A nurse is caring for a client following a vaginal delivery of a term fetal demise. Which of the following statements should the nurse make?
"You should name the baby so she can have an identity.”
"If you don't hold the baby, it will make letting go much harder.”
"I'm sure you will be able to have another baby when you're ready.”
"You can bathe and dress your baby if you'd like to.”
The Correct Answer is D
A nurse caring for a client following a vaginal delivery of a term fetal demise should offer the client the option to bathe and dress their baby if they would like to.
Choice A is incorrect because it is not appropriate for the nurse to suggest that the client should name the baby.
Choice B is incorrect because it is not appropriate for the nurse to suggest that not holding the baby will make letting go much harder.
Choice C is incorrect because it is not appropriate for the nurse to make assumptions about future pregnancies.
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Related Questions
Correct Answer is C
Explanation
Rationales
A. Rust-stained urine.
Rust or brick-dust staining in the diaper is usually caused by urate crystals in the urine. This is a common and benign finding in newborns during the first days of life, particularly when fluid intake is still low. It does not require provider notification unless it persists beyond the first week or is accompanied by other abnormalities.
B. Subconjunctival hemorrhage.
A subconjunctival hemorrhage often results from pressure during delivery, especially in vaginal births. It appears as a bright red patch on the sclera but is harmless and resolves spontaneously within several weeks. It is considered a normal newborn finding and does not need to be reported.
C. Single palmar creases.
A single transverse palmar crease, also known as a simian crease, can be associated with chromosomal abnormalities such as Down syndrome. While it may sometimes be an isolated normal variant, its presence warrants further evaluation. The nurse should report this finding to the provider for assessment and potential genetic follow-up.
D. Transient circumoral cyanosis.
Brief bluish discoloration around the lips in a newborn is typically due to vasomotor instability and is common when the infant is crying or cold. As long as the central mucous membranes remain pink and oxygenation is normal, this finding is not concerning and usually resolves without intervention.
Correct Answer is A
Explanation
A. The nurse should monitor for chorioamnionitis, which is an infection of the amniotic sac and fluid.
The other choices are not potential complications of gonorrhea:
B. Vaginal laceration during birth is not a complication of gonorrhea.
C. Oligohydramnios is not a complication of gonorrhea.
D. Excessive bleeding after birth is not a complication of gonorrhea.
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