A nurse in a clinic is caring for a client who is 3 weeks postpartum following the birth of a healthy newborn.
The client reports feeling "down" and sad, having no energy, and wanting to cry.
Which of the following is a priority action by the nurse?.

Anticipate a prescription by the provider for an antidepressant.

Reinforce postpartum and newborn care discharge teaching.

Assist the family to identify prior use of positive coping skills in family crises.

Ask the client if she has considered harming herself or her newborn.

Answer and Explanation

The Correct Answer is D

The correct answer is choice D.

Choice A rationale:

While antidepressants can be an effective treatment for postpartum depression, it is not the priority action. The priority is to ensure the safety of the mother and the baby.

Choice B rationale:

Reinforcing postpartum and newborn care discharge teaching is important, but it is not the priority action when a client is showing signs of postpartum depression.

Choice C rationale:

Assisting the family to identify prior use of positive coping skills in family crises can be helpful, but it is not the priority action when a client is showing signs of postpartum depression.

Choice D rationale:

The priority action when a client is showing signs of postpartum depression is to assess for suicidal ideation or thoughts of harming herself or her baby. This is because postpartum depression can lead to thoughts of self-harm or harm to the baby, and immediate intervention is necessary to ensure the safety of both the mother and the baby.

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Correct Answer is A

Explanation

The correct answer is choice A.

Choice A rationale:

The GTPAL system stands for Gravida, Term, Preterm, Abortions, and Living children. In this case, the woman has been pregnant 4 times (Gravida 4), has had one term birth (Term 1), one preterm birth (Preterm 1), one abortion/miscarriage (Abortions 1), and one living child (Living 1). Therefore, the correct classification is 4, 1, 1, 1, 1.

Choice B rationale:

This choice incorrectly classifies the number of pregnancies (Gravida should be 4, not 3) and does not account for the preterm birth or the number of living children.

Choice C rationale:

This choice overcounts the number of term births and living children.

Choice D rationale:

This choice incorrectly classifies the number of pregnancies (Gravida should be 4, not 3) and overcounts the number of living children.

A. Superficial structures above the muscle. B. Through the anterior rectal wall. C. Through the anal sphincter muscle. D. Through the perineal muscles.

Correct Answer is D

Explanation

The correct answer is choice D.

Choice A rationale:

Superficial structures above the muscle refer to first-degree lacerations, which only involve the skin of the perineum and vaginal mucosa.

Choice B rationale:

A fourth-degree laceration does not stop at the anterior rectal wall. It extends through the anal sphincter and into the rectal mucosa.

Choice C rationale:

While a fourth-degree laceration does involve the anal sphincter muscle, it also includes the underlying rectal mucosa.

Choice D rationale:

A fourth-degree laceration involves the perineal muscles, the anal sphincter, and the underlying rectal mucosa.

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A nurse in a clinic is caring for a client who is 3 weeks postpartum following the birth of a healthy newborn.The client reports feeling "down" and sad, having no energy, and wanting to cry.Which of the following is a priority action by the nurse?.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant.This is her 4th pregnancy.She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.

Correct Answer is A

Explanation

When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a fourth-degree laceration.The nurse understands that the laceration extends to which area?.

Correct Answer is D

Explanation

Which documentation in the health record is most correct for the third stage of labor?

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A nurse in a clinic is caring for a client who is 3 weeks postpartum following the birth of a healthy newborn.
The client reports feeling "down" and sad, having no energy, and wanting to cry.
Which of the following is a priority action by the nurse?.