A nurse on a postpartum unit is caring for a client.
Complete the following sentence by using the lists of options.
The client is most likely experiencing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Rationale for correct choices
• Endometritis: The client presents with multiple risk factors for postpartum uterine infection, including cesarean delivery, prolonged rupture of membranes, and high parity. Clinical findings of uterine tenderness, foul-smelling lochia, fever, and tachycardia are classic for endometritis. The markedly elevated WBC count further supports an infectious process rather than normal postpartum changes.
• Uterus and lochia assessment: The uterus is tender to palpation and positioned above the umbilicus, with lochia that is dark brown and foul-smelling, which is abnormal in the postpartum period. Foul-smelling lochia is a hallmark sign of uterine infection due to bacterial overgrowth. Uterine tenderness reflects inflammation of the endometrial lining.
Rationale for incorrect choices
• Mastitis: Although the client reports breast firmness, warmth, and nipple discomfort, these findings are consistent with normal breast engorgement rather than infection. Mastitis typically presents with localized breast redness, unilateral pain, and systemic symptoms such as chills. The uterine findings and foul-smelling lochia are not associated with mastitis.
• Postpartum hemorrhage: Postpartum hemorrhage is characterized by excessive bleeding, hypotension, and signs of hypovolemia, which are not present in this client. The lochia amount is moderate rather than heavy and the hemoglobin level is stable. Although the fundus was initially boggy, it firmed with massage, indicating uterine tone is responsive.
• WBC: Leukocytosis can occur normally in the postpartum period due to physiologic stress and inflammation. While the WBC count is significantly elevated, it is not specific on its own for diagnosing endometritis. Without supporting uterine and lochia findings, an elevated WBC is not the strongest single piece of evidence for this diagnosis.
• Fever: A mild fever can occur postpartum due to breast engorgement, dehydration, or normal inflammatory responses. Fever alone does not localize the source of pathology or confirm uterine infection. When paired with uterine tenderness and foul-smelling lochia, the diagnosis becomes clearer. On its own, fever is insufficient to make the diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Probiotics: Probiotics are generally considered safe and are not associated with perioperative hypotension. They primarily affect gut flora and digestion and do not have systemic hemodynamic effects that would increase surgical risk.
B. Black cohosh: Black cohosh can have estrogen-like effects and may potentiate hypotensive episodes during anesthesia by causing vasodilation. It can interact with anesthetic agents, increasing the risk of intraoperative hypotension, making it important to identify and withhold prior to surgery.
C. Flaxseed: Flaxseed is a source of dietary fiber and omega-3 fatty acids. While it may affect coagulation or gastrointestinal motility, it does not typically alter blood pressure or contribute to intraoperative hypotension.
D. Soy: Soy contains phytoestrogens and can influence hormone levels but does not significantly affect blood pressure in the perioperative period. Its use does not increase the risk of hypotension during surgery.
Correct Answer is ["A","B","D"]
Explanation
Rationale for correct choices
• Migraine headaches with aura: Combined oral contraceptives (COCs) increase the risk of ischemic stroke in individuals with migraine with aura. Estrogen-containing contraception can exacerbate cerebrovascular risk, making it a contraindication regardless of age or other vascular risk factors. Even with good glycemic control, the presence of aura elevates stroke risk significantly.
• History of deep vein thrombosis: COCs increase the risk of venous thromboembolism (VTE). A previous DVT is a strong contraindication because estrogen-containing contraceptives can trigger recurrence. Even if the event occurred years ago, the risk remains elevated, particularly in the presence of other risk factors such as immobility or hypercoagulable states.
• Diabetes mellitus (long-standing): Although the client currently has well-controlled blood sugar (HbA1c 6.7%), the duration of diabetes (24 years) significantly increases the risk of cardiovascular disease. Estrogen-containing contraceptives further elevate cardiovascular and thrombotic risk, making long-standing diabetes a relative contraindication.
Rationale for incorrect choices
• Lifetime nonsmoker / Rare alcohol use: Non-smoking status reduces cardiovascular risk, which is protective rather than contraindicating. Alcohol use in small amounts does not increase risk significantly.
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