A nurse is caring for a postpartum client who reports feeling anxious, irritable, and unable to sleep despite extreme fatigue. The client also expresses feelings of inadequacy as a mother. Which of the following nursing interventions is the most appropriate?

Advise the client to seek help from family members to reduce stress and manage the baby's care

Assess the client for further signs of postpartum mood disorders

Reassure the client that these feelings are normal and will subside in a few days

Encourage the client to rest whenever the baby is sleeping to alleviate fatigue

Answer and Explanation

The Correct Answer is B

A. Advise the client to seek help from family members to reduce stress and manage the baby's care – While social support is helpful, it does not directly address potential postpartum mood disorders, which require further evaluation.

B. Assess the client for further signs of postpartum mood disorders – These symptoms may indicate postpartum depression, which requires further assessment and potential intervention. Early identification is crucial to ensuring the client's safety and well-being.

C. Reassure the client that these feelings are normal and will subside in a few days – While some mood changes are common postpartum ("baby blues"), the intensity of these symptoms may indicate postpartum depression, which requires assessment.

D. Encourage the client to rest whenever the baby is sleeping to alleviate fatigue – While rest is important, it does not address the client's concerns about anxiety, irritability, and feelings of inadequacy, which may signal a mood disorder.

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Correct Answer is ["B","C"]

Explanation

A. Discontinue the oxytocin infusion The patient is not receiving an oxytocin infusion; therefore, discontinuing it is not applicable. Oxytocin is typically stopped in cases of uterine tachysystole or fetal distress, neither of which is present in this scenario. The fetal heart rate (FHR) is within normal range, and no contractions have been noted.

B. Notify the health care provider: The nurse should notify the healthcare provider because the patient is exhibiting severe hypertension (168/100 mmHg), minimal fetal heart rate variability, and laboratory findings consistent with preeclampsia with severe features (elevated liver enzymes, thrombocytopenia, and proteinuria).

C. Assist the patient onto her left side: Repositioning the patient onto her left side can improve uteroplacental blood flow by reducing pressure on the inferior vena cava, thereby enhancing oxygen delivery to the fetus.

D. Administer oxygen at 10L/min via nonrebreather face mask : Oxygen therapy is typically reserved for cases of acute fetal distress. In this case, the FHR is within the normal range, and there are no signs of immediate fetal compromise requiring supplemental oxygen.

E. Stop the magnesium sulfate: Magnesium sulfate is administered to prevent seizures in preeclampsia with severe features and should not be stopped unless there are signs of magnesium toxicity, such as absent deep tendon reflexes (DTRs), respiratory depression, or altered mental status.

F. Assist with a vaginal exam for cord prolapse: A vaginal examination for cord prolapse is only indicated when there is a sudden, severe fetal bradycardia or variable decelerations, particularly following rupture of membranes.

A. "It halts cervical dilation." B. "It increases the fetal heart rate." C. "It promotes fetal lung maturity." D. "It is used to stop preterm labor contractions."

Correct Answer is C

Explanation

A. "It halts cervical dilation."
This is incorrect because betamethasone does not stop cervical dilation or preterm labor. Medications like tocolytics (e.g., nifedipine, magnesium sulfate, terbutaline) are used to delay labor, while betamethasone is given to enhance fetal lung maturity.

B. "It increases the fetal heart rate."
This is incorrect because betamethasone does not directly increase fetal heart rate. While corticosteroids may cause temporary fetal tachycardia, their primary role is enhancing fetal lung development.

C. "It promotes fetal lung maturity."
This is correct because betamethasone is a corticosteroid given to promote the production of surfactant in the fetal lungs, reducing the risk of respiratory distress syndrome (RDS) in preterm infants. It is typically administered between 24 and 34 weeks of gestation in cases of anticipated preterm birth.

D. "It is used to stop preterm labor contractions."
This is incorrect because betamethasone does not stop contractions. Tocolytics like nifedipine, magnesium sulfate, and terbutaline are used for that purpose, whereas betamethasone is specifically for fetal lung development.

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A nurse is caring for a postpartum client who reports feeling anxious, irritable, and unable to sleep despite extreme fatigue. The client also expresses feelings of inadequacy as a mother. Which of the following nursing interventions is the most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) The nurse will implement the following interventions based on the fetal heart rate.(Select All that Apply.)

Correct Answer is ["B","C"]

Explanation

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

Correct Answer is C

Explanation

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