The nurse is reviewing the charts of several clients as she prepares to go over discharge teaching. Which of the following clients does the nurse recognize as having an increased risk for a difficult or ineffective transition to motherhood?
A 29-year-old G3P3003 who had an uncomplicated SVD at term. Husband is at bedside. Older daughter is currently meeting her new sibling.
A 37-year-old G3P1112 with worsening preeclampsia who was induced at 34 weeks. She is currently on Magnesium Sulfate. Baby is in the NICU.
A 31-year-old G3P2012 who had an uncomplicated SVD. History of depression. Her husband is active-duty military and is currently deployed.
A 16-year-old G1P1001 who delivered via cesarean section.
A 20-year-old G1P1001 who had an unmedicated, uncomplicated spontaneous vaginal delivery (SVD) at term.
The Correct Answer is B
Choice A rationale
A 29-year-old G3P3003 with an uncomplicated SVD at term and a supportive family environment is less likely to experience difficulties in transitioning to motherhood. The presence of her husband and older daughter provides a strong support system, which is beneficial for her adjustment.
Choice B rationale
A 37-year-old G3P1112 with worsening preeclampsia, induced at 34 weeks, currently on Magnesium Sulfate, and with a baby in the NICU, faces multiple stressors. The medical complications, preterm delivery, and separation from her baby due to NICU admission increase her risk for a difficult transition to motherhood. The use of Magnesium Sulfate can also affect her physical and emotional well-being.
Choice C rationale
A 31-year-old G3P2012 with a history of depression and a husband who is deployed faces significant challenges. The history of depression increases her risk for postpartum depression, and the absence of her husband can lead to feelings of isolation and increased stress.
Choice D rationale
A 16-year-old G1P1001 who delivered via cesarean section is at risk due to her young age and the surgical delivery. Adolescents may have less experience and resources to cope with the demands of motherhood, and the recovery from a cesarean section can add to the physical and emotional challenges.
Choice E rationale
A 20-year-old G1P1001 with an uncomplicated SVD and the presence of her boyfriend is less likely to face significant difficulties. The uncomplicated delivery and the support of her boyfriend provide a stable environment for her transition to motherhood. .
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Correct Answer is C
Explanation
Choice A rationale
Long-acting reversible contraceptives, like an intrauterine device (IUD), are highly effective in preventing pregnancy. This statement is accurate and does not indicate a need for additional education.
Choice B rationale
Breastfeeding is not a form of contraception. This statement is correct as breastfeeding alone is not a reliable method of preventing pregnancy.
Choice C rationale
The statement “I will begin to use a barrier method after I start my first menstrual cycle” indicates a need for additional education. Ovulation can occur before the first postpartum menstrual cycle, so contraception should be used as soon as sexual activity resumes.
Choice D rationale
The withdrawal method is not very effective at avoiding pregnancy. This statement is accurate and does not indicate a need for additional education.
Correct Answer is D
Explanation
Choice A rationale
Changing the dressing on a cesarean incision for a patient who is 1 day post-op requires sterile technique and assessment skills, which are beyond the scope of practice for assistive personnel (AP). This task should be performed by a licensed nurse.
Choice B rationale
Documenting the lochia amount on the perineal pad of a client who just transferred from labor and delivery involves assessment and documentation, which are nursing responsibilities. This task should not be delegated to AP.
Choice C rationale
Assessing an area of redness on the breast of a client who is 4 days postpartum requires clinical judgment and assessment skills, which are within the scope of practice for a licensed nurse. This task should not be delegated to AP.
Choice D rationale
Providing a sitz bath to a client who has a third-degree laceration and is 2 days postpartum is an appropriate task for AP. It is a comfort measure that does not require clinical judgment or assessment skills, making it suitable for delegation to AP.