A nurse in a provider's office is reinforcing teaching about home care with a client who has mild preeclampsia. Which of the following information should the nurse include in the teaching?
Perform daily fetal movement counts.
Limit fluid intake to 1,000 mL/day.
Limit sodium intake to 2,000 mg/day.
Rest in bed in the supine position.
The Correct Answer is A
Choice A rationale:
The nurse should include teaching the client to perform daily fetal movement counts because it is an essential aspect of monitoring the baby's well-being and assessing fetal distress. Fetal movement counts help the client become familiar with their baby's normal patterns of movement, allowing them to detect any changes or decreased movements promptly. This can be crucial in identifying potential issues with the baby's health and seeking timely medical attention.
Choice B rationale:
The nurse should not advise limiting fluid intake to 1,000 mL/day for a client with mild preeclampsia. Adequate hydration is important during pregnancy, and excessive fluid restriction can lead to dehydration, which is harmful to both the mother and the baby. Preeclampsia can cause fluid retention and high blood pressure, but complete fluid restriction is not the appropriate approach for managing the condition.
Choice C rationale:
The nurse should not suggest limiting sodium intake to 2,000 mg/day for a client with mild preeclampsia. While reducing sodium intake can be beneficial for some individuals with hypertension, it is not the primary focus in managing mild preeclampsia. The mainstay of treatment for mild preeclampsia typically involves close monitoring, rest, and potential medications to control blood pressure if necessary.
Choice D rationale:
The nurse should not recommend that the client rest in bed in the supine position. During pregnancy, especially with preeclampsia, lying flat on the back (supine position) can lead to a condition called supine hypotensive syndrome. This occurs when the weight of the uterus presses on the vena cava, reducing blood flow back to the heart and potentially causing a drop in blood pressure and decreased blood flow to the baby.
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Correct Answer is D
Explanation
Choice A rationale:
Vaginal hematoma is not the most significant risk in the 4th stage of labor. While vaginal hematomas can occur due to trauma during delivery, they are less common and usually manageable compared to other complications.
Choice B rationale:
Hypoglycemia is not a typical complication in the 4th stage of labor. This stage refers to the immediate postpartum period, during which the mother's blood sugar levels may decrease slightly, but it is not the greatest concern at this stage.
Choice C rationale:
Chorioamnionitis is an infection of the fetal membranes and amniotic fluid. While it can be a concern during labor, the question specifically refers to the 4th stage, which occurs after the delivery of the placenta. Chorioamnionitis is more relevant to earlier stages of labor.
Choice D rationale:
Uterine hemorrhage is the greatest risk during the 4th stage of labor. This stage, also known as the "placental stage,”. is when the uterus contracts to expel the placenta. If the uterus fails to contract adequately, it can lead to significant bleeding, known as postpartum hemorrhage. This is a critical concern that requires immediate attention to prevent complications.
Choice E rationale:
Dehiscence, which refers to the reopening of a surgical wound, is not a common complication during the 4th stage of labor. The 4th stage primarily focuses on uterine contraction and placental delivery, making dehiscence less relevant in this context.
Correct Answer is A
Explanation
Choice A rationale:
The nurse should recommend the client to increase cellulose and fluid in the diet. Cellulose is a type of fiber found in fruits, vegetables, and whole grains. Increasing fiber intake can help alleviate constipation by adding bulk to the stool and promoting regular bowel movements. Additionally, the recommendation to increase fluid intake complements the effect of fiber, as it softens the stool, making it easier to pass through the intestines. This combination of increased cellulose and fluid intake is a safe and natural way to address constipation during pregnancy without the need for medication or invasive interventions.
Choice B rationale:
Regular use of glycerine suppositories is not the best recommendation for pregnant clients experiencing constipation. Suppositories are inserted into the rectum to stimulate bowel movements and should only be used sparingly when other methods have failed. Pregnant individuals may have increased sensitivity, and it's essential to avoid unnecessary procedures or potential discomfort.
Choice C rationale:
Regular use of a laxative is also not the most suitable recommendation for a pregnant client with constipation. While laxatives can provide relief, they may lead to dependency and might have adverse effects on the developing fetus. It is best to explore safer and more natural methods before resorting to laxative use during pregnancy.
Choice D rationale:
Maintenance of good posture is essential during pregnancy for various rationales, but it is not a specific solution for constipation. While maintaining good posture can help alleviate back pain and other discomforts, it does not directly address the issue of constipation.
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