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A nurse is caring for a client who is 1 hr postpartum.

 

Exhibits

For each assessment finding, click to specify if the finding indicates the client's condition has improved or remains unchanged. There must be at least 1 selection in every row. There does not need to be a selection in every column.

A.

Blood pressure

B.

Skin temperature

C.

Fundal assessment

D.

Bleeding

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"}}

  • Blood pressure: At 2100, the client’s BP was 90/56 mm Hg, indicating hypotension likely from postpartum hemorrhage. By 2115, BP increased to 108/72 mm Hg, showing improved hemodynamic stability after interventions such as fundal massage, oxytocin administration, and bladder emptying.
  • Skin temperature: At both 2100 and 2115, the client’s skin remained cool to the touch. This could indicate ongoing peripheral vasoconstriction or residual hypoperfusion, suggesting that although circulation improved, thermoregulation and peripheral perfusion have not fully normalized.
  • Fundal assessment: Initially, the fundus was boggy, deviated to the right, and 2 cm above the umbilicus, indicating uterine atony worsened by bladder distention. After catheterization and uterotonic therapy, the fundus became midline, firm, and at the level of the umbilicus, which is expected postpartum and reduces bleeding risk.
  • Bleeding: At 2100, there was heavy lochia rubra saturating a perineal pad in 20 min with passage of a large clot. At 2115, bleeding decreased to a moderate amount of lochia rubra with a few pea-sized clots, indicating that hemorrhage control measures were effective.


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Related Questions

Correct Answer is C

Explanation

A. Atrial fibrillation: This dysrhythmia is characterized by an irregularly irregular rhythm with absent or unidentifiable P waves, not a prolonged constant P-R interval.

B. Premature atrial complexes: PACs involve early P waves that may have a normal or slightly different P-R interval, but they do not cause a consistently prolonged P-R interval across all beats.

C. First-degree atrioventricular block: A constant P-R interval greater than 0.20 seconds indicates a first-degree AV block. The atrial impulses are delayed at the AV node, but all impulses are conducted to the ventricles, producing a regular rhythm with prolonged P-R intervals.

D. Complete heart block: In complete heart block (third-degree AV block), there is no relationship between P waves and QRS complexes. The P-R interval is variable, unlike the constant prolongation seen in first-degree AV block.

Correct Answer is C

Explanation

Rationale:

A. Current fecal impaction: While fecal impaction requires treatment, it is not related to the safety or pharmacologic effects of conjugated estrogen therapy and does not constitute a contraindication.

B. Present report of abdominal pain: Abdominal pain requires evaluation, but it is nonspecific and not an absolute contraindication to conjugated estrogen unless related to certain underlying conditions like liver disease or cancer.

C. Thrombophlebitis: Estrogen increases the risk of thromboembolic events by promoting clot formation. A history or presence of thrombophlebitis makes estrogen therapy unsafe due to the elevated risk of worsening venous thromboembolism.

D. Diverticulitis: Diverticulitis is an inflammatory bowel condition that is not directly affected by estrogen therapy. It would not typically prohibit the use of conjugated estrogen unless complications or comorbidities present additional risks.

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