Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is experiencing?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Loss of increased blood volume associated with pregnancy. During pregnancy, a woman's blood volume significantly increases to support the needs of the developing fetus. After childbirth, the body undergoes rapid adjustments to return to its pre-pregnancy state. The diaphoresis (excessive sweating) and diuresis (increased urination) experienced by the woman are due to the body's physiological response to eliminate the excess fluid that was necessary during pregnancy. This process helps to prevent complications such as postpartum edema and hypertension. Option A) Elevated temperature caused by postpartum infection is incorrect because there is no mention of fever or other signs of infection in the scenario. Option B) Increased basal metabolic rate after giving birth is incorrect as this would not directly cause diaphoresis and diuresis. Option D) Increased venous pressure in the lower extremities is unrelated to the symptoms described and does not explain the woman's experience of diaphoresis and diuresis. Educationally, understanding the postpartum physiological changes is crucial for maternal newborn nurses to provide appropriate care and support to women during this transitional period. Recognizing the normal adaptation processes helps nurses differentiate between expected postpartum changes and potential complications, ensuring optimal maternal and newborn outcomes.

Correct Answer: D

Rationale: The correct answer is D) Headaches. During the puerperium, which is the period immediately following childbirth, headaches can be indicative of serious conditions such as postpartum preeclampsia or post-dural puncture headache. These conditions require careful medical assessment to ensure timely intervention and prevent complications. Option A) Varicosities of the legs are common in pregnancy but are not typically a significant concern during the puerperium. They usually improve postpartum without requiring immediate medical attention. Option B) Carpal tunnel syndrome is also a common issue in pregnancy due to fluid retention, but it usually does not pose a critical threat during the puerperium. It can be managed conservatively and does not typically require urgent medical assessment. Option C) Periodic numbness and tingling of the fingers can be related to conditions like carpal tunnel syndrome or fluid retention, but unless accompanied by other concerning symptoms, it is less likely to require immediate medical assessment during the puerperium. Understanding the importance of differentiating between common discomforts of pregnancy and potentially serious postpartum complications is crucial in maternal newborn nursing. Proper assessment and prompt identification of conditions like postpartum preeclampsia are vital to ensuring maternal well-being and preventing adverse outcomes.

Correct Answer: B

Rationale: The correct answer is option B) Vaginal rugae reappear by 3 weeks postpartum. This is accurate because after childbirth, the vaginal walls lose their rugae (folds) due to stretching during labor. It takes about 3 weeks for these rugae to reappear as the vaginal tissues heal and regain their elasticity. Option A is incorrect because while the cervix does undergo changes postpartum, it does not return to its pre-pregnancy form within a month. It takes several weeks for the cervix to gradually return to its normal state. Option C is incorrect as most episiotomies, which are surgical incisions made during childbirth to aid delivery, take longer than a week to heal completely. Healing time can vary but typically ranges from 4 to 6 weeks. Option D is incorrect as hemorrhoids, swollen veins in the rectal area common during pregnancy and childbirth, may take longer than 2 weeks to decrease in size and resolve. It can take several weeks to months for hemorrhoids to fully heal. Understanding the timeline of postpartum restoration and healing is crucial for maternal newborn nurses to provide accurate information and support to postpartum mothers. It helps in managing expectations, identifying complications, and promoting overall well-being during the postpartum period.

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take is to assist the client in assuming the knee-chest position (Option D). This position helps relieve pressure on the umbilical cord by reducing compression and improving blood flow to the fetus, thus preventing cord compression and potential fetal distress. Option A, administering oxytocin, is incorrect as it does not address the emergent issue of cord prolapse and could potentially worsen the situation by increasing contractions and further compressing the cord. Option B, applying oxygen, may be beneficial for fetal oxygenation but does not directly address the cord prolapse. Option C, preparing for an intrauterine pressure catheter, is not a priority in this situation and may delay necessary interventions to relieve cord compression. In an educational context, understanding the urgency and appropriate interventions for umbilical cord prolapse is crucial for maternal newborn nurses to prevent adverse outcomes for both the mother and the baby. Prompt recognition and action can significantly impact the outcome and safety of both patients in this critical situation.

Correct Answer: B

Rationale: In the context of maternal newborn nursing, providing dietary teaching is crucial to ensure the health and well-being of both the mother and the developing fetus. In this scenario, the correct answer is option B) A sliced apple and red grapes. The rationale behind this choice is that fruits like apples and grapes are rich in essential nutrients such as vitamins, minerals, and fiber, which are beneficial for maternal health and fetal development. Additionally, these fruits are low in phenylalanine, which is important for clients with phenylketonuria (PKU) as they need to restrict their intake of this amino acid. On the other hand, options A, C, and D are not ideal choices for a client with PKU. Option A contains peanut butter, which is high in protein and phenylalanine. Option C includes a chocolate chip cookie, which typically contains high amounts of protein and phenylalanine. Option D contains cheddar cheese, which is also high in phenylalanine. Educationally, understanding the dietary needs of clients with specific conditions such as PKU is essential for nurses working in maternal newborn care. By explaining the rationale behind the correct choice and highlighting why the other options are not suitable, nurses can provide effective and evidence-based dietary teaching to support optimal outcomes for both the mother and the newborn.