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

Exhibits

For each finding, click to specify if the finding is consistent with uterine atony or infection. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row. (Note: Each column must have at least 1 response option selected)

Prenatal anemia

Polyhydramnios

High parity

Prolonged rupture of membranes

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"}}

Rationale:

Prenatal anemia: Anemia may impair immune function and tissue oxygenation, making the postpartum client more vulnerable to infections such as endometritis, especially after cesarean delivery.
Polyhydramnios: Excessive amniotic fluid stretches the uterus beyond normal capacity, which can impair uterine contractility postpartum, increasing the risk of uterine atony and resulting in subinvolution or hemorrhage.
High parity: Multiple previous pregnancies lead to uterine muscle fatigue, reducing tone and contractility, which predisposes the uterus to poor involution and increases the risk of uterine atony.

Prolonged rupture of membranes: A rupture lasting more than 18 hours increases the risk of ascending bacterial infection and is a significant risk factor for postpartum endometritis or chorioamnionitis.

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Correct Answer is C

Explanation

Rationale:

A. Coarse lung sounds: Coarse lung sounds are typically associated with pulmonary issues such as fluid overload or pneumonia. They are not specific to cardiac tamponade and may appear later or not at all in this condition.

B. Widening pulse pressure: Cardiac tamponade causes narrowing of the pulse pressure due to decreased stroke volume, not widening. A narrowing pulse pressure is a more reliable hemodynamic sign of tamponade.

C. Muffled heart sounds: Muffled or distant heart sounds are a classic early sign of cardiac tamponade. They result from fluid accumulation in the pericardial sac, which insulates the heart and dampens the transmission of sound.

D. Decreased jugular vein distention: Cardiac tamponade typically causes increased jugular vein distention due to impaired venous return to the heart. A decrease in JVD would not be expected and may indicate a different process.

A. Arrange for an ethics committee meeting to address the family's concerns. B. Support the family's decision and initiate life-sustaining measures. C. complete an incident report D. Encourage the family to contact an attorney.

Correct Answer is A

Explanation

Rationale:

A. Arrange for an ethics committee meeting to address the family's concerns: An ethics committee helps resolve conflicts between families and healthcare teams while respecting patient autonomy and legal directives. This step promotes ethical decision-making and interdisciplinary collaboration.

B. Support the family's decision and initiate life-sustaining measures: Providing treatments against the client’s documented wishes violates ethical and legal standards. Advance directives must be honored, even when family members disagree.

C. Complete an incident report: An incident report is used to document errors or adverse events, not ethical conflicts. This situation requires ethical consultation and communication, not a formal incident report.

D. Encourage the family to contact an attorney: While families may seek legal counsel, it is not the nurse’s role to suggest legal action. This may escalate the conflict unnecessarily and delay proper ethical resolution.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is postoperative following a coronary artery bypass graft surgery. The nurse should identify that which of the following findings is an early indication of cardiac tamponade?

Correct Answer is C

Explanation

A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client's family wants the client to have life-sustaining measures. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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