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

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.

Rationale for correct choices

• opioid intoxication: The client was found unresponsive and pulseless with a needle present, strongly suggesting opioid use. Clinical findings of decreased level of consciousness, respiratory depression, hypotension, and response to naloxone align with opioid intoxication. Miotic pupils and decreased bowel sounds further support opioid effects on the central nervous system.

• pupil characteristics: The client’s pupils are miotic, which is a classic hallmark of opioid intoxication. Opioids stimulate parasympathetic pathways leading to pinpoint pupils, especially when combined with respiratory depression. Pupillary changes directly correlate with opioid receptor activation.

Rationale for incorrect choices

• alcohol withdrawal: Alcohol withdrawal typically presents with tremors, agitation, tachycardia, hypertension, diaphoresis, and possibly seizures. The client is instead bradycardic, hypotensive, and profoundly sedated. There is no history of alcohol dependence or recent cessation to support withdrawal.

• opioid withdrawal: Opioid withdrawal is characterized by mydriasis, diarrhea, vomiting, piloerection, tachycardia, and hypertension. The client shows opposite findings, including miosis, decreased respirations, and sedation. Naloxone administration implies overdose reversal rather than withdrawal management. Withdrawal would not cause respiratory depression.

• alcohol intoxication: Alcohol intoxication can cause CNS depression, but it does not produce pinpoint pupils or respond to naloxone. The reported intake of one beer is insufficient to explain unresponsiveness and apnea. Injection marks and prior opioid-related admissions further reduce the likelihood of alcohol as the primary cause. Pupillary findings are inconsistent with alcohol intoxication.

• breath sounds: Breath sounds are clear and equal bilaterally, which does not directly identify the cause of the condition. While respiratory rate is decreased, auscultation findings alone do not distinguish opioid intoxication from other causes. Breath sounds provide supportive but nonspecific information.

• amount of alcohol consumed: The reported consumption of one beer does not explain the severity of symptoms observed. Alcohol quantity is unreliable due to potential underreporting and does not correlate with the physical findings. The presence of injection marks and naloxone response outweigh the quantity of alcohol consumed.

• current temperature: The client’s temperature is within normal limits and does not contribute to identifying the cause. Fever or hypothermia might suggest infection or environmental exposure, which are not primary concerns here. Temperature changes are not characteristic markers of opioid intoxication.

A. Administer a bronchodilator after the procedure: Bronchodilators are usually administered before postural drainage and percussion to open the airways, enhance mucus clearance, and reduce bronchospasm. Administering afterward would not optimize airway clearance.

B. Perform the procedure prior to meals: Performing postural drainage before meals helps prevent nausea and vomiting, which can occur if the stomach is full. This timing also enhances comfort and safety during chest physiotherapy for children with cystic fibrosis.

C. Perform the procedure twice each day: Children with cystic fibrosis often require more frequent airway clearance, sometimes three to four times daily, depending on clinical status. Limiting it to twice daily may be insufficient to prevent mucus accumulation.

D. Hold hand flat to perform percussions on the child: Percussions should be performed with cupped hands, not flat hands, to create a vibration that loosens mucus in the airways. Flat-hand technique is ineffective and does not facilitate optimal airway clearance.