An ultrasound report of a fetus' heart states that 'normal fetal circulation is noted.' Which statement is consistent with the finding?

Correct Answer: A

Rationale: Choice A is the correct answer because a right to left shunt between the atria is consistent with normal fetal circulation. During fetal development, a fetus has a hole in the heart called the foramen ovale which allows blood to bypass the lungs and flow directly from the right atrium to the left atrium. This is important as the lungs are not yet functioning in utero. Therefore, seeing a right to left shunt between the atria on an ultrasound report is normal and indicates that blood is flowing as it should in a fetus. Choice B is incorrect because a right to left shunt between the umbilical arteries would not be consistent with normal fetal circulation. The umbilical arteries carry deoxygenated blood from the fetus to the placenta for oxygenation, so a shunt in this direction would not be normal. Choice C is incorrect because blood returning to the placenta via the umbilical vein is part of fetal circulation but it is not indicative of normal fetal circulation. In a normal fetus, oxygenated blood returns to the fetus from the placenta via the umbilical vein, but this statement does not specifically address the shunting of blood within the heart. Choice D is incorrect because blood returning to the right atrium from the pulmonary system is indicative of postnatal circulation, not fetal circulation. In a fetus, blood bypasses the lungs through the foramen ovale and ductus arteriosus, so seeing blood returning to the right atrium from the pulmonary system on an ultrasound report would not be consistent with normal fetal circulation.

Correct Answer: B

Rationale: B: The nurse stabilizes the base of the uterus with one hand while massaging the fundus. This is the correct action because it ensures that the fundus is properly supported and allows for accurate assessment of the fundal height. Massaging the fundus also helps to prevent postpartum hemorrhage by promoting contractions of the uterus to reduce bleeding. A: The nurse measures the fundal height using a paper tape. This is an incorrect action because measuring the fundal height with a paper tape is not necessary during the immediate postpartum period. The focus should be on assessing the firmness, position, and height of the fundus to ensure proper involution of the uterus. C: The nurse palpates the fundus with the tips of his or her fingers. This action is incorrect because palpating the fundus with the fingertips may not provide enough support to accurately assess the fundal height. It is important to use the palm of the hand to provide adequate support and pressure while assessing the fundus. D: The nurse precedes the assessment with a sterile vaginal exam. This action is incorrect because a sterile vaginal exam is not necessary for assessing the fundus during the immediate postpartum period. The focus should be on assessing the fundus externally to ensure proper involution and prevent complications such as postpartum hemorrhage.

Correct Answer: B

Rationale: Lochia serosa is a type of postpartum vaginal discharge that typically occurs from days 3 to 10 after delivery. This discharge is pinkish-brown in color and contains leukocytes, erythrocytes, serous fluid, and cervical mucus. Choice A (Days 3 and 4 PP) is incorrect because lochia serosa does not start as early as day 3; it typically begins around day 3 and can last up to day 10. Choice C (Days 10-14 PP) is incorrect because lochia serosa usually stops around day 10, so it would not be present up to day 14. Choice D (Days 14 to 42 PP) is incorrect because lochia serosa is not present beyond day 10. After lochia serosa, the discharge transitions to lochia alba, which is a creamy white or light yellow color. Therefore, the correct answer is B (Days 3 to 10 PP) as this is the timeframe during which the client can expect to experience lochia serosa.

Correct Answer: A

Rationale: Option A is the correct answer because the symptoms described by the partner (anger, confusion, having conversations with herself) could indicate a serious mental health issue such as postpartum psychosis. Postpartum psychosis is a rare but severe condition that requires immediate medical attention as it can be life-threatening to both the mother and the baby. By advising the partner to take the client to the nearest emergency room for evaluation, the nurse is ensuring that the client receives the necessary urgent care and support. Option B is incorrect because simply bringing the client to the physician's office for medication may not be sufficient to address the severity of the symptoms described. Postpartum psychosis requires more immediate and intensive intervention than just medication. Option C is incorrect because outpatient care is not appropriate for someone experiencing symptoms of postpartum psychosis. This condition requires immediate and intensive treatment, which is typically not provided in an outpatient setting. Option D is incorrect because while intensive behavioral therapy may be a component of treatment for postpartum psychosis, it is not the most appropriate initial response. In this case, immediate medical evaluation in an emergency room setting is necessary to ensure the safety and well-being of the client and her baby.

Correct Answer: C

Rationale: Choice C is correct because the transdermal contraceptive patch should not be applied to the breast. This is because the breast tissue has a different composition and sensitivity compared to other areas where the patch is typically placed, such as the abdomen or buttocks. Applying the patch to the breast may result in decreased effectiveness of the contraceptive, as the absorption of hormones may be altered. Additionally, the breast is a sensitive area and applying the patch there may cause skin irritation or discomfort. Choice A is incorrect because simply documenting the use of the patch does not address the issue of its inappropriate placement on the breast. While documentation is important for the woman's medical record, addressing the incorrect placement of the patch is a more immediate concern. Choice B is incorrect because questioning the woman on her satisfaction with the patch does not address the issue at hand, which is the inappropriate placement of the patch on the breast. While it is important to assess the woman's satisfaction with her contraceptive method, this should not take precedence over addressing the incorrect application of the patch. Choice D is incorrect because removing the patch to complete the breast exam is unnecessary and may not be within the scope of practice for a midwife. The primary concern should be educating the woman on the correct placement of the patch and ensuring that she understands the potential risks associated with applying it to the breast.