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A nurse on a postpartum unit is caring for a client.

Exhibits

Drag words from the choices below to fill in each blank in the following sentence.

The nurse should anticipate a provider's prescription for an

and
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"E"}

  • Tocolytic medication: Tocolytics are used to suppress preterm labor, which is not applicable for this postpartum client. There is no indication of uterine contractions needing suppression.
  • Intravenous antibiotic: The client exhibits signs of postpartum endometritis—including fever, uterine tenderness, foul-smelling lochia, and a very high WBC count (33,000/mm³). These findings strongly support the need for IV antibiotics to treat the infection.
  • Intrauterine tamponade balloon: This device is used for managing postpartum hemorrhage, which is not present in this case. The client’s lochia is moderate, not excessive, and her uterus is responding to massage.
  • Kleihauer-Betke test: This test is used to detect fetal-to-maternal hemorrhage, particularly in Rh-negative mothers after trauma or potential placental separation. It is not relevant in the context of postpartum infection.
  • Increase in daily fluid intake: The client is febrile and shows signs of systemic infection. Increased fluids support hydration, promote recovery, and help manage the effects of fever and infection, making this an appropriate supportive measure.


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Related Questions

Correct Answer is D

Explanation

A. Revise the current policy for catheter care. Policy changes should be based on evidence and root cause analysis. Revising the policy prematurely without identifying contributing factors may not address the actual causes of infection.
B. Schedule nursing staff training for infection control procedures. Education and training are important but should be guided by identified gaps. Implementing training without understanding the root cause may result in ineffective interventions.
C. Meet with providers to discuss measures to decrease the infections. While interdisciplinary collaboration is valuable, it should occur after gathering and analyzing relevant data. This ensures targeted, evidence-based recommendations.
D. Identify possible precipitating factors related to the infections. The first step in quality improvement is to investigate and assess contributing factors. This helps guide the most appropriate and effective interventions to reduce infection rates.

Correct Answer is B

Explanation

A. Open the outermost flap of the sterile kit toward the body. The outermost flap should always be opened away from the body first to prevent contamination of the sterile field by leaning over it. This helps maintain sterility by minimizing the risk of contact.
B. Place the cap from the solution sterile side up on a clean surface. Placing the cap sterile side up prevents the sterile inner surface from touching the contaminated surface and helps maintain aseptic technique during solution use.
C. Place the sterile dressing within 1.25 cm (0.5 in) of the edge of the sterile field. The outer 2.5 cm (1 inch) border of a sterile field is considered contaminated. Placing items too close to the edge increases the risk of contamination and compromises the field's sterility.
D. Set up the sterile field 5 cm (2 in) below waist level. Any sterile item held or placed below waist level is considered contaminated. The sterile field must always be maintained above waist level to preserve asepsis.

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