A nurse is caring for a patient with a chest tube connected to wall suction due to a right-sided pneumothorax. The patient reports a sensation of chest burning.
What should the nurse do next?

Choice A rationale

The shoulder is not the correct fetal presentation in this case. The shoulder presentation, also known as a transverse lie, occurs when the fetus is positioned horizontally in the uterus, and the shoulder is the presenting part. This is not the case in an RSA (Right Sacrum Anterior) position, which indicates a breech presentation.

Choice B rationale

The vertex presentation, also known as a cephalic presentation, occurs when the fetus is positioned head down in the uterus. However, in an RSA position, the fetus is in a breech presentation, not a vertex presentation.

Choice C rationale

The mentum (face) presentation is a rare type of fetal presentation where the neck of the fetus is hyperextended, and the face presents at the cervix. This is not the case in an RSA position, which indicates a breech presentation.

Choice D rationale

In an RSA (Right Sacrum Anterior) position, the fetus is in a breech presentation. This means that the buttocks or feet of the fetus are positioned to enter the birth canal first. Therefore, the nurse should document a breech presentation in the patient’s medical record.

Choice A rationale

The statement “Do you think you could keep him in the nursery for the next feeding so I can get some sleep?” indicates that the mother may be experiencing inhibited parental attachment.

After childbirth, it is normal for a new mother to feel tired and need rest. However, consistently preferring to have the baby cared for in the nursery rather than spending time bonding may suggest inhibited parental attachment.

Choice B rationale

The statement “I don’t need a baby bath demonstration. I know how to do it.”. suggests that the mother is confident in her ability to care for her baby, which is a positive sign of parental attachment. It shows that she is prepared and willing to take on the responsibilities of parenthood.

Choice C rationale

The statement “I wish he had more hair. I will keep a hat on his head until he grows some.”. may indicate a slight disappointment in the baby’s appearance but does not necessarily indicate inhibited parental attachment. It’s common for parents to have certain expectations or hopes about their baby’s appearance.

Choice D rationale

The statement “He’s got my husband’s nose, that’s for sure.”. indicates that the mother is observing and commenting on the baby’s features, which is a positive sign of parental

attachment. Recognizing familial features helps in bonding and forming an attachment with the baby.