The nurse is educating a client about managing heartburn during pregnancy. What is the best advice?

Correct Answer: B

Rationale: In the context of pharmacology and maternal newborn nursing, proper management of heartburn during pregnancy is crucial for the well-being of both the mother and the developing fetus. The best advice to give to a client experiencing heartburn during pregnancy is to eat small, frequent meals (Option B). This recommendation helps prevent overeating, which can exacerbate heartburn symptoms by putting pressure on the stomach. By eating smaller meals more frequently, the stomach is not overly distended, reducing the likelihood of reflux and heartburn. Option A, lying down immediately after eating, is incorrect because it can worsen heartburn symptoms due to the horizontal position allowing stomach acid to flow back into the esophagus. Option C, drinking a glass of water with meals, may provide some temporary relief by diluting stomach acid, but it does not address the underlying issue of overeating or stomach distension. Option D, consuming spicy foods to aid digestion, is incorrect as spicy foods can actually trigger or worsen heartburn symptoms in many individuals. Educationally, it is important to emphasize to pregnant clients the significance of dietary modifications in managing common discomforts like heartburn. Teaching about appropriate meal sizes and frequency can empower clients to take control of their symptoms in a safe and effective manner, promoting a healthier pregnancy experience for both mother and baby.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Assess fetal heart rate and contraction pattern. The priority action for a client at 34 weeks' gestation experiencing regular uterine contractions is to assess the fetal well-being to determine if the contractions are affecting the baby. This assessment helps in identifying any signs of fetal distress or compromise. Option A) Encouraging ambulation may be beneficial in some situations to relieve discomfort, but it is not the priority when fetal well-being is at stake. Option B) Performing a sterile vaginal examination is invasive and not indicated as the initial action in this situation. It could potentially introduce infection or cause further irritation. Option D) Administering an analgesic without assessing the fetal status first could mask important signs of distress in the baby, which could be detrimental. Educationally, understanding the rationale behind the priority actions in maternal newborn nursing is crucial for providing safe and effective care to both the mother and the baby. Assessing fetal well-being in cases of maternal contractions is a fundamental aspect of monitoring and ensuring a positive outcome for both patients.

Correct Answer: B

Rationale: In the postpartum period, the finding that indicates a need for immediate intervention is option B) Lochia rubra with large clots. Lochia rubra is the normal vaginal discharge after childbirth, but the presence of large clots can indicate excessive bleeding or retained placental tissue, which are serious postpartum complications requiring immediate medical attention to prevent hemorrhage and infection. Option A) Fundus firm and midline is a normal finding indicating proper uterine involution, which is expected in the postpartum period. Option C) Perineal pain after delivery is common due to the trauma of childbirth and is managed with pain relief measures. Option D) Slight swelling of the feet can be a normal postpartum symptom due to fluid shifts, but it does not require immediate intervention unless it is severe and associated with other signs of preeclampsia. In an educational context, it is crucial for nurses working in maternal newborn care to recognize abnormal postpartum findings that require immediate intervention to ensure the well-being of the mother. Understanding normal postpartum changes and potential complications is essential in providing safe and effective care to postpartum clients. Regular assessment and early detection of abnormal findings can prevent serious postpartum complications and promote optimal recovery for the mother.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Compression of pelvic nerves. Leg cramps during pregnancy, especially at 20 weeks' gestation, can be attributed to the growing uterus exerting pressure on the pelvic nerves, leading to compression and subsequent leg cramps. This is a common occurrence in pregnancy due to the expanding uterus putting pressure on surrounding structures. Option A) Dehydration is less likely to be the cause of leg cramps in this case, as the physiological changes in pregnancy often lead to an increased need for fluid intake. However, dehydration can contribute to muscle cramps in general. Option B) Calcium deficiency is an important consideration during pregnancy, but it is less likely to be the primary cause of leg cramps at 20 weeks' gestation. Adequate calcium intake is crucial for bone health and muscle function, but in this case, nerve compression is the more likely cause. Option C) Increased blood volume is a normal adaptation during pregnancy, but it is not directly linked to the development of leg cramps. While changes in blood volume can impact circulation and potentially contribute to other symptoms, it is not the primary reason for leg cramps in this context. Educationally, understanding the physiological changes and common discomforts experienced during pregnancy is essential for nurses caring for expectant mothers. Recognizing the causes of symptoms like leg cramps helps nurses provide appropriate education, support, and interventions to promote maternal well-being throughout pregnancy.

Correct Answer: B

Rationale: In the case of a client at 34 weeks' gestation diagnosed with polyhydramnios, the nurse's priority assessment should be to assess for signs of preterm labor, making option B the correct answer. Polyhydramnios, an excess of amniotic fluid, can increase the risk of preterm labor due to uterine distention and placental compression. By assessing for signs of preterm labor such as regular uterine contractions, lower back pain, pelvic pressure, or vaginal bleeding, the nurse can intervene promptly to prevent premature birth and its associated complications. Monitoring maternal blood pressure (option A) is important in prenatal care, but in this specific scenario, the risk of preterm labor takes precedence. Checking for signs of infection (option C) is also important but not the priority when dealing with polyhydramnios and its potential complications. Evaluating fetal heart rate changes (option D) is crucial in many situations, but in this case, assessing for preterm labor is more directly related to the client's current condition and needs. This educational context highlights the critical thinking skills required in maternal newborn nursing to prioritize assessments based on the client's specific condition and potential risks. Nurses must be able to recognize the most urgent needs of their clients to provide timely and appropriate care, especially in high-risk situations such as polyhydramnios during pregnancy.