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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice B.
Choice A rationale:
Vitamin K is given to newborns to prevent bleeding disorders, not eye conditions.
Choice B rationale:
Erythromycin ophthalmic ointment is commonly used for prophylaxis of neonatal conjunctivitis (pink eye) caused by Neisseria gonorrhoeae and Chlamydia trachomatis.
Choice C rationale:
Gentamicin ophthalmic ointment can be used to treat bacterial infections of the eye, but it is not typically used for prophylaxis of neonatal eye conditions.
Choice D rationale:
Silver nitrate solution was once used for prophylaxis of neonatal eye conditions, but it is no longer commonly used due to the risk of chemical conjunctivitis.
Correct Answer is D
Explanation
The correct answer is choice D.
Choice A rationale:
Cervix dilation of 5 cm with 50% effacement is a sign of active phase of the first stage of labor, not the end of it.
Choice B rationale:
Rupturing of fetal membranes can occur at any time during labor, not specifically at the end of the first stage.
Choice C rationale:
Start of regular contractions is a sign of the onset of labor, not the end of the first stage.
Choice D rationale:
Cervix dilation of 10 cm with 100% effacement indicates the end of the first stage of labor and the beginning of the second stage.
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