: Spinal block. Spinal anesthesia provides rapid onset and reliable anesthesia for cesarean section, making it the preferred method in nonemergent cases. It is safe for both the mother and the baby, as it does not cross the placental barrier. Spinal anesthesia also allows for better pain control postoperatively compared to other methods. Choice B (Epidural block) may be a suitable option, but spinal anesthesia is preferred due to its faster onset and reliability. Choice C (General anesthesia) is not the preferred method in nonemergent cases as it carries more risks compared to regional anesthesia and may have adverse effects on the baby. Choice D (Intravenous sedation) is not appropriate for cesarean section as it does not provide adequate anesthesia for the procedure and may not be safe for the baby.

Correct Answer: A

Rationale: The correct answer is A: provide comfort measures. Comfort measures such as massage, positioning, and relaxation techniques help the laboring person cope with the pain and intensity of contractions. By providing comfort, the nurse can help reduce stress and anxiety, promoting a more positive labor experience. Choice B (assist with breathing exercises) can be helpful, but comfort measures are more essential for overall well-being during labor. Choice C (provide reassurance and comfort) is similar to the correct answer but lacks the specific action of providing comfort measures. Choice D (administer antibiotics) is irrelevant to the management of strong contractions and is not indicated unless there is a specific medical reason for antibiotics.

Correct Answer: A

Rationale: The primary purpose of performing an episiotomy during delivery is to reduce the risk of perineal trauma. Episiotomy is a surgical incision made in the perineum to widen the vaginal opening during childbirth, which can help prevent severe tearing of the perineal tissue. This procedure is performed to provide controlled and precise incision, reducing the likelihood of extensive tears that may lead to complications such as infection or prolonged healing time. It is not done to promote faster delivery, facilitate fetal descent, or provide immediate fetal oxygenation. These choices do not accurately reflect the main goal of episiotomy, which is to minimize perineal trauma.

Correct Answer: B

Rationale: The correct answer is B: Blood pressure. In a patient with gestational hypertension, monitoring blood pressure is crucial to assess for worsening hypertension, which can lead to complications such as preeclampsia and eclampsia. Elevated blood pressure can affect both maternal and fetal well-being. Assessing fetal heart rate (A) is important but not the most critical factor in this scenario. Uterine contractions (C) are important but secondary to monitoring blood pressure. Fetal malpresentation (D) can impact delivery but is not the most vital factor to assess in a patient with gestational hypertension.

Correct Answer: D

Rationale: Celery is high in fiber and water, making it an effective choice for relieving constipation.

Correct Answer: A

Rationale: The correct answer is A: Count fetal movements and report a decrease of more than 10 movements per day. This recommendation is evidence-based and aligns with guidelines for monitoring fetal well-being. Counting fetal movements helps assess fetal health, and a decrease in movements could indicate potential issues like fetal distress. Reporting a decrease of more than 10 movements per day ensures timely intervention if needed. Choice B is incorrect because waiting until after 32 weeks could delay necessary intervention if there are concerns about fetal movements. Choice C is incorrect as it dismisses the importance of monitoring fetal movements altogether. Choice D is incorrect as there is no requirement to always lie down or restrict monitoring to only after meals, which could lead to missed opportunities for detecting potential problems.

Correct Answer: B

Rationale: The correct answer is B: ultrasound. Ultrasound is the most accurate and non-invasive method to determine the presentation of the fetus by visualizing the position of the baby in the womb. It allows the nurse to see if the fetus is in a cephalic (head-down) or breech (feet or buttocks down) position. This information is crucial for assessing the progress of labor and planning appropriate interventions. A: Vaginal exam is not typically used to determine fetal presentation as it does not provide a clear view of the baby's position. C: Palpation of contractions helps assess the strength and frequency of contractions but does not directly determine fetal presentation. D: Laboring person interview may provide valuable information about symptoms and history but does not offer direct insight into fetal presentation.