A client who delivered vaginally 18-hours ago develops a slight fever. The delivery record shows spontaneous rupture of membranes (SROM) for 36 hours prior to delivery and labor lasting 24 hours. An epidural was placed during labor, and the client experienced a third-degree perineal laceration.
The practical nurse (PN) should recognize which information poses the greatest risk for developing postpartum endometritis?
Epidural anesthesia.
SROM for 36 hours.
Third-degree perineal laceration.
Labor lasting for 24 hours.
The Correct Answer is B
The information that poses the greatest risk for developing postpartum endometritis in this situation is that the client experienced spontaneous rupture of membranes (SROM) for 36 hours prior to delivery. SROM for an extended period of time increases the risk of infection, including postpartum endometritis, which is an infection of the uterus. The practical nurse (PN) should recognize this risk factor and monitor the client closely for signs of infection. The other information listed may also be important to consider, but SROM for 36 hours poses the greatest risk for developing postpartum endometritis in this situation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This could indicate reduced blood flow to the affected arm, which may be a sign of compartment syndrome. Compartment syndrome is a serious condition that requires immediate intervention by a registered nurse (RN). The other options may also require intervention, but they are not as urgent as the situation described in option B.
Correct Answer is B
Explanation
This finding may indicate a potential cardiac issue that needs immediate medical atention. Projectile vomiting and excessive hunger in a young infant may be signs of pyloric stenosis, a condition in which the muscle between the stomach and small intestine thickens, making it difficult for food to pass through.
Hyperactive gastric sounds may be present with vomiting, but it is not an immediate concern.
Crying without tears may be a sign of dehydration, but it is not an immediate concern.
Underweight for age is a concern but it is not a finding that requires immediate intervention.
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