35-year-old postpartum client.

Select the condition, risk factors and assessment findings that the client may be experiencing.

Answer and Explanation

The Correct Answer is []

Condition: Postpartum Hemorrhage (PPH)

Postpartum hemorrhage is defined as blood loss ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean delivery. In this case, the client has heavy bleeding, large clots, and lightheadedness, which are key indicators of excessive postpartum blood loss.

Risk Factors

1. Fetal Macrosomia: The baby weighs 9 lbs 4 oz (4196 grams), which is considered macrosomia (birth weight > 4000 g). Large fetal size increases the risk of uterine overdistension, which can impair uterine contractions and lead to uterine atony, the most common cause of postpartum hemorrhage.

2. Uterine Atony: The nurse initially noted a boggy uterus that required massage to become firm. Uterine atony occurs when the uterus fails to contract effectively after delivery, leading to excessive bleeding. This is the leading cause of PPH.

3. Prolonged Labor: A prolonged labor can cause uterine fatigue, reducing the uterus's ability to contract properly after delivery, thereby increasing the risk of uterine atony and PPH.

Assessment Findings

1. Heavy vaginal bleeding: The client has heavy bleeding with three quarter-sized clots, which is abnormal postpartum and indicates excessive blood loss.

2. Blood pressure: The client’s BP is 150/86 mmHg, which may indicate compensatory vasoconstriction due to ongoing blood loss. If hemorrhage continues, hypotension may develop.

3. Urine output: The client did not feel the urge to void, and catheterization drained 450 mL of urine. A full bladder can prevent proper uterine contraction, worsening uterine atony and bleeding.

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Free Nursing Study Resources

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Preeclampsia:

Blood pressure of 150/96 mmHg: A BP of ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive client is diagnostic of preeclampsia.

Preeclampsia with Severe Features:

Blood pressure of 162/112 mmHg: Severe hypertension is ≥160/110 mmHg on two occasions at least 4 hours apart. This is a criterion for severe preeclampsia, requiring immediate intervention to prevent complications like eclampsia or stroke.

Elevated liver enzymes (ALT/AST > 2x the upper limit of normal) are indicative of severe preeclampsia due to hepatic involvement. This can progress to HELLP syndrome, increasing the risk of liver rupture and disseminated intravascular coagulation (DIC).

Neither:

Negative for protein on a urine dipstick: Preeclampsia is typically diagnosed with proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3). A negative urine dipstick means proteinuria is absent, making preeclampsia unlikely. However, preeclampsia can also be diagnosed without proteinuria if other systemic features (e.g., thrombocytopenia, renal dysfunction) are present.

Seizures in a client with preeclampsia indicate eclampsia, which is a medical emergency requiring magnesium sulfate to prevent further seizures. If the client had no preeclampsia, the seizures could be due to another cause (e.g., epilepsy, metabolic disturbance).

Correct Answer is []

Explanation

A. Assessment Cues

Unprotected Sexual Activity increases the risk of sexually transmitted infections (STIs). The client has had multiple sexual partners in the past month without protection, making her susceptible to infections such as trichomoniasis, gonorrhea, chlamydia, and bacterial vaginosis. This is a significant risk factor for her symptoms.
Foul-smelling discharge is a common symptom of trichomoniasis, bacterial vaginosis, and other vaginal infections. UTIs primarily cause dysuria, frequency, urgency, and suprapubic pain, not vaginal symptoms. Since the urinalysis does not show leukocytes, nitrates, or bacteria, a UTI is unlikely.

B. Condition – Trichomoniasis

The client's symptoms—green-yellow vaginal discharge, vaginal itching, and foul-smelling odor—are classic signs of trichomoniasis, a sexually transmitted infection caused by Trichomonas vaginalis. The disease is associated with malodorous discharge, vaginal irritation, and possible dysuria.

C. Anticipated Solutions

Oral Metronidazole: The first-line treatment for trichomoniasis is oral metronidazole (Flagyl) 2g as a single dose or 500mg twice daily for 7 days. Metronidazole effectively eliminates the infection. Patients must be educated to avoid alcohol while taking metronidazole due to the risk of a disulfiram-like reaction (severe nausea and vomiting).
Safe sexual behaviors, such as consistent condom use, regular STI screening, mutual monogamy, and open communication about sexual history, are essential for reducing the risk of sexually transmitted infections (STIs), including trichomoniasis.

Incorrect answers:

Human Papillomavirus (HPV): HPV causes genital warts and increases the risk of cervical cancer, but it does not typically cause vaginal discharge, itching, or foul odor. Therefore, HPV is not the most likely condition in this case.

Depression: While multiple sexual partners and STI diagnoses can cause emotional distress, depression is not directly relevant to her current presentation. However, mental health screening may be beneficial if she expresses concerns about her emotional well-being.

Herpes simplex virus (HSV) is a sexually transmitted infection (STI) that can cause genital ulcers, pain, and discomfort. However, based on the client’s symptoms, HSV is not the most likely diagnosis.

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35-year-old postpartum client. Select the condition, risk factors and assessment findings that the client may be experiencing.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) As the nurse, you can identify whether the following findings are indicative of preeclampsia, preeclampsia with severe features, or neither. Select at least one answer in each row.

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Exhibits Select a condition, the assessment cues, and anticipated solutions for this client.

Correct Answer is []

Explanation

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35-year-old postpartum client. Select the condition, risk factors and assessment findings that the client may be experiencing.

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) Complete the following sentence using the drop-down options. The nurse's greatest concern is the client's risk of developing __i_____ and related to __ii____ and ___iii____.

35-year-old postpartum client.

Select the condition, risk factors and assessment findings that the client may be experiencing.