The nurse would expect a physician to prescribe which medication to a postpartum client with heavy bleeding and a boggy uterus?

Correct Answer: C

Rationale: In the scenario described, the correct medication that the physician would prescribe to a postpartum client with heavy bleeding and a boggy uterus is option C) Methylergonovine maleate (Methergine). Methylergonovine is a uterotonic medication that helps to stimulate uterine contractions, leading to decreased bleeding and firming up of the uterus, which is essential in managing postpartum hemorrhage due to uterine atony. Option A) Docusate (Colace) is a stool softener used to prevent constipation, which is not relevant in this situation. Option B) Terbutaline (Brethine) is a tocolytic agent used to stop premature labor contractions, not indicated for postpartum hemorrhage. Option D) Rh immune globulin (RhoGAM) is administered to Rh-negative mothers to prevent Rh incompatibility issues with the baby, not indicated for postpartum hemorrhage. In an educational context, understanding the rationale behind the choice of Methylergonovine in this scenario highlights the importance of recognizing and promptly treating postpartum hemorrhage, a critical complication that can occur after childbirth. Nurses caring for postpartum clients should be aware of the appropriate medications used to manage this condition and understand their mechanisms of action to provide optimal care and prevent complications.

Correct Answer: D

Rationale: In the context of pharmacology and nursing care of newborns, understanding conditions related to poor peripheral circulation is crucial for providing quality care. In this question, the correct answer is D) Acrocyanosis. Acrocyanosis is a condition characterized by bluish discoloration of the extremities, such as hands and feet, which is often seen in newborns due to poor peripheral circulation. This occurs because the baby's circulatory system is still maturing, leading to reduced oxygenation in the peripheral tissues. Option A) Harlequin sign is a transient condition where a newborn's body is divided into two halves with one side appearing pale and the other side appearing red. This is due to immature autonomic regulation and is not directly related to poor peripheral circulation. Option B) Jaundice is a condition characterized by yellowing of the skin and eyes due to elevated levels of bilirubin in the blood, commonly seen in newborns. Jaundice is not directly caused by poor peripheral circulation. Option C) Mottling is a pattern of reddish-blue marbling of the skin that can be seen when there is poor circulation to the skin's surface. While mottling is related to circulation, it is not specific to poor peripheral circulation and can be caused by various factors. By understanding the differences between these conditions, nurses can accurately assess and provide appropriate care for newborns with various circulatory-related issues. Recognizing acrocyanosis as a sign of poor peripheral circulation can prompt intervention and monitoring to ensure the newborn's well-being.

Correct Answer: B

Rationale: The correct answer is B) The baby’s bilirubin is 19mg/dl. This situation would require the baby’s discharge to be cancelled because a bilirubin level of 19mg/dl in a 2-day-old newborn is significantly elevated and poses a risk for severe jaundice and potential neurotoxicity if not treated promptly. Hyperbilirubinemia in newborns can lead to kernicterus, a condition characterized by bilirubin deposition in the brain, which can cause neurological damage. Option A) The parents own a car seat that only faces the rear of the car is not a reason to cancel discharge. Rear-facing car seats are actually recommended for infants as they provide better protection in the event of a crash. Option C) The baby’s blood glucose is 65 mg/dl may be slightly low, but it is not a critical value that would require cancellation of discharge. It can be managed with feeding and monitoring. Option D) There is a large bluish spot on the left buttock of the baby is likely a common birthmark known as a Mongolian spot and does not typically require cancellation of discharge unless it is accompanied by other concerning symptoms. In the context of nursing care of the newborn and family, it is crucial to prioritize the safety and well-being of the newborn. Understanding the significance of abnormal lab values, such as elevated bilirubin levels, is essential for nurses to provide appropriate care and make informed decisions regarding discharge planning. Hyperbilirubinemia is a common condition in newborns that requires close monitoring and intervention to prevent complications.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) None; it will disappear within about a month. This rash described is likely erythema toxicum neonatorum, a common benign skin condition in newborns that typically resolves on its own without any specific treatment. A) Applying aloe vera lotion (Option A) is unnecessary and may not provide any additional benefit as the rash will naturally disappear. B) Using hormonal skin cream (Option B) is not recommended for newborns as it can be harsh on their delicate skin and may cause harm. D) Vigorously washing and cleansing the baby's skin (Option D) can actually irritate the skin further and disrupt the natural balance, leading to more issues. Educationally, it is important for nurses and parents to be aware of common skin conditions in newborns to provide appropriate care and avoid unnecessary treatments. Understanding the natural course of conditions like erythema toxicum neonatorum helps prevent over-treatment and promotes the overall well-being of the newborn. By choosing the correct answer, the nurse demonstrates knowledge of neonatal skin conditions and promotes evidence-based care.

Correct Answer: D

Rationale: The correct answer is D) Supine, which means placing the infant on their back to sleep. This sleeping position is recommended by the American Academy of Pediatrics (AAP) to reduce the risk of sudden infant death syndrome (SIDS). When infants sleep on their backs, it helps maintain an open airway, reduces the risk of suffocation, and allows for better regulation of body temperature. Option A) Prone (on stomach) is not recommended as it increases the risk of SIDS due to potential airway obstruction. Option B) Side-lying can also pose risks as the infant may roll onto their stomach unintentionally. Option C) Side-lying with a blanket roll behind the infant's back is not advised because the blanket roll can shift, potentially covering the baby's face and increasing the risk of suffocation. As perinatal nurses, it is crucial to educate parents on safe sleep practices to promote infant safety and reduce the risk of SIDS. By emphasizing the importance of placing infants on their backs to sleep, nurses can empower parents to create a safe sleep environment for their newborns. This education is essential in ensuring the well-being of the newborn and promoting healthy sleep habits from an early age.