A nurse is caring for the client.
Nurses' Notes
Postpartum Day 3, 0815:
Client reports feeling unwell. Lung sounds clear but diminished in the bases. Client states breasts feel firm, heavy, and warm with moderate nipple discomfort while breastfeeding. Uterus firm at 1 cm above the umbilicus and tender to palpation. Fundus boggy but firmed with massage. Moderate amount of dark brown, foul-smelling lochia noted. Surgical incision well approximated with slight edema present; no signs of infection noted. No bowel movement since birth, hypoactive bowel sounds
Vital Signs
Postpartum Day 3, 0815:
Temperature 38.2° C (100.8° F)
Heart rate 104/min
Respiratory rate 18/min
BP 108/70 mm Hg
SaO2 97% on room air
Diagnostic Results
Postpartum Day 3, 0900:
Hemoglobin 11.1 g/dL
WBC count 33,000/mm3
Uterus firm at 1 cm above the umbilicus and tender to palpation.
Moderate amount of dark brown, foul-smelling lochia noted
Surgical incision well approximated with slight edema present
Temperature 38.2° C (100.8° F)
Respiratory rate 18/min
SaO2 97% on room air
WBC count 33,000/mm3
The Correct Answer is ["A","B","D","G"]
Rationale for Correct Answers:
- Uterus firm at 1 cm above the umbilicus and tender to palpation: Normally, by postpartum day 3, the uterus should be well below the umbilicus. A uterus that is still above and tender suggests endometritis or subinvolution, especially when combined with foul-smelling lochia.
- Moderate amount of dark brown, foul-smelling lochia noted: Lochia should progress from rubra (day 1–3, red) → serosa (day 4–10, pink/brown) → alba (day 10 onward, white/yellow). Foul-smelling lochia is a hallmark of uterine infection (endometritis).
- Temperature 38.2° C (100.8° F): A postpartum fever ≥38°C on two occasions, or even once when associated with uterine tenderness and foul lochia, is significant and indicates infection.
- WBC count 33,000/mm³: Although WBCs can be physiologically elevated postpartum (up to 20,000–25,000), a count this high is abnormal and strongly suggests severe infection.
Rationale for Incorrect Answers:
- Surgical incision well approximated with slight edema present: Mild edema is expected in the early healing process; no erythema, drainage, or dehiscence is noted, so no immediate concern.
- Respiratory rate 18/min: This is within normal range (12–20/min), no evidence of respiratory compromise.
SaO₂ 97% on room air: This is normal oxygen saturation, not concerning
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Asks the client what her plans are for follow-up care: This is an appropriate action that demonstrates concern for the client’s continuity of care and safety, even if she decides to leave against medical advice.
B. Asks the client to sign a form releasing the hospital from legal responsibility: This is standard practice when a client leaves against medical advice, as it documents that the client was informed of potential risks and chose to leave voluntarily.This action is appropriate and does not require the charge nurse to intervene.
C. Shows the client her abnormal laboratory results: Providing relevant medical information is appropriate to help the client make an informed decision about her care before leaving the facility.
D. Asks security to detain the client until the provider is notified: Clients have the legal right to leave a healthcare facility unless they are under specific legal or mental health holds. Detaining a competent adult against their will is unlawful and violates patient rights hence requiring intervention by the charge nurse.
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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