Which of the following should be implemented in is experiencing increased oral mucus should provide management of hypovolemic shock due to postpar- parent education on which of the following? tum hemorrhage? Select all that apply.

Correct Answer: A

Rationale: The correct answer is A: Correctly positioning the infant for feedings. This is the most appropriate intervention as it addresses the specific issue of increased oral mucus in an infant, which can be a sign of difficulty feeding and potential aspiration. Positioning the infant correctly can help facilitate safe and effective feeding, reducing the risk of complications. Summary of why other choices are incorrect: B: IV fluid replacement with 5% dextrose - This choice does not directly address the issue of increased oral mucus and hypovolemic shock due to postpartum hemorrhage. C: Initiating cardiopulmonary resuscitation - This choice is not indicated for the given scenario and is more appropriate for a life-threatening emergency situation. D: Administration of oxygen with a nonrebreather - While oxygen may be necessary in certain cases, it does not address the specific issue of increased oral mucus and hypovolemic shock due to postpartum hemorrhage.

Correct Answer: A

Rationale: The correct answer is A: Ballottement. This is a probable sign of pregnancy because it involves the rebounding of the fetus against the examiner's fingers on palpation. This occurs when the examiner pushes against the uterus and feels a bouncing back, indicating the presence of a fetus. Choice B, Chadwick's sign, is actually the violet coloration of mucous membranes of cervix, vagina, and vulva at around 6-8 weeks, not 4 weeks as stated. Choice C, uterine enlargement, is a presumptive sign of pregnancy as it can be caused by factors other than pregnancy, such as fibroids. Choice D, Hegar's sign, involves the compressibility and softening of the lower uterine segment at around 6 weeks, but it is a probable sign rather than a definitive one like Ballottement.

Correct Answer: A

Rationale: The correct answer is A: Document the findings and continue to monitor the client. This is the appropriate action because the client's fundus is midline and firm, indicating good uterine tone. Lochia rubra and small clots are expected findings in the immediate postpartum period. The nurse should document these findings for future reference and continue to monitor the client's condition. Choice B (Notify the client's provider) is incorrect because there are no concerning signs that warrant immediate provider notification, as the fundus is firm and midline. Choice C (Increase the frequency of fundal massage) is unnecessary since the fundus is already firm at the umbilicus, indicating good uterine tone. Choice D (Encourage the client to empty her bladder) is not the priority in this scenario, as the client's fundal assessment and lochia observations take precedence.

Correct Answer: D

Rationale: Correct Answer: D. The lowermost portion of the fetus is at the level of the ischial spines. Rationale: 1. Station 0 indicates the presenting part of the fetus is at the level of the ischial spines. 2. This position is significant as it helps determine the progress of labor. 3. It means the fetus has not descended into the birth canal yet, indicating early labor stages. Summary: A: Incorrect. Left occiput posterior position is related to fetal head position, not station. B: Incorrect. Passing through the pelvic outlet refers to engagement, not station. C: Incorrect. The posterior fontanel being palpable is not directly related to station.

Correct Answer: B

Rationale: The correct answer is B: A surge of energy. This is because an increase in energy is often seen in pregnant women shortly before labor begins, known as the "nesting instinct." This burst of energy can indicate that the body is preparing for labor. A: Decreased vaginal discharge is not a sign that precedes labor. In fact, an increase in vaginal discharge is more common as labor approaches. C: Urinary retention is not a sign of labor onset. In late pregnancy, pressure on the bladder may cause frequent urination, but retention is not typical. D: Weight gain of 0.5 to 1.5 kg is not a specific sign of labor onset. Weight gain can fluctuate throughout pregnancy and is not a reliable indicator of impending labor.