A nurse is caring for the client.
Select the 5 findings that indicate the client's condition has improved.
Heart rate
Temperature
Lochia
Hgb
WBC count
Fundal height
Correct Answer : A,B,C,E,F
A. Heart rate. The client’s heart rate decreased from 110/min on postpartum day 3 to 78/min on day 5, returning to normal resting range, which suggests improvement in systemic inflammation or infection, and better overall hemodynamic stability.
B. Temperature. The temperature has decreased from 38.6° C (101.5° F) to 37.1° C (98.9° F), which is within normal limits. This reduction is a key indicator of resolving infection or inflammation, especially considering the earlier febrile response.
C. Lochia. Lochia has improved from a moderate, foul-smelling, dark brown discharge to a small amount of brownish-red lochia with no odor, which suggests infection resolution and appropriate progression of postpartum uterine involution.
D. Hgb. The client’s hemoglobin dropped from 11.1 g/dL to 10 g/dL, which is below the normal postpartum range. This is likely due to ongoing recovery, recent surgery, and fluid shifts, but it does not indicate improvement and may require continued monitoring.
E. WBC count. The WBC count normalized from a significantly elevated 33,000/mm³ to 10,000/mm³, which is within the normal reference range. This is a strong sign that the infection or inflammatory response is resolving.
F. Fundal height. The fundus has decreased from 1 cm above the umbilicus on day 3 to 4 cm below on day 5, which is consistent with normal involution of the uterus during the postpartum period and is a positive sign of recovery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Remove the safety inspection sticker before plugging in the IV pump. The safety inspection sticker is proof that the equipment has passed a required check. It should not be removed, as doing so may violate facility policies and regulatory standards.
B. Grasp the IV pump cord when unplugging it from the electrical outlet. Pulling on the cord rather than the plug itself can damage the cord or outlet and pose an electrical hazard. Always unplug by gripping the plug directly.
C. Check the cords of the IV pump for fraying. Inspecting cords for fraying or damage is essential before using any electrical equipment. Damaged cords can lead to electric shock, equipment failure, or fire, and must be reported and replaced.
D. Ensure that the electric outlet has two prongs for the IV pump. Medical equipment should be plugged into a three-pronged (grounded) outlet to prevent electrical shock. Two-prong outlets are not grounded and are inappropriate for hospital-grade devices.
Correct Answer is A
Explanation
A. Hydrocodone. This is an opioid analgesic appropriate for moderate to severe pain, such as a pain rating of 7/10. It is commonly used for acute pain management in cases like fractures and provides effective relief when non-opioids are insufficient.
B. Acetaminophen. While useful for mild to moderate pain, acetaminophen alone is likely inadequate for severe pain like that associated with a fracture rated 7/10.
C. Fentanyl. Fentanyl is a potent opioid used for severe or chronic pain, often in controlled settings such as surgery or cancer care. For an acute fracture, hydrocodone is typically preferred unless pain is extreme or uncontrolled.
D. Aspirin. Aspirin is primarily used for mild pain or anti-inflammatory purposes and is not appropriate as a first-line agent for severe pain. Additionally, it may increase the risk of bleeding, which is a consideration in trauma cases.
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