The nurse received end of shift report in a high-risk maternity unit. Which patient should the nurse see first?

Correct Answer: C

Rationale: The patient who should be seen first is the 35 weeks' gestation with grade I abruptio placenta in labor who has a strong urge to push. Abruptio placenta is a serious condition where the placenta detaches from the uterine wall before delivery, leading to significant bleeding and potential compromise to both the mother and baby. The strong urge to push indicates that the baby is in distress and immediate intervention is required to prevent potential harm. This patient needs urgent assessment and intervention to ensure the safety of both the mother and the baby.

Correct Answer: A

Rationale: If a woman has been in labor for 16 hours and her cervix is not dilated, it suggests that the fetal presenting part is not engaged. Engagement refers to the descent of the fetal presenting part (usually the head) into the pelvis. When the presenting part is not engaged, it may lead to a prolonged labor as the fetus needs to descend further for labor to progress effectively. This can result in slower cervical dilation and may require interventions to help facilitate engagement, such as position changes or use of gravity-assisted techniques.

Correct Answer: A

Rationale: Conduction is the transfer of heat between objects that are in direct contact with each other. In the scenario where a newborn is placed on a cold scale or touched with cold hands, heat loss occurs through conduction. The cold temperature of the scale or hands will draw heat away from the infant's body, leading to a drop in body temperature. It is essential to ensure that newborns are not exposed to cold surfaces or objects for prolonged periods to prevent heat loss through conduction and maintain their body temperature within a safe range.

Correct Answer: D

Rationale: In the context of pharmacology and maternal newborn nursing, understanding lifestyle factors that impact health outcomes is crucial. The correct answer, option D - excessive alcohol consumption, is associated with an increased risk of developing breast cancer due to its ability to disrupt hormone levels and increase estrogen production, which can promote the growth of cancer cells in breast tissue. Excessive alcohol intake is a known risk factor for various health conditions, including breast cancer. Option A, regular physical activity, is actually associated with a decreased risk of developing breast cancer. Exercise can help regulate hormone levels, boost the immune system, and contribute to maintaining a healthy weight, all of which can lower the risk of breast cancer. Option B, moderate alcohol consumption, is a bit nuanced. While excessive alcohol intake is a clear risk factor, some studies suggest that moderate alcohol consumption may have a slight increase in breast cancer risk, but the evidence is not as strong as with excessive alcohol consumption. Option C, maintaining a healthy weight after menopause, is actually a protective factor against breast cancer. Obesity and being overweight, especially after menopause, can increase the risk of developing breast cancer due to higher estrogen levels produced by fat cells. Educationally, this question highlights the importance of understanding how lifestyle factors can impact health outcomes, specifically in the context of maternal newborn nursing where promoting health and preventing diseases like breast cancer are key aspects of care. Nurses must be equipped to educate patients on making informed choices to reduce their risk factors for breast cancer and other health conditions.

Correct Answer: B

Rationale: In menopause, the correct answer is B) variable hot flushes and sleep difficulties. This is because hot flushes, also known as hot flashes, and sleep disturbances are two of the most persistent and commonly experienced physical changes during menopause. Hot flushes result from hormonal fluctuations, leading to sudden feelings of warmth, sweating, and flushing of the skin. Sleep disturbances, such as insomnia or night sweats, are often related to hormonal imbalances and can significantly impact a woman's quality of life during menopause. Option A) secondary sex characteristics and growth spurt is incorrect because these changes occur during puberty, not menopause. Menopause marks the end of the reproductive years, characterized by the cessation of menstruation and hormonal shifts, rather than the development of secondary sex characteristics. Option C) thinning of skin and loss or dryness of hair is incorrect because while changes in skin and hair quality can occur during menopause due to hormonal changes, they are not as consistently experienced or as defining as hot flushes and sleep disturbances. Option D) irregular menstruation for a few years after menarche transition is incorrect because menarche refers to the onset of menstruation, not menopause. Irregular menstruation is a common occurrence during perimenopause, the transitional period leading to menopause, but it is not a persistent symptom experienced after menopause has been reached. Understanding the physical changes associated with menopause is crucial for nurses caring for women during this life stage. By recognizing common symptoms like hot flushes and sleep disturbances, nurses can provide appropriate education, support, and symptom management strategies to help women navigate this significant transition in their lives.