Choice A rationale

A neonate's respiratory rate of 46 breaths per minute is within the normal range for a newborn, which is typically between 30 and 60 breaths per minute. Shallow respirations and brief periods of apnea lasting less than 20 seconds are also common in the immediate newborn period as the respiratory system adapts to extrauterine life. Therefore, continued routine monitoring is the appropriate initial action.

Choice B rationale

While apnea monitors are used for infants at high risk for apnea, such as preterm infants or those with known respiratory issues, a healthy term neonate with brief periods of apnea less than 20 seconds and a respiratory rate within the normal range does not typically require continuous electronic monitoring. This intervention would be premature given the current assessment findings.

Choice C rationale

Following a respiratory arrest protocol is indicated when a patient exhibits signs of respiratory distress or cessation of breathing. The neonate's current respiratory rate of 46 bpm, although shallow with brief pauses, does not indicate respiratory arrest. Initiating such a protocol would be an overreaction to the current assessment findings.

Choice D rationale

While it is important to keep the pediatrician informed about any significant changes in a neonate's condition, the findings described (respiratory rate of 46 bpm, shallow respirations, and apnea up to 5 seconds) are often normal in the first few hours after birth. Calling the pediatrician immediately for these findings alone is not the priority action; continued monitoring is more appropriate initially.

Choice A rationale

Placenta previa is a condition where the placenta partially or totally covers the cervix. While it poses risks for hemorrhage during labor and delivery, it does not directly increase the risk of postpartum infection. The primary risks associated with placenta previa are related to bleeding, not infection.

Choice B rationale

Meconium aspiration occurs when a fetus inhales meconium-stained amniotic fluid. This primarily affects the newborn's respiratory system and does not directly increase the postpartum client's risk of infection. The complications of meconium aspiration are focused on the neonate.

Choice C rationale

A midline episiotomy is a surgical incision made in the perineum during childbirth to enlarge the vaginal opening. This incision creates a break in the skin and mucous membranes, providing a potential portal of entry for bacteria. Therefore, a midline episiotomy places the postpartum client at an increased risk for local infection at the incision site.

Choice D rationale

Gestational hypertension is high blood pressure that develops during pregnancy and typically resolves after delivery. While it poses risks to both the mother and the fetus, it does not directly increase the postpartum client's risk of infection. The primary concerns with gestational hypertension are related to blood pressure control and potential end-organ damage.

Choice A rationale

Fetal hypoxemia, a deficiency in oxygen reaching the fetal tissues, typically manifests as late decelerations in the fetal heart rate tracing, which reflect uteroplacental insufficiency. While severe hypoxemia can lead to various FHR patterns, variable decelerations are more directly associated with mechanical factors affecting the umbilical cord.

Choice B rationale

Altered fetal cerebral blood flow can be a consequence of various factors, including hypoxemia and cord compression, and can influence the fetal heart rate. However, variable decelerations are specifically caused by events that directly impede blood flow through the umbilical vessels rather than a generalized alteration in cerebral circulation.

Choice C rationale

Uteroplacental insufficiency, a condition where the placenta is unable to deliver an adequate supply of oxygen and nutrients to the fetus, typically results in late decelerations, indicating fetal distress due to chronic hypoxia. Variable decelerations, in contrast, have a more abrupt onset and recovery, reflecting acute changes in umbilical cord blood flow.

Choice D rationale

Umbilical cord compression occurs when the umbilical cord, which carries oxygen and nutrients to the fetus, is squeezed or constricted. This compression leads to a transient decrease in fetal blood flow and oxygenation, resulting in a rapid drop and subsequent return of the fetal heart rate, which is characteristic of variable decelerations. The shape, timing, and abrupt nature of variable decelerations directly correlate with the intermittent pressure on the umbilical cord.

Choice A rationale

The ventrogluteal muscle, located in the hip, is a safe site for intramuscular injections in adults and children older than seven months due to its distance from major nerves and blood vessels. However, the vastus lateralis muscle in the thigh is the preferred site for IM injections in newborns and infants due to its well-developed muscle mass and accessibility.

Choice B rationale

The deltoid muscle, located in the upper arm, is small and not well-developed in newborns, making it an unsuitable site for intramuscular injections. There is also a risk of injury to the brachial nerve and blood vessels in this area in neonates.

Choice C rationale

The dorsogluteal muscle, located in the buttocks, is no longer the recommended site for intramuscular injections in infants and young children due to the proximity of the sciatic nerve and major blood vessels, increasing the risk of nerve damage.

Choice D rationale

The vastus lateralis muscle, located on the anterolateral aspect of the thigh, is the recommended site for intramuscular injections in newborns. It is a large, well-developed muscle that is easily accessible and away from major nerves and blood vessels, making it a safe and effective site for administering vitamin K to prevent hemorrhagic disease of the newborn.

Choice A rationale

Misoprostol is a prostaglandin analog that stimulates uterine contractions. It is contraindicated in clients with placenta previa due to the risk of severe hemorrhage from placental separation if contractions are induced.

Choice B rationale

Active genital herpes is a contraindication for vaginal delivery and therefore also a contraindication for induction of labor with Misoprostol, as it could potentially lead to vertical transmission of the herpes simplex virus to the newborn during passage through the birth canal.

Choice C rationale

A previous uterine incision due to multiple myomectomy can be a contraindication for labor induction with Misoprostol, depending on the type and location of the incisions. The increased risk of uterine rupture with strong contractions stimulated by Misoprostol is a significant concern in such cases.

Choice D rationale

Gestational hypertension, in the absence of other contraindications, can be an indication for induction of labor if the benefits of delivering the baby outweigh the risks of continuing the pregnancy. Misoprostol can be used cautiously in this situation to ripen the cervix and induce labor.

Choice A rationale

Pounding headache, visual changes, and epigastric pain in a patient with pregnancy-induced hypertension (PIH), now known as gestational hypertension or preeclampsia, are classic signs of worsening disease and indicate central nervous system irritability and potential hepatic involvement. These symptoms suggest the condition is progressing towards severe preeclampsia and increase the risk of eclampsia, which is characterized by seizures.

Choice B rationale

Magnesium sulfate is used to prevent seizures in severe preeclampsia. While it can cause side effects such as flushing, warmth, and muscle weakness, it does not typically cause pounding headache, visual changes, or epigastric pain. These symptoms are more indicative of the underlying disease process rather than the treatment.

Choice C rationale

Anxiety due to hospitalization can cause various symptoms, but the specific combination of pounding headache, visual changes, and epigastric pain is more strongly associated with the physiological changes occurring in worsening preeclampsia rather than solely psychological distress.

Choice D rationale

Gastrointestinal upset can cause epigastric pain, but it would not typically be accompanied by pounding headache and visual changes in the context of pregnancy-induced hypertension. The constellation of these symptoms strongly points towards a worsening of the hypertensive condition and potential end-organ involvement. .

Choice A rationale

Encouraging a hands-and-knees position may help rotate a malpositioned fetus or relieve back pain, but it does not directly address hypotonic uterine dysfunction, which is characterized by weak, ineffective contractions. While it can improve maternal comfort and potentially aid in fetal descent if malpositioning is a contributing factor to slow labor progress, it will not augment the strength or frequency of contractions necessary for cervical dilation.

Choice B rationale

Providing a comfortable environment with dim lighting can promote relaxation and potentially enhance the progress of labor in cases of hypertonic uterine dysfunction (uncoordinated, painful contractions). However, in hypotonic dysfunction, the issue is a lack of adequate uterine muscle activity. While comfort measures are always important, they do not directly stimulate stronger contractions.

Choice C rationale

Administering oxytocin is the primary medical intervention for hypotonic uterine dysfunction. Oxytocin is a synthetic hormone that stimulates uterine smooth muscle to contract more frequently and with greater intensity. This augmentation of uterine activity aims to establish an effective labor pattern, leading to cervical dilation and fetal descent when fetopelvic disproportion has been ruled out.

Choice D rationale

Preparing for an amniotomy (artificial rupture of membranes) might be considered to augment labor if the membranes are intact. However, the question states the membranes have already ruptured. Amniotomy can sometimes stimulate contractions by releasing prostaglandins, but it is not the first-line intervention for established hypotonic dysfunction after membrane rupture, and oxytocin is generally more effective in this situation.

Choice A rationale

Nausea and vomiting are common discomforts of pregnancy, particularly in the first trimester. While they can be distressing, they are not typically indicative of an immediate life-threatening condition for the mother or fetus at 14 weeks gestation. Hyperemesis gravidarum, a more severe form, would warrant closer attention, but the description here is general.

Choice B rationale

Painless vaginal bleeding in the second or third trimester (28 weeks gestation) is a concerning sign and could indicate placenta previa or placental abruption, both of which can lead to significant maternal and fetal hemorrhage and compromise fetal oxygenation. This client requires immediate assessment to determine the cause and ensure prompt intervention if necessary.

Choice C rationale

A cough and fever at 38 weeks gestation could indicate an infection, such as influenza or pneumonia. While these conditions can be serious for a near-term pregnant woman and potentially affect the fetus, they are generally less immediately life-threatening than significant vaginal bleeding in the second or third trimester and would be addressed after the client with potential placental issues.

Choice D rationale

Missed period and vaginal spotting can be early signs of pregnancy or a threatened abortion. While it warrants investigation, it is generally not an immediate emergency requiring triage before a client with painless vaginal bleeding at 28 weeks gestation, which carries a higher risk of acute complications.

Choice A rationale

Thoroughly cooking meat to an internal temperature of 160°F (71°C) kills the Toxoplasma gondii parasite, thus preventing transmission through ingestion of contaminated meat. This is a crucial preventive measure recommended for pregnant women.

Choice B rationale

Drinking unpasteurized milk poses a risk of toxoplasmosis, as well as other foodborne illnesses like listeriosis and brucellosis. Pasteurization is a process that heats milk to a specific temperature for a set time, killing harmful bacteria and parasites, including Toxoplasma gondii. Therefore, this statement indicates a need for further instruction, as pregnant women should consume only pasteurized dairy products.

Choice C rationale

Cat feces can contain oocysts of Toxoplasma gondii, which can become infectious after a period of sporulation. Avoiding contact with materials possibly contaminated with cat feces, such as litter boxes and garden soil, is an important measure to prevent toxoplasmosis.

Choice D rationale

Handling raw meat can expose a person to Toxoplasma gondii cysts. Avoiding touching mucous membranes of the mouth or eyes after handling raw meat and washing hands thoroughly reduces the risk of self-inoculation with the parasite.

Choice A rationale

Reducing fluid intake will not alleviate breast engorgement and may even be detrimental to milk production and overall maternal hydration. Engorgement is caused by increased blood flow and milk production in the breasts, not excess fluid intake.

Choice B rationale

Frequent breastfeeding, ideally every 1-2 hours, helps to remove milk from the breasts, which relieves pressure and engorgement. Regular emptying of the breasts signals the body to regulate milk production and prevents the buildup of milk that causes discomfort and can lead to complications like mastitis.

Choice C rationale

Avoiding the use of a breast pump when breasts are engorged can worsen the condition. A breast pump can be used to express milk and relieve pressure if the infant is not feeding effectively or frequently enough. Complete milk removal is key to reducing engorgement.

Choice D rationale

Skipping feedings will exacerbate breast engorgement as milk will continue to accumulate in the breasts, increasing pressure, pain, and the risk of complications. Regular milk removal is essential for managing engorgement and establishing a healthy breastfeeding pattern.