Which patient would be most likely to have severe afterbirth pains and request a narcotic analgesic?

Correct Answer: A

Rationale: The correct answer is A - Gravida 5, para 5. Afterbirth pains are caused by uterine contractions as the uterus returns to its pre-pregnancy size. The more pregnancies a woman has had, the more stretched and prone to stronger contractions her uterus becomes. In this case, a gravida 5, para 5 patient has had multiple pregnancies and deliveries, leading to a higher likelihood of severe afterbirth pains. The other choices are incorrect because a primipara (B) would have less uterine stretching, a patient bottle feeding her first child (C) would still experience afterbirth pains due to uterine contractions, and a patient breastfeeding her second child (D) would experience milder afterbirth pains due to the release of oxytocin during breastfeeding which helps the uterus contract and reduce bleeding.

Correct Answer: C

Rationale: The correct answer is C: “They will fade to silvery lines but won’t disappear completely.” This response is the best because it provides a realistic expectation to the patient. Stretch marks may lighten over time but typically do not completely disappear. Choice A is incorrect as it provides a definitive and discouraging answer. Choice B is vague and does not offer a clear timeframe. Choice D is incorrect as it gives an overly optimistic timeline that may not be realistic for most individuals. Overall, choice C is the most accurate and supportive response for the patient's query.

Correct Answer: D

Rationale: The correct answer is D because the rubella vaccine contains live virus and poses a risk to the fetus if the patient becomes pregnant within 28 days of receiving the vaccine. Providing instructions about the risks of pregnancy after vaccination is crucial to prevent potential harm to the fetus. A: Incorrect - Specific instructions are necessary due to the live virus in the vaccine. B: Incorrect - Drinking fluids does not address the specific risks associated with pregnancy after vaccination. C: Incorrect - Stopping breastfeeding is not necessary after receiving the rubella vaccine.

Correct Answer: D

Rationale: The correct answer is D. Gently palpating the fundus is the appropriate technique after cesarean birth to assess fundal contraction. This technique is recommended to prevent causing discomfort or dislodging the uterus. Assessing lochial flow (A) does not directly evaluate fundal contraction. Palpating forcefully through the abdominal dressing (B) can be painful and may not provide an accurate assessment. Placing hands on both sides of the abdomen and pressing downward (C) is not a recommended technique as it can potentially cause uterine displacement.

Correct Answer: B

Rationale: The correct answer is B because the patient's statement about not needing birth control if breastfeeding and supplementing with formula is incorrect. Breastfeeding is not a reliable form of birth control and additional contraception is necessary to prevent unintended pregnancy. Explanation: 1. Breastfeeding alone is not a foolproof method of contraception. 2. The combination of breastfeeding and formula feeding does not guarantee contraception. 3. Lactational amenorrhea method (LAM) is only effective if specific criteria are met. 4. The patient's misconception about not needing birth control while breastfeeding and supplementing with formula puts her at risk of unintended pregnancy. Summary: A: Correct statement about the timing of bowel movements postpartum. C: Incorrect statement about the normal pattern of bowel elimination postpartum. D: Correct statement about the need for birth control if not breastfeeding.