After a Preparation for Parenting class session, a pregnant client tells the nurse that she has had some yellow-gray frothy vaginal discharge and local itching. The nurse's best action is to advise the client to do which of the following?

Correct Answer: B

Rationale: Rationale: The correct answer is B) Schedule an appointment at the clinic for an examination. The client's symptoms of yellow-gray frothy vaginal discharge and itching could indicate a possible infection, such as bacterial vaginosis or trichomoniasis, rather than a yeast infection. It is essential for the client's health and the health of the fetus to have a healthcare provider evaluate and diagnose the condition accurately. Option A) Using an over-the-counter cream for yeast infections is not appropriate in this case because the symptoms described are not typical of a yeast infection. Misdiagnosis and inappropriate treatment could lead to worsening of the condition. Option C) Administering a vinegar douche under low pressure is not recommended as it can disrupt the natural pH balance of the vagina and worsen the symptoms or even lead to further complications. Option D) Preparing for preterm labor and delivery is premature and not indicated based solely on the client's symptoms of vaginal discharge and itching. It is essential to rule out any infections or other underlying issues first before considering preterm labor. In an educational context, this question highlights the importance of accurate assessment and appropriate intervention in perinatal care. Nurses need to be vigilant in recognizing abnormal symptoms in pregnant clients and guiding them to seek proper medical evaluation and treatment to ensure the well-being of both the mother and the baby.

Correct Answer: C

Rationale: The correct answer is C) She may have a hidden laceration. In this scenario, the client's complaint of severe perineal pain despite receiving ibuprofen and the presence of edema suggest that there may be an underlying issue such as a hidden laceration that is causing the pain. It is crucial for the nurse to consider this possibility and further assess the client to rule out any complications that may require medical intervention. Option A) She should be assessed by her doctor is incorrect because the nurse should first assess the client herself to determine the cause of the pain before involving the doctor unnecessarily. Option B) She should have a sitz bath is incorrect as a sitz bath may provide comfort but it does not address the underlying issue of severe perineal pain that persists despite pain medication. Option D) She needs a narcotic analgesic is incorrect as the first step should be to investigate the cause of the pain rather than automatically escalating to a stronger pain medication. In an educational context, this question highlights the importance of thorough assessment and critical thinking in postpartum care. It emphasizes the need for nurses to consider all possible causes of a client's symptoms and to prioritize appropriate interventions based on assessment findings rather than jumping to conclusions or treatments. This scenario also underscores the significance of vigilance in detecting potential complications following childbirth, especially in cases where the client's symptoms are not improving as expected.

Correct Answer: A

Rationale: Rationale: The correct answer is A) Serial grip strengths. When a client is on magnesium sulfate therapy for severe preeclampsia, monitoring for signs of magnesium toxicity is crucial. Serial grip strength assessments are important because magnesium toxicity can lead to neuromuscular complications such as muscle weakness or loss of deep tendon reflexes. By assessing grip strength regularly, the nurse can detect these early signs of toxicity and intervene promptly to prevent further complications. Option B) Kernig assessments are used to assess for meningitis, not magnesium sulfate toxicity. Option C) Pupillary responses are important for assessing neurological status but are not specific to monitoring magnesium toxicity. Option D) Apical heart rate checks are important for monitoring cardiac function but do not specifically indicate magnesium toxicity. Educational context: Understanding the signs and symptoms of magnesium sulfate toxicity is essential for nurses caring for clients with severe preeclampsia. By regularly assessing grip strength, nurses can identify early signs of magnesium toxicity and prevent serious complications. This knowledge and skill are critical for providing safe and effective care to perinatal clients at risk for complications related to hypertension in pregnancy.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Foul-smelling lochia. This sign indicates a possible infection, specifically endometritis, which is a common complication postpartum. Rupture of membranes for an extended period increases the risk of infection. Reporting foul-smelling lochia promptly is crucial for early intervention to prevent serious complications like sepsis. Option B) Engorged breasts is a common postpartum occurrence due to increased blood flow and milk production and does not require immediate intervention unless associated with severe pain or signs of mastitis. Option C) Cracked nipples are common breastfeeding issues that can be managed with proper technique and support and do not pose immediate health risks. Option D) Cluster of hemorrhoids is not directly related to the prolonged rupture of membranes and spontaneous vaginal delivery scenario, and while uncomfortable, it does not require immediate intervention. Educationally, understanding the significance of different postpartum signs and symptoms is vital for nurses to provide safe and effective care. Recognizing abnormal findings promptly and taking appropriate actions can prevent complications and promote positive outcomes for both the mother and newborn.

Correct Answer: C

Rationale: In this scenario, the correct answer is option C: Fundus firm at umbilicus. Methergine is a medication commonly used to prevent or control postpartum hemorrhage by promoting uterine contractions. The firmness of the fundus at the level of the umbilicus indicates effective contraction of the uterus, which helps prevent excessive bleeding after childbirth. Option A: Blood pressure 120/80 is not a direct indicator of the effectiveness of Methergine in preventing postpartum hemorrhage. While stable blood pressure is important, it is not a specific indicator of the medication's effectiveness in this context. Option B: Pulse rate 80 bpm and regular is also not a direct indicator of the medication's effectiveness in preventing postpartum hemorrhage. A normal pulse rate is important but does not directly reflect uterine contraction and prevention of hemorrhage. Option D: Increase in prothrombin time is incorrect because an increase in prothrombin time would actually suggest a disturbance in the blood's ability to clot, which is not the desired effect of Methergine in this situation. Educationally, understanding the rationale behind the correct answer helps nurses recognize the appropriate assessment findings to monitor after administering Methergine in postpartum care. This knowledge is crucial for providing safe and effective care to postpartum patients and preventing complications such as postpartum hemorrhage.