A nurse is caring for a female client, age 36, in the postpartum unit following a scheduled cesarean birth 12 hours ago.
Complete the following sentence by using the lists of options.
The client is at greatest risk for developing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
The client is at greatest risk for developing Endometritis as evidenced by the client’s Lochia characteristics.
Rationale for correct answers:
Endometritis is a postpartum uterine infection commonly occurring after cesarean birth due to ascending bacterial contamination. The client’s foul-smelling lochia is a hallmark sign, indicating infection of the uterine lining. Normally, lochia is odorless and changes from red to serous and then to white over weeks postpartum. The elevated WBC count (18,000/mm³; normal 5,000–15,000/mm³) supports infection but is nonspecific. The firm uterine tone reduces likelihood of postpartum hemorrhage. Urinalysis positive for bacteria suggests UTI but does not explain uterine signs. Hence, lochia changes are the most direct indicator of endometritis.
Rationale for incorrect Response 1 answers:
Postpartum hemorrhage typically involves heavy bleeding, uterine atony, or a rapidly dropping hematocrit, none of which is reported here. Urinary tract infection is suggested by urinalysis but does not account for uterine tenderness or foul lochia. Deep vein thrombosis would present with limb swelling, pain, and possible fever but no uterine or lochia changes.
Rationale for incorrect Response 2 answers:
Urinalysis positive for bacteria points to UTI but not uterine infection. Elevated WBC count indicates infection or inflammation but lacks specificity for endometritis versus other infections. Uterine tone is firm here, making hemorrhage or uterine atony unlikely and less relevant to infection diagnosis.
Take home points:
- Endometritis often presents postpartum with foul-smelling lochia and elevated WBC.
- Foul-smelling lochia is a critical clinical sign distinguishing endometritis from other postpartum complications.
- Positive urinalysis suggests UTI, a separate postpartum infection that requires differentiation.
- Uterine tone helps rule out hemorrhage and guides diagnosis of infection versus atony.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Polyuria, an abnormally large production of urine, is not a typical adverse effect of epidural analgesia. Epidural analgesia, due to its influence on sympathetic nervous system blockade, can sometimes lead to urinary retention by inhibiting bladder detrusor muscle contraction and relaxing the urethral sphincter. Therefore, polyuria would be an unexpected finding.
Choice B rationale
A maternal temperature of 37.4° C (99.4° F) is within the normal physiological range for a laboring client. Slight elevations can occur due to the metabolic demands of labor or dehydration, but this temperature does not indicate an adverse effect directly attributable to epidural analgesia. Fever, defined as a temperature above 38° C (100.4° F), can be associated with epidural use due to thermoregulatory changes.
Choice C rationale
A fetal heart rate of 152/min is within the normal range for a term fetus, typically 110-160 beats per minute. This finding indicates a healthy fetal response and does not suggest an adverse effect of epidural analgesia. Epidural analgesia itself usually does not directly alter the fetal heart rate in a negative way if maternal hemodynamics remain stable.
Choice D rationale
Hypotension is a common adverse effect of epidural analgesia. It occurs due to sympathetic blockade, which causes vasodilation and peripheral pooling of blood, leading to decreased venous return to the heart and a subsequent drop in cardiac output and blood pressure. This reduction in blood pressure can compromise uteroplacental perfusion.
Correct Answer is B
Explanation
Choice A rationale
Administering oxygen via nasal cannula at 2 L/min might marginally increase fetal oxygenation, but it does not address the primary issue of hypotension causing decreased placental perfusion. The fundamental problem is reduced blood flow to the placenta, necessitating interventions that increase maternal circulating volume and blood pressure to improve perfusion.
Choice B rationale
Administering a lactated Ringer's 500 mL bolus directly addresses hypotension by expanding the maternal intravascular volume. This increased circulating volume raises blood pressure, thereby improving placental perfusion and oxygen delivery to the fetus. Lactated Ringer's is an isotonic solution, effective for rapid volume expansion.
Choice C rationale
Placing the client in a knee-chest position is typically used to alleviate cord compression or prolapse by shifting the fetus, not for treating hypotension. This position can actually worsen hypotension by trapping blood in the lower extremities and reducing venous return to the heart, further compromising placental blood flow.
Choice D rationale
Monitoring the client's blood pressure every 30 minutes is a crucial assessment but is not an immediate intervention for acute hypotension with decreased placental perfusion. While ongoing monitoring is essential, immediate actions are required to correct the underlying cause of hypotension and restore adequate blood flow to the placenta.
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