A nurse is caring for a postpartum client in an outpatient setting.
Complete the following sentence by using the lists of options.
The client is at highest risk for developing
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}
The client is at highest risk for developing mastitis as evidenced by the client'scracked nipple.
Rationale
The client has visible cracks on the left nipple, which is a key risk factor for mastitis. Cracked nipples can allow bacteria to enter the breast tissue during breastfeeding, leading to mastitis, especially if the nipples are not healing properly or the breastfeeding technique is suboptimal. The client also reports nipple discomfort throughout breastfeeding, which increases the likelihood of mastitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A noncoring needle is specifically designed to access venous access ports without damaging the port, making it the appropriate choice.
B. An angiocatheter is used for peripheral IV insertion, not for accessing an implanted port.
C. A butterfly needle is used for short-term venous access, not for implanted ports.
D. A 25-gauge needle is too small for accessing an implanted port and would not be effective.
Correct Answer is {"A":{"answers":"A,C"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A,B,C"},"E":{"answers":"A"}}
Explanation
Hypercapnia (elevated PaCO2)
Malignant hyperthermia: Yes. Malignant hyperthermia (MH) is a life-threatening condition triggered by certain anesthetic agents, and it leads to hypermetabolism, muscle rigidity, and hypercapnia (elevated carbon dioxide levels.
Latex allergy: No. Hypercapnia is not associated with latex allergy.
Hypovolemic shock: Yes. In hypovolemic shock, hypercapnia can occur as a compensatory response due to tissue hypoxia and poor perfusion. However, it is less directly characteristic of hypovolemic shock than of malignant hyperthermia.
2. Wheezes
Malignant hyperthermia: No. Wheezing is not a typical feature of malignant hyperthermia. Instead, it is primarily characterized by muscle rigidity, hypercapnia, and tachycardia.
Latex allergy: Yes. A latex allergy can cause respiratory symptoms, including wheezing, shortness of breath, or bronchospasm. This can occur when an allergic reaction triggers an asthma-like response in the airways.
Hypovolemic shock: No. Wheezing is not characteristic of hypovolemic shock. Hypovolemic shock primarily involves signs of decreased blood volume and perfusion, such as tachycardia, hypotension, and altered mental status.
3. Urticaria (hives)
Malignant hyperthermia: No. Urticaria is not a feature of malignant hyperthermia. MH is characterized by hyperthermia, muscle rigidity, and tachycardia, not an allergic skin reaction.
Latex allergy: Yes. Urticaria (hives) is a common sign of a latex allergy. An allergic reaction to latex can lead to skin reactions, including hives, itching, or rash.
Hypovolemic shock: No. Urticaria is not a typical finding in hypovolemic shock. In hypovolemic shock, the primary concern is hypotension, tachycardia, cool, clammy skin, and poor perfusion, not skin reactions like hives.
4. Tachycardia
Malignant hyperthermia: Yes. Tachycardia is a prominent feature of malignant hyperthermia, often occurring alongside hyperthermia (high body temperature) and muscle rigidity. The elevated heart rate is a response to the increased metabolic demand and stress during MH.
Latex allergy: Yes. Tachycardia can be a response to an allergic reaction such as latex allergy. In more severe cases, anaphylaxis due to latex exposure can cause a rapid heart rate as part of the body's response to the allergic reaction.
Hypovolemic shock: Yes. Tachycardia is a compensatory mechanism in hypovolemic shock. As the body tries to compensate for fluid loss or reduced blood volume, the heart rate increases to maintain perfusion.
5. Muscle rigidity
Malignant hyperthermia: Yes. Muscle rigidity is a classic sign of malignant hyperthermia. It occurs as a result of abnormal muscle contraction, leading to increased metabolic activity, hyperthermia, and hypercapnia.
Latex allergy: No. Muscle rigidity is not a typical feature of latex allergy.
Hypovolemic shock: No. Muscle rigidity is not characteristic of hypovolemic shock, which is primarily marked by reduced blood volume, hypotension, and poor perfusion.
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