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.
Prolonged rupture of membranes
Prenatal anemia
Polyhydramnios
High parity
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"}}
Rationale:
- Prolonged rupture of membranes: Membranes ruptured for over 24 hours (28 hr), increasing the risk for ascending bacterial infections such as endometritis or chorioamnionitis.
- Prenatal anemia: Anemia reduces immune function and tissue oxygenation, making the client more susceptible to postpartum infections, including uterine and systemic infections.
- Polyhydramnios: Excessive amniotic fluid causes uterine overdistension, which weakens uterine contractility and increases the risk of atony and postpartum hemorrhage.
- High parity: Repeated stretching of the uterus in grand multiparity reduces muscle tone, making the uterus less responsive to postpartum contraction and more prone to atony.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Fibrocystic breast condition: This benign breast disorder does not interfere with the use of oral contraceptives. In fact, hormonal birth control may sometimes reduce breast pain and nodularity associated with this condition.
B. Hypertension: High blood pressure is a known contraindication for oral contraceptive use, especially if it is uncontrolled. Estrogen-containing contraceptives can further elevate blood pressure and increase the risk of cardiovascular events such as stroke or myocardial infarction.
C. Fibromyalgia: Fibromyalgia does not interact with oral contraceptives and is not a contraindication. While hormonal changes may influence pain perception, there is no direct risk in using contraceptives for someone with this condition.
D. Asthma: Asthma is not a contraindication to using oral contraceptives. There is no evidence that hormonal contraceptives worsen asthma symptoms or interfere with its management.
Correct Answer is D
Explanation
Rationale:
A. A client must create a do-not-resuscitate order when completing advance directives: A DNR is a separate medical order and is not required when completing advance directives. Clients may choose to include resuscitation preferences in their directive but are not obligated to.
B. Advance directives cannot be changed once implemented: Advance directives are flexible documents that can be revised or revoked by the client at any time, as long as the client is mentally competent. This allows clients to adjust their wishes as circumstances or preferences change.
C. Assigning a health care surrogate requires legal consultation: While laws vary by state, in most cases, a legal consultation is not required. Clients can designate a surrogate by completing a form that is often available at healthcare facilities or through state-provided templates.
D. A health care surrogate makes health care decisions when the client is no longer able: A surrogate, also known as a durable power of attorney for health care, steps in only when the client loses decision-making capacity. This ensures that the client’s preferences are respected when they cannot communicate them.
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