During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to:

Correct Answer: D

Rationale: Option D is the correct answer because the woman is likely experiencing symptoms of supine hypotensive syndrome, which occurs when the weight of the uterus compresses the vena cava when lying on the back, leading to decreased blood flow to the heart and brain. This can result in dizziness and lightheadedness. Teaching the woman to avoid lying on her back and to rise slowly can help alleviate these symptoms and prevent further complications. Option A, ordering a nonstress test to assess fetal well-being, is incorrect because the woman's symptoms are likely related to her position rather than fetal distress. While monitoring fetal well-being is important during pregnancy, it is not the most appropriate action in this situation. Option B, ordering an EKG, is also incorrect because the woman's symptoms are likely not cardiac-related. Supine hypotensive syndrome is a common issue in pregnancy and can be managed without the need for an EKG. Option C, reporting the abnormal finding immediately to her care provider, is not the most appropriate action in this situation. While it is important to communicate any concerns to the care provider, educating the woman on how to manage her symptoms is a more immediate and practical intervention in this case.

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.

Correct Answer: B

Rationale: Choice A is incorrect because a variable baseline heart rate of 140 with V-shaped decelerations to 120 unrelated to contractions is concerning. V-shaped decelerations are usually associated with cord compression, which can lead to fetal distress. Choice C is incorrect because a flat baseline heart rate of 140 with decelerations to 120 that return to baseline after the contraction indicates fetal distress. Decelerations should not drop below the baseline heart rate, and a flat baseline can suggest fetal hypoxia. Choice D is incorrect because a flat baseline heart rate of 140 with no obvious decelerations or accelerations can be indicative of fetal compromise. A lack of variability in the heart rate can be a sign of fetal distress. Choice B is the correct answer because a variable baseline heart rate of 140 with decelerations to 100 that mirror each of the contractions is considered normal. This pattern, known as early decelerations, is typically caused by head compression during contractions and is not associated with fetal distress. It is a reassuring sign of fetal well-being during labor.