After instructing participants in a childbirth education class about methods for coping with discomforts in the first stage of labor, the nurse determines that one of the pregnant clients needs further instruction when she says that she has been practicing which of the following?

Correct Answer: D

Rationale: In this scenario, option D, pelvic tilt exercises, is the correct method for coping with discomforts in the first stage of labor. Pelvic tilt exercises help to relieve back pain and discomfort during labor by strengthening the muscles in the lower back and abdomen. These exercises also help to improve the position of the baby in the pelvis, which can facilitate a smoother labor process. Option A, biofeedback, is not typically used for coping with discomforts in labor but rather for stress management and relaxation in other contexts. Option B, effleurage, involves light circular stroking movements on the abdomen and is more commonly used for pain relief during labor rather than discomfort in the first stage. Option C, guided imagery, can be a helpful relaxation technique during labor, but it is not specifically targeted at coping with discomforts in the first stage. Providing this educational context can help pregnant clients understand the rationale behind using pelvic tilt exercises as a coping mechanism during labor.

Correct Answer: A

Rationale: In this case, the correct answer is A) Uterine atony. Uterine atony is a condition where the uterus fails to contract after delivery, leading to postpartum hemorrhage, which is a significant concern after a macrosomic baby and a prolonged labor. Monitoring for uterine atony is crucial to prevent excessive bleeding and its complications. Option B) Hypoprolactinemia is not directly related to the scenario described. While lactation issues may arise after delivery, hypoprolactinemia is not a common or immediate concern postpartum. Option C) Infection is a general concern after any delivery, but it is not specifically associated with a macrosomic baby or prolonged labor unless there were specific risk factors or complications during labor that would increase the risk of infection. Option D) Mastitis is an inflammation of the breast tissue that usually occurs during breastfeeding and is not directly related to the scenario described, as it typically occurs after delivery and is not specific to macrosomia or prolonged labor. Educationally, understanding the potential complications following a macrosomic baby and prolonged labor is crucial for healthcare providers working in perinatal care. Monitoring for specific issues like uterine atony can help prevent serious complications and ensure the well-being of both the mother and baby postpartum.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Candida albicans. Candida albicans is a type of yeast that commonly causes thrush, an oral fungal infection in infants, and can also lead to breast infections in breastfeeding mothers. This organism thrives in warm, moist environments like a baby's mouth or on the skin of the breast, especially when there is prolonged exposure to milk residue. Staphylococcus aureus (option A) is a common bacterium that can cause skin infections but is not typically associated with thrush or fungal infections. Streptococcus pneumonia (option B) is a bacterium that causes respiratory infections and is not related to thrush or breast infections. Escherichia coli (option C) is a bacterium found in the intestines and is associated with gastrointestinal infections, not thrush. From an educational standpoint, understanding the specific pathogens responsible for different infections is crucial in providing appropriate care and treatment. In the context of perinatal loss, healthcare providers need to have a thorough knowledge of common infections associated with breastfeeding and be able to differentiate between bacterial and fungal causes to offer effective interventions for both the baby and the mother.

Correct Answer: D

Rationale: The highest priority nursing diagnosis in this scenario is "D) Pain." This is because the client has just undergone a forceps delivery and episiotomy, both of which can cause significant pain and discomfort. Managing pain is crucial to ensure the client's comfort, promote healing, and support their emotional well-being during this sensitive time. Untreated pain can lead to increased stress, delayed recovery, and hinder the bonding process with the newborn. Regarding the other options: A) Ineffective breastfeeding: While this is an important consideration postpartum, addressing pain takes precedence as it directly impacts the client's immediate well-being and ability to engage in other activities such as breastfeeding. B) Fluid volume deficit: While important to monitor, pain management should be the priority as addressing pain will not only improve the client's comfort but also their ability to drink fluids effectively. C) Infection: While infection prevention is crucial, it is not the most immediate concern in this case. Pain management should be prioritized to address the client's immediate postpartum discomfort and promote recovery. In an educational context, understanding the hierarchy of nursing priorities is essential for providing effective and efficient care. By prioritizing pain management in this case, nurses can ensure the client's immediate needs are addressed, setting the foundation for comprehensive postpartum care and promoting optimal recovery and well-being.

Correct Answer: C

Rationale: In this case, the nurse should assess patient C, PP3 from vacuum delivery with a hemoglobin of 7.2 g/dL, first. This patient's low hemoglobin level indicates potential postpartum hemorrhage, a critical condition requiring immediate attention to prevent complications like hypovolemic shock. Option A, burning on urination for PP1 from vaginal delivery, is likely indicative of a urinary tract infection which is important but not immediately life-threatening. Option B, PP1 from forceps delivery with blood loss of 500 mL, may have experienced a significant blood loss but this occurred at delivery and should have been addressed during the delivery process. Option D, PO3 from cesarean delivery with firm and painful breasts, likely has mastitis, which is important to address promptly but does not pose the immediate life-threatening risk that a hemoglobin level of 7.2 g/dL does. Educationally, this scenario highlights the importance of prioritizing care based on the urgency and severity of the patient's condition, especially in the postpartum period where complications can arise quickly and have serious consequences. It reinforces the need for nurses to be vigilant in monitoring and assessing postpartum patients for any signs of complications.