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The nurse has reviewed the Nurses' Notes, Diagnostic Results, and Laboratory Results.

Exhibits
Select prescriptions the nurse should prescribe.

Enoxaparin 80 mg subcutaneous twice a

Potassium chloride 20 mEq PO twice a day

Ciprofloxacin 750 mg PO twice a day

Enalapril 5 mg PO daily

Rosuvastatin 20 mg PO daily

Digoxin 0.25 mg PO daily

Metformin 850 mg PO daily

Albuterol 2 puffs every 4 to 6 hr as needed

Answer and Explanation

Correct Answer : B,D,E,G

Rationale:

A. Enoxaparin 80 mg subcutaneous twice a day: Enoxaparin is an anticoagulant used for prevention or treatment of thromboembolic events. There is no indication from the client’s current labs, vitals, or diagnostics (D-dimer within normal limits, no evidence of clot) to initiate anticoagulation at this time.

B. Potassium chloride 20 mEq PO twice a day: The client’s potassium level is 3.6 mEq/L, which is at the lower end of the normal range. Supplementation may be warranted, particularly if antihypertensive therapy such as a diuretic is initiated, to prevent hypokalemia and maintain cardiac stability.

C. Ciprofloxacin 750 mg PO twice a day: There is no evidence of bacterial infection in the client’s assessment, labs, or diagnostics. Prescribing an antibiotic is unnecessary and not indicated.

D. Enalapril 5 mg PO daily: The client’s blood pressure is 164/92 mm Hg, which is hypertensive. Enalapril, an ACE inhibitor, is appropriate to manage hypertension, reduce cardiovascular risk, and potentially improve renal outcomes given the family history of renal failure.

E. Rosuvastatin 20 mg PO daily: The client has significantly elevated cholesterol (total cholesterol 280 mg/dL, LDL 220 mg/dL, HDL 20 mg/dL) and triglycerides 220 mg/dL. Initiating a statin is appropriate to reduce cardiovascular risk and manage hyperlipidemia.

F. Digoxin 0.25 mg PO daily: The client does not exhibit heart failure symptoms or arrhythmias that require digoxin at this time. ECG shows only sinus tachycardia without S-T changes, so digoxin is not indicated.

G. Metformin 850 mg PO daily: The client’s glucose is 310 mg/dL and HbA1c is 7%, indicating diabetes mellitus. Initiating metformin is appropriate for glycemic control and to reduce the risk of complications associated with hyperglycemia.

H. Albuterol 2 puffs every 4 to 6 hr as needed: The client’s lungs are clear on auscultation, and there is no active respiratory distress. Albuterol is not indicated for ongoing therapy in this assessment.

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Correct Answer is ["A","D","F"]

Explanation

Rationale:

A. Monitor the height and tone of the client's fundus: Assessing uterine fundus is essential postpartum, especially with signs of infection and moderate lochia. Monitoring for firmness, height, and consistency helps identify uterine atony or worsening infection, guiding timely interventions to prevent hemorrhage or complications.

B. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: Most antibiotics prescribed for postpartum infections, such as clindamycin, are considered compatible with breastfeeding. Advising formula feeding unnecessarily could disrupt breastfeeding without clinical justification.

C. Initiate contact precautions: Postpartum infections like endometritis or mastitis are generally not spread via contact in a hospital setting. Standard precautions, including hand hygiene, are sufficient unless a specific transmissible pathogen is identified.

D. Instruct the client to wash her hands before and after changing her perineal pad: Hand hygiene prevents the spread of infection and reduces the risk of secondary infections. Teaching proper handwashing is an essential standard precaution for clients with postpartum infections.

E. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab: Routine cultures of lochia are not indicated unless there is suspicion of an unusual pathogen or worsening infection. Assessment and empiric antibiotics are standard for postpartum endometritis based on clinical findings.

F. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Semi-Fowler’s positioning promotes uterine drainage, reduces stasis of lochia, and supports comfort. This position aids in preventing complications such as uterine infection or retention of lochia.

G. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic used to suppress preterm labor. It is not indicated for postpartum infection, uterine atony, or lochia management and is not appropriate in this scenario.

A. Sits steadily unsupported B. Changes from prone to sitting C. Rolls from back to abdomen D. Rolls from back to side

Correct Answer is D,C,A,B

Explanation

D. Rolling from back to side is the earliest movement and reflects initial development of trunk rotation and muscle control. This typically occurs around 4 months of age. C. Rolling from back to abdomen requires greater coordination and strength than rolling to the side and usually occurs around 5 to 6 months as infants gain better control of their core muscles. A. Sitting steadily unsupported develops once the infant has strong trunk control and balance, typically around 6 to 8 months. This skill indicates improved postural stability. B. Changing from prone to sitting is the most advanced skill listed. It requires coordinated use of the arms, core, and balance, and typically occurs later around 8 to 10 months as mobility becomes more purposeful.

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The nurse has reviewed the Nurses' Notes, Diagnostic Results, and Laboratory Results. Exhibits Select prescriptions the nurse should prescribe.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse on a postpartum unit is caring for a client. Exhibits The nurse is continuing to care for the client. Which of the following actions should the nurse take? Select all that apply.

Correct Answer is ["A","D","F"]

Explanation

Correct Answer is D,C,A,B

Explanation

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The nurse has reviewed the Nurses' Notes, Diagnostic Results, and Laboratory Results.

Exhibits
Select prescriptions the nurse should prescribe.