A nurse is caring for a client who is 12 hours postpartum and has a fourth-degree laceration of the perineum. The nurse should take which of the following actions?
Provide the client with a cool sitz bath.
Administer methylergonovine 0.2 mg IM.
Apply povidone-iodine to the client's perineum after she voids.
Apply a moist, warm compress to the perineum.
The Correct Answer is D
A fourth-degree laceration involves a tear that extends through the perineal muscles and extends to the anal sphincter. This type of laceration requires careful management to promote healing and prevent infection. Applying a moist, warm compress to the perineum helps to promote blood flow, reduce swelling, and provide comfort to the client.
Option a) Providing the client with a cool sitz bath is not appropriate for a fourth-degree laceration. Cool sitz baths are typically used for relieving discomfort and reducing swelling in cases of perineal trauma, but in the case of a fourth-degree laceration, warm compresses are preferred.
Option b) Administering methylergonovine 0.2 mg IM is not necessary for a fourth-degree laceration. Methylergonovine is a medication used to promote uterine contractions and prevent postpartum hemorrhage. However, it is not specifically indicated for the management of perineal lacerations.
Option c) Applying povidone-iodine to the client's perineum after she voids is not recommended for a fourth-degree laceration. Povidone-iodine is an antiseptic solution used to disinfect the skin. However, it is not typically used on open wounds, such as perineal lacerations, as it may delay wound healing.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A postpartum client who has type 1 diabetes mellitus and is breastfeeding her newborn should maintain
scheduled mealtimes for herself to prevent hypoglycemia and ensure adequate milk production¹. Breastfeeding may lower glucose levels in the parent and the risk of type 1 and type 2 diabetes in the child¹. Breastfeeding may also help the parent lose weight, prevent diabetes-related complications, and reduce the chances of some cancers¹.
The other options are incorrect because:
a) Taking more insulin with each meal than you did prior to pregnancy may cause hypoglycemia, especially if you are breastfeeding. You should adjust your insulin doses according to your blood glucose levels and carbohydrate intake, and consult your doctor or diabetes educator for guidance²³.
b) Checking your blood glucose levels every 8 hours is not frequent enough to monitor your diabetes during breastfeeding. You should check your blood glucose levels before and after each breastfeeding session, as well as before meals and snacks, at bedtime, and during the night if needed²³.
c) Limiting your carbohydrate intake to 30 grams per day is too restrictive and may impair your milk production and quality, as well as cause hypoglycemia or ketoacidosis. You should consume adequate carbohydrates from healthy sources, such as whole grains, fruits, vegetables, legumes, and dairy products, to meet your energy and nutritional needs²³.
Correct Answer is A
Explanation
Hemolytic disease of the newborn (HDN) is a condition that occurs when there is an incompatibility between the blood types of the mother and the baby. It causes the mother's immune system to produce antibodies that attack and destroy the baby's red blood cells, leading to anemia, jaundice, organ enlargement, and other complications¹.
One of the most common causes of HDN is Rh incompatibility. This happens when the mother is Rh negative and the baby is Rh positive. The Rh factor is a protein that can be present or absent on the surface of red blood cells. People who have the protein are Rh positive and people who do not have it are Rh negative
Rh incompatibility can cause HDN when the baby's Rh positive blood cells cross the placenta and enter the mother's bloodstream. This can happen during delivery, miscarriage, abortion, or invasive prenatal testing. The mother's immune system recognizes the baby's blood cells as foreign and produces antibodies against them. These antibodies can cross back to the baby's bloodstream and attack the baby's red blood cells, causing hemolysis (breakdown) and anemia².
HDN due to Rh incompatibility usually does not affect the first pregnancy, because the mother has not been exposed to Rh positive blood before and has not developed antibodies yet. However, it can affect subsequent pregnancies with Rh positive babies, because the mother has become sensitized and has antibodies ready to attack².
The other options are not causes of HDN:
- a) The mother and the father are both Rh negative. This is not a cause of HDN because both parents have the same Rh factor and there is no incompatibility between them. The baby will also be Rh negative and will not trigger an immune response from the mother².
- b) The mother and the father are both Rh positive. This is not a cause of HDN because both parents have the same Rh factor and there is no incompatibility between them. The baby will also be Rh positive and will not trigger an immune response from the mother².
- c) The mother is Rh positive and the father is Rh negative. This is not a cause of HDN because the mother has a dominant Rh factor and will not produce antibodies against it. The baby will either be Rh positive or Rh negative, depending on whether they inherit the father's gene or not. In either case, the baby's blood type will not trigger an immune response from the mother².
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