The nurse is assessing a new mother at a health care facility.
Which symptom would the nurse identify as a symptom of postpartum blues?

Choice A rationale

Preparing for an immediate cesarean birth is not the initial priority; assessment is needed first to confirm the diagnosis, determine the degree of placental involvement, and evaluate maternal-fetal status. A cesarean birth is indicated only if bleeding is heavy or the fetus is distressed, not automatically upon admission.

Choice B rationale

A vaginal examination is strictly contraindicated as a priority action when painless, bright red vaginal bleeding occurs late in the second trimester, as this is the classic sign of placenta previa. Such an examination could cause a catastrophic hemorrhage by disturbing the placental site.

Choice C rationale

An ultrasound assessment is the priority to non-invasively confirm the diagnosis of placenta previa, determine the precise placental location relative to the cervical os, and assess fetal well-being, including estimated weight and amniotic fluid volume. This diagnostic step guides all subsequent safe management decisions.

Choice D rationale

Assessment of uterine contractions using an Intrauterine Pressure Catheter (IUPC) is an invasive procedure requiring ruptured membranes, which is not indicated upon admission for suspected placenta previa. External tocodynamometry is used for contraction monitoring, and the IUPC is reserved for specific labor management situations.

Choice A rationale

Placing the client in a prone position (on the abdomen) is generally contraindicated during labor, especially with an occupied uterus, as it places pressure on the gravid abdomen and can compromise fetal circulation or cause discomfort. Instead, positions that encourage pelvic rocking or shifting the baby's position, like hands-and-knees, are preferred to rotate the occiput posterior fetus.

Choice B rationale

The intense, poorly localized back pain associated with occiput posterior (OP) position is caused by the fetal head's occiput pressing directly against the maternal sacrum during contractions. Ice packs provide superficial vasoconstriction and temporary local analgesia, which is less effective than heat or deep pressure for the deep, visceral pain originating from this internal pressure point.

Choice C rationale

Massage (often counterpressure) applied directly to the lower back (sacral area) is the most effective non-pharmacological intervention for the pain of an OP position. The firm, consistent pressure helps to splint the sacrum, counteracting the intense pressure exerted by the fetal occiput during a contraction, thereby significantly reducing the client's discomfort through a mechanical mechanism.

Choice D rationale

The Trendelenburg position involves placing the head lower than the feet and is not typically used to alleviate back pain in labor or facilitate fetal rotation. This position increases intracranial pressure and can be uncomfortable. Positions that elevate the hips, such as hands-and-knees or forward-leaning, are more effective at encouraging the fetal occiput to rotate anteriorly and move off the sacrum.