A nurse in a postpartum unit is caring for several clients. After receiving a change-of-shift report, which of the following clients should the nurse assess first?
A client who is 2 days postpartum and whose fundus is 2 fingerbreadths below the umbilicus
A client who is 1 day postpartum and has not voided in 8 hr
A client who is 3 days postpartum and has not had a bowel movement since prior to admission
A client who is 4 days postpartum and has lochia serosa
The Correct Answer is B
A. A fundal height of 2 fingerbreadths below the umbilicus in a client who is 2 days postpartum is within the expected range for that time frame and does not require immediate assessment.
B. A client who is 1 day postpartum and has not voided in 8 hours may be at risk for urinary retention, which can lead to complications such as bladder distension or urinary tract infection. Prompt assessment and intervention are needed.
C. Not having a bowel movement since prior to admission is not an urgent concern in the
immediate postpartum period, especially if the client is otherwise stable and not experiencing discomfort or other symptoms.
D. Lochia serosa, which is the normal vaginal discharge that occurs 3 to 10 days postpartum, is not an urgent concern and does not require immediate assessment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
- A: Garlic supplements are not contraindicated for clients taking antidepressants. While garlic is known to have a variety of health benefits, there is no well-documented interaction between garlic supplements and antidepressants that would contraindicate their concurrent use.
- B: There is no direct contraindication for the use of garlic supplements in clients with a history of seizure disorders. Garlic supplements do not have a seizure threshold-lowering effect, which is a common concern with some medications and conditions that may exacerbate seizure disorders.
- C: Garlic supplements may increase the risk of bleeding, especially when taken with other substances that have anticoagulant properties, such as aspirin. This is due to garlic's potential effect on platelet aggregation and the blood clotting process, making it a contraindication for clients who take aspirin daily.
- D: Garlic supplements do not have a contraindication for clients with a history of rheumatoid arthritis. In fact, some studies suggest that garlic may have anti-inflammatory properties, which could be beneficial for individuals with inflammatory conditions like rheumatoid arthritis.
Correct Answer is D
Explanation
A) The recommended hepatitis vaccine series is not a series of four but typically a three-dose series, which provides protection against hepatitis B.
B) Hepatitis B is not transmitted by contaminated food. It is spread through contact with infected blood, semen, or other body fluids.
C) While chronic hepatitis C has been associated with an increased risk of renal cell carcinoma, this is not established as a common outcome for all chronic hepatitis infections.
D) Individuals with a history of viral hepatitis, specifically hepatitis B or C, are generally ineligible to donate blood due to the risk of transmission.
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