Which of the following is a priority nursing diagnosis for a woman, G10P6226, who is PP1 from a spontaneous vaginal delivery with a significant postpartum hemorrhage?

Correct Answer: C

Rationale: The priority nursing diagnosis for a woman like G10P6226 who experienced a significant postpartum hemorrhage after a spontaneous vaginal delivery is "Fluid volume deficit related to blood loss" (Option C). This is the most critical issue to address first because postpartum hemorrhage can lead to severe hypovolemia and shock if not managed promptly. Replacing lost fluids and blood is essential to stabilize the patient's condition and prevent further complications. Option A, "Alteration in comfort related to afterbirth pains," is not the priority in this situation because the patient's physiological stability takes precedence over pain management. Option B, "Risk for altered parenting related to grand multiparity," is not an immediate concern when the patient is experiencing a life-threatening complication like fluid volume deficit. Option D, "Risk for sleep deprivation related to mothering role," is also not the priority as it is a long-term concern compared to the urgent need to address the fluid volume deficit. Educationally, understanding the concept of prioritizing nursing diagnoses based on the patient's immediate needs is crucial in providing effective and safe patient care. Nurses need to be able to recognize and address life-threatening conditions first before addressing other less urgent issues. This case highlights the importance of quick assessment and intervention in managing postpartum complications.

Correct Answer: D

Rationale: The correct answer is D) Provide the client with supervised instruction on baby care skills. Rationale: The client's positive toxicology results for alcohol and cocaine indicate substance use that can impair her ability to care for her newborn safely. Providing supervised instruction on baby care skills ensures that the client receives guidance and support in understanding the baby's needs and how to care for him effectively despite her substance use issues. Option A) Strongly advising the client to breastfeed her baby is not appropriate in this situation due to the potential harmful effects of alcohol and cocaine exposure through breast milk. Option B) Performing hourly incentive spirometer respiratory assessments is not relevant to the client's situation of substance use and does not address the immediate need for appropriate baby care. Option C) Suggesting that the nursery nurse feed the baby in the nursery does not address the underlying issue of the client's ability to care for her baby independently and safely. Educational Context: In cases of perinatal loss and postpartum clients with substance use issues, it is crucial to provide tailored education and support to ensure the safety and well-being of both the mother and the newborn. Supervised instruction on baby care skills can help empower the client to care for her baby appropriately and mitigate potential risks associated with her substance use. It is essential for healthcare providers to address these complex situations with sensitivity, empathy, and evidence-based interventions to promote optimal outcomes for both mother and baby.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Urine output of 200 mL for the last 8 hours. This finding is critical to report to the obstetrician because a decreased urine output postpartum could indicate inadequate renal perfusion, potentially due to continued hemorrhage or other complications. This information is crucial for the obstetrician to assess the client's fluid status and intervene promptly if necessary. Option B) Weight decrease of 2 pounds since delivery may not be as urgent to report immediately as changes in urine output. While weight loss is expected postpartum, a significant decrease could indicate excessive blood loss or fluid shifts, but it is not as time-sensitive as monitoring urine output in this context. Option C) Drop in hematocrit of 2% since admission is important but may not be as indicative of the current status as urine output in the immediate postpartum period. Hematocrit changes take time to manifest and may not reflect acute changes as rapidly as urine output. Option D) Pulse rate of 68 beats per minute, while within the normal range, is not as concerning as changes in urine output in this context. Pulse rate alone may not provide enough information to assess the client's overall condition post hemorrhage without considering other parameters like blood pressure and clinical symptoms. In an educational context, it is essential for nurses caring for postpartum clients to understand the significance of monitoring urine output as a vital sign, especially in cases of postpartum hemorrhage. Nurses need to recognize the importance of timely communication of critical findings to the healthcare team to ensure prompt interventions and optimal patient outcomes.

Correct Answer: A

Rationale: In the context of perinatal loss nursing care, understanding postpartum psychosis is crucial for providing effective care. The correct answer is A) Hallucinations. Postpartum psychosis is a severe mental health condition that can occur in the postpartum period. Hallucinations, along with delusions, are common symptoms of postpartum psychosis. These hallucinations can be auditory, visual, or tactile in nature and are often distressing for the woman experiencing them. Option B) Polyphagia refers to excessive hunger, which is not typically a symptom of postpartum psychosis. Option C) Induced vomiting is more indicative of an eating disorder like bulimia and is not a common symptom of postpartum psychosis. Option D) Weepy sadness is more characteristic of postpartum depression rather than postpartum psychosis. Educationally, understanding the differences between postpartum psychosis, postpartum depression, and other postpartum mental health conditions is essential for nurses caring for women during this vulnerable period. Recognizing the signs and symptoms of postpartum psychosis is crucial for early intervention and support for the woman and her family. By knowing the specific manifestations of postpartum psychosis, nurses can provide appropriate care and referrals to mental health professionals for further evaluation and treatment.

Correct Answer: B

Rationale: In this scenario, option B is the most appropriate action for the nurse to take. The correct answer is to carefully check the record to ensure that the RhoGAM injection was administered. This is important because the mother is Rh-negative, and if the injection was not given, there could be a risk of Rh incompatibility issues in future pregnancies. By verifying the administration of RhoGAM, the nurse can ensure the mother's safety. Option A is incorrect because the client needs the RhoGAM injection regardless of the baby's Coombs' test results. Option C is incorrect as the negative Coombs' test does not negate the need for RhoGAM in an Rh-negative mother. Option D is incorrect because RhoGAM should be given within 72 hours of delivery, not necessarily before discharge. Educationally, this question highlights the importance of understanding Rh incompatibility and the necessity of RhoGAM in Rh-negative mothers to prevent hemolytic disease of the newborn in future pregnancies. It emphasizes the critical role nurses play in ensuring proper administration of medications to prevent complications.