A nurse is assessing a client who is 6 hours postpartum and has endometritis. Which of the following findings should the nurse expect?
Temperature 37.4°C (99.3°F)
Scant lochia
Uterine tenderness
WBC count 9,000/mm³
The Correct Answer is C
Endometritis is an infection of the endometrium, the lining of the uterus, typically occurring after childbirth. When assessing a client with endometritis, the nurse should expect to find uterine tenderness as a common clinical finding. This finding is consistent with endometritis, which is characterized by inflammation and infection of the endometrium. Additional signs and symptoms may include an elevated temperature, increased lochia, foul-smelling lochia, and an elevated WBC count. Prompt identification and treatment of endometritis are important to prevent further complications.
Option a) A temperature of 37.4°C (99.3°F) is within the normal range and does not necessarily indicate endometritis. However, an elevated temperature above 38°C (100.4°F) or a persistent fever may be indicative of an infection and should be further evaluated.
Option b) Scant lochia (minimal vaginal bleeding) is not a characteristic finding of endometritis. In endometritis, lochia is often increased in amount and may have an unpleasant odor.
Option d) A white blood cell (WBC) count of 9,000/mm³ is within the normal range. However, in cases of endometritis, there is usually an elevation in the WBC count as a response to the infection. An elevated or increasing WBC count may be observed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Uterine atony is a condition in which the uterus does not contract properly after delivery, leading to excessive bleeding or postpartum hemorrhage. Uterine atony can be caused by various factors, such as
prolonged or fast labor, multiple gestation, large baby, polyhydramnios, infection, or use of certain medications¹.
The nurse should monitor the client for any signs of uterine atony, such as:
- A soft or boggy uterus that does not respond to massage
- Excessive bleeding or clots from the vagina
- Low blood pressure or fast pulse
- Pale or clammy skin
- Dizziness or fainting
The nurse should also provide immediate interventions to stop the bleeding and restore uterine tone, such
as:
- Massaging the uterus firmly until it contracts
- Administering uterotonic medications as ordered to stimulate uterine contractions
- Administering intravenous fluids and blood products as needed to replace blood loss
- Notifying the provider and preparing for possible surgical procedures if bleeding persists
Uterotonic medications are drugs that cause the uterus to contract and reduce bleeding. They are used to prevent or treat postpartum hemorrhage due to uterine atony. The most common uterotonic medications are:
- Oxytocin: a hormone that is naturally produced by the body during labor and breastfeeding. It is the first- line drug for uterine atony and is given intravenously or intramuscularly. It causes strong and sustained contractions of the uterus and also reduces blood pressure and pain. It has few side effects, but it can cause water retention, nausea, vomiting, or headache in high doses²³.
- Methylergonovine: a synthetic derivative of ergot, a fungus that grows on rye. It is a second-line drug for uterine atony and is given intramuscularly or orally. It causes prolonged contractions of the uterus and also constricts blood vessels in other parts of the body. It can cause side effects such as hypertension, headache, nausea, vomiting, chest pain, or allergic reactions. It is contraindicated in clients with hypertension, preeclampsia, cardiac disease, or liver disease²³.
- Carboprost: a synthetic form of prostaglandin F2 alpha, a hormone that regulates inflammation and blood clotting. It is a third-line drug for uterine atony and is given intramuscularly. It causes intense contractions of the uterus and also relaxes smooth muscles in other parts of the body. It can cause side effects such as fever, diarrhea, nausea, vomiting, bronchospasm, or allergic reactions. It is contraindicated in clients with asthma, liver disease, or kidney disease²³.
- Misoprostol: a synthetic form of prostaglandin E1, a hormone that protects the stomach lining from ulcers. It is an alternative drug for uterine atony and is given orally, rectally, sublingually, or vaginally. It causes mild to moderate contractions of the uterus and also dilates blood vessels in other parts of the body. It can cause side effects such as fever, chills, shivering, nausea, vomiting, diarrhea, or abdominal pain. It is contraindicated in clients with allergy to prostaglandins²³.
Therefore, the nurse should anticipate the use of methylergonovine for a client who has uterine atony that does not respond to oxytocin administration. The nurse should also monitor the client's blood pressure and vital signs closely and report any adverse reactions to the provider.
The other options are not medications that the nurse should anticipate the use of for uterine atony:
- a) Terbutaline is a medication that belongs to a class of drugs called beta-adrenergic agonists. It is used to relax the smooth muscles of the bronchi and uterus. It is used to treat asthma and preterm labor by preventing or stopping contractions. It is not indicated for uterine atony and can cause side effects such as tachycardia, palpitations, tremors, anxiety or hypotension²⁴.
- c) Hydralazine is a medication that belongs to a class of drugs called vasodilators. It is used to lower blood pressure by relaxing the smooth muscles of the arteries. It is used to treat hypertension and preeclampsia by reducing vascular resistance and improving blood flow. It is not indicated
Correct Answer is D
Explanation
In a newborn, bluish discoloration of the hands and feet may indicate a condition called peripheral cyanosis, which suggests poor oxygenation. It is important to report this finding to the healthcare provider promptly, as it may indicate a respiratory or circulatory problem that requires immediate attention.
Option a) Overlapping of the cranial bones is a common finding in newborns due to the molding of the head during delivery. This is not a priority finding to report unless there are other signs of concern, such as abnormal head shape or signs of trauma.
Option b) Small, distended white sebaceous glands on the face are called milia and are a normal finding in newborns. They are not a priority finding to report and typically resolve on their own within a few weeks.
Option c) Forward and lateral positioning of the ears is a normal finding in a newborn and is not a priority to report. The ears may appear folded or positioned differently due to the pressure and positioning in the womb.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today