The nurse is caring for a client whose fetus died in utero at 32-weeks gestation. After the fetus is delivered vaginally, the nurse implements routine fetal demise protocol and identification procedures Which action is most important for the nurse to take?

Explain reasons consent for an infant autopsy is needed

Determine if the mother desires a visit from her clergy

Encourage the mother to hold and spend time with her baby

Create a memory box of baby's footprints and photographs

Answer and Explanation

The Correct Answer is C

Explain reasons consent for an infant autopsy is needed:
Autopsy might be necessary for understanding the cause of fetal demise, providing answers to the parents, and helping future pregnancies. However, it's not the most immediate or essential action in this scenario.

Determine if the mother desires a visit from her clergy:
Spiritual and emotional support is crucial during this distressing time. While clergy support is valuable, it's not the most urgent action needed immediately after delivery.

Encourage the mother to hold and spend time with her baby:
This is a crucial part of the grieving process and helps in acknowledging and creating memories with the baby. It's an essential step in providing emotional support to the mother.

Create a memory box of baby's footprints and photographs:
This is also a critical step in assisting the parents with the grieving process. It helps in cherishing the memories and creating keepsakes that may provide comfort in the future.

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Correct Answer is C

Explanation

A. Schedule an appointment for the client with the diabetic nurse educator:
This could be a helpful action. The diabetic nurse educator can provide valuable support and education on managing insulin needs during breastfeeding.

B. Counsel her to increase her caloric intake:
While adequate nutrition is essential, increasing caloric intake may not be the primary factor affecting insulin needs. It's important to consider the specific needs of the client, and any adjustments to insulin should be made based on careful monitoring.

C. Inform her that a decreased need for insulin occurs while breastfeeding:
This is accurate information. Breastfeeding can lead to a decreased need for insulin in some individuals. The nurse should provide education on this aspect of managing diabetes during breastfeeding.

D. Advise the client to breastfeed more frequently:
While breastfeeding frequency can impact insulin needs, it's essential to consider the overall picture. Simply increasing breastfeeding frequency may not be the only factor affecting insulin requirements.

A. Review the fetal heart rate pattern B. Check the pH of the vaginal fluid C. Determine cervical dilation. D. Palpate the client's bladder

Correct Answer is D

Explanation

A. Review the fetal heart rate pattern: Checking the fetal heart rate (FHR) pattern is crucial during labor to ensure the baby is tolerating labor well and there are no signs of fetal distress. However, when the client expresses a need to use the bathroom, this may not be the immediate action required.

B. Check the pH of the vaginal fluid: Checking the pH of the vaginal fluid is not typically an initial action when a laboring client expresses a need to go to the bathroom. Monitoring the pH may be relevant for various reasons, but it's not a primary consideration in this context.

C. Determine cervical dilation: The initial examination revealed the cervix was 3 cm dilated. While reassessing the cervical dilation could provide information about the progress of labor, it may not be the most immediate action needed when the client wants to use the bathroom.

D. Palpate the client's bladder: This is the most relevant action when a laboring client expresses a desire to go to the bathroom. Palpating the bladder can help determine if it's full, which is important because a full bladder might impede labor progress or cause discomfort during contractions.

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The nurse is caring for a client whose fetus died in utero at 32-weeks gestation. After the fetus is delivered vaginally, the nurse implements routine fetal demise protocol and identification procedures Which action is most important for the nurse to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A new mother who is breastfeeding her 4-week-old infant and has type 1 diabetes, reports that her insulin needs have decreased since the birth of her child. Which action should the nurse implement?

Correct Answer is C

Explanation

The nurse examines a client who is admitted in active labor and determines the cervix is 3 cm dilated 50% effaced, and the presenting part is at 0 station. An hour later. she tells the nurse that she wants to go to the bathroom. Which action should the nurse implement first?

Correct Answer is D

Explanation

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