A nurse is collecting data from a client who has skeletal traction.

Which of the following findings should the nurse identify as an indication of infection at the pin sites?

Warmth.

Mild erythema.

Serosanguineous drainage.

Fever.

Answer and Explanation

The Correct Answer is D

Fever is a sign of infection and can indicate that there is an infection at the pin sites.

Choice A is not correct because warmth can be a normal finding at the pin sites.
Choice B is not correct because mild erythema can be a normal finding at the pin sites.
Choice C is not correct because serosanguineous drainage can be a normal finding at the pin sites.

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Correct Answer is D

Explanation

A postpartum fever is defined as a temperature greater than 100.4 degrees F (38.0 degrees C) on at least two occasions.
These fevers cannot be ignored as they can represent serious infections. The first task is to identify the source.
Choice A is not correct because continuing to monitor for another hour may delay necessary treatment.
Choice B is not correct because administering an antipyretic may only treat the symptom and not address the underlying cause of the fever.
Choice C is not correct because assisting the client in ambulation does not address the underlying cause of the fever.

A. It provides oxygen to the fetus. B. This is how the baby is fed. C. It helps cushion the baby. D. It prevents viruses from passing to the baby.

Correct Answer is C

Explanation

Amniotic fluid helps cushion the baby12.
It acts as a shock absorber and protects the fetus from injury should the mother’s abdomen be subject to trauma or sudden impact.
Choice A is incorrect because the amniotic fluid does not provide oxygen to the fetus.
Oxygen is provided to the fetus through the umbilical cord.
Choice B is incorrect because amniotic fluid is not how the baby is fed. The baby receives nutrients through the umbilical cord.
Choice D is incorrect because while amniotic fluid does have some antibacterial properties2, it does not prevent viruses from passing to the baby.

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A nurse is collecting data from a client who has skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites?

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Naxlex Comprehensive Predictor Exams

The nurse is monitoring a client who is 3 hours postpartum. On assessment, the nurse notes a temperature of 102.4°F. Which action should the nurse prioritize?

Correct Answer is D

Explanation

The nurse is teaching a prenatal class on the functions of the various structures involved with pregnancy. The nurse determines the class is successful when the class correctly chooses which function of amniotic fluid.

Correct Answer is C

Explanation

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A nurse is collecting data from a client who has skeletal traction.

Which of the following findings should the nurse identify as an indication of infection at the pin sites?