The nurse asks a 31-week gestation client to lie on the examining table during a prenatal examination. In which of the following positions should the client be placed?

Correct Answer: B

Rationale: In perinatal care, it is crucial to consider the positioning of the pregnant client during examinations to optimize maternal and fetal well-being. The correct answer is B) Left lateral position for this 31-week gestation client. Placing the client in the left lateral position helps to alleviate pressure on the vena cava, promoting optimal blood flow to the placenta and reducing the risk of supine hypotension syndrome, which can occur when the pregnant woman lies flat on her back, especially in the later stages of pregnancy. Option A) Supine position is incorrect because it can compress the vena cava, compromising blood flow and potentially causing hypotension and decreased fetal perfusion. Option C) Right lateral position is also incorrect in this scenario as the left lateral position is preferred to maximize blood flow to the placenta and reduce the risk of complications related to supine positioning. Option D) Semi-Fowler's position is not the best choice for this prenatal examination as it does not address the specific considerations of vena cava compression and optimal blood flow as effectively as the left lateral position. Educationally, understanding the rationale behind positioning during prenatal examinations is essential for nurses caring for pregnant clients to promote maternal and fetal health. By knowing the reasons for choosing specific positions, nurses can provide safe and effective care, reducing the risk of complications and promoting positive outcomes for both the mother and the baby.

Correct Answer: B

Rationale: In a perinatal loss NCLEX question involving a parenting class for primigravid clients, the correct answer is B) Increased risk for urinary tract infections. The physiologic changes during pregnancy, specifically in the first half, include an increase in urinary stasis due to the growing uterus pressing on the bladder. This can lead to incomplete emptying of the bladder, promoting bacterial growth and increasing the risk of urinary tract infections (UTIs). Educating primigravid clients on this aspect is crucial for early detection and prevention of UTIs, which can have serious implications for both the mother and the fetus. Now, let's discuss why the other options are incorrect: A) Decreased plasma volume: During pregnancy, plasma volume actually increases to support the growing fetus and prepare for labor and delivery. C) Increased peripheral vascular resistance: Pregnancy typically leads to a decrease in peripheral vascular resistance to ensure adequate blood flow to the fetus. D) Increased hemoglobin levels: Hemoglobin levels may be slightly diluted due to the expansion of plasma volume, leading to a relative decrease in hemoglobin concentration during pregnancy. Including this information in a parenting class for primigravid clients is essential as it empowers them with knowledge to recognize potential health issues and seek timely medical intervention, contributing to a healthier pregnancy outcome.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Postpartum hemorrhage. After delivering the placenta, the nurse should carefully observe the woman for signs of postpartum hemorrhage, which is a significant concern in the immediate postpartum period. Postpartum hemorrhage is defined as excessive bleeding of 500ml or more within the first 24 hours following childbirth. This complication can lead to maternal morbidity and mortality if not promptly addressed. Therefore, close monitoring and prompt intervention are crucial. Option A) Endometrial ischemia is incorrect because it is not a common complication following placental delivery. While inadequate blood flow to the endometrium can lead to issues like delayed involution, it is not the primary concern immediately post-delivery. Option C) Prolapsed uterus is incorrect as this typically occurs when the uterus descends into or outside the vaginal canal, which is not related to the delivery of the placenta. Option D) Vaginal hematoma is incorrect as it refers to localized bleeding into the soft tissues of the vagina and is not directly related to the delivery of the placenta. Educationally, understanding the potential complications in the postpartum period is crucial for nurses caring for women after delivery. Recognizing and managing postpartum hemorrhage promptly is vital to ensure the well-being of the mother. This knowledge is essential for nurses working in labor and delivery, postpartum units, and any setting where they may encounter women in the postpartum period.

Correct Answer: B

Rationale: The correct answer is B) Encourage the woman to breastfeed frequently. Rationale: Encouraging the woman to breastfeed frequently on the affected breast helps to empty the breast and prevent milk stasis, which can worsen mastitis. Continued breastfeeding also helps in clearing the infection and promoting faster recovery. It is safe for the infant to breastfeed from the affected breast as the milk is still safe for the baby. Option A) advising the woman to apply ice packs to her breasts is incorrect as ice packs can worsen the condition by decreasing milk flow and causing further stasis. Option C) informing the woman to wean immediately is not recommended as breastfeeding should continue to help clear the infection and prevent further complications. Option D) directing the woman to notify her pediatrician is not the priority in this situation. The woman should be guided on appropriate nursing interventions to manage mastitis effectively. Educational Context: Teaching nursing interventions for mastitis is crucial in providing comprehensive care to breastfeeding mothers. Educating on the importance of continued breastfeeding, proper latch techniques, frequent nursing, and ensuring adequate rest and hydration are key components in managing mastitis effectively and promoting successful breastfeeding.

Correct Answer: B

Rationale: In this scenario of perinatal loss, the appropriate nursing action is option B, which involves dressing the baby in a tee shirt and swaddling the baby in a receiving blanket. This response is correct because it promotes a sensitive and compassionate approach to the situation. By dressing and swaddling the baby, the nurse acknowledges the baby as a person and respects the mother's need to see and hold her child, even in this tragic moment. Option A is incorrect as it dismisses the current loss by focusing on the possibility of future pregnancies, which can invalidate the mother's current grief and emotions. Option C is inappropriate as it suggests sedation as a primary response to emotional distress, which may not address the mother's needs effectively. Option D is also incorrect as it deprives the mother of the opportunity to spend time with her baby, which is crucial for the grieving process and bonding. Educationally, this question highlights the importance of providing sensitive and empathetic care in situations of perinatal loss. Nurses need to recognize the significance of supporting parents through their grief and facilitating meaningful experiences to help them cope with their loss. It underscores the value of humanizing the experience for the parents and treating the baby with dignity and respect, regardless of the outcome.