The nurse is monitoring a client who is 3 hours postpartum. On assessment, the nurse notes a temperature of 102.4°F.

Which action should the nurse prioritize?

Continue to monitor for another hour.

Administer an antipyretic.

Assist the client in ambulation.

Notify the RN; she will notify the provider.

Answer and Explanation

The Correct Answer is D

A postpartum fever is defined as a temperature greater than 100.4 degrees F (38.0 degrees C) on at least two occasions.
These fevers cannot be ignored as they can represent serious infections. The first task is to identify the source.
Choice A is not correct because continuing to monitor for another hour may delay necessary treatment.
Choice B is not correct because administering an antipyretic may only treat the symptom and not address the underlying cause of the fever.
Choice C is not correct because assisting the client in ambulation does not address the underlying cause of the fever.

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Correct Answer is C

Explanation

This question is important because it helps the nurse assess the level of risk and determine the appropriate intervention.
It is important to take all threats, communications, and suggestions regarding suicide seriously.
Choice A is not correct because it focuses on past events rather than the current situation.
Choice B is not correct because it may come across as confrontational and may not be helpful in assessing the level of risk.
Choice D is not correct because it focuses on the reason for feeling depressed rather than assessing the level of risk and determining appropriate intervention.

A. Contractions are short and irregular B. Contractions are relieved by walking C. Cervix does not dilate D. Contractions continue and are stronger.

Correct Answer is D

Explanation

True labor contractions continue and become stronger over time.
Choice A is incorrect because true labor contractions are usually regular and become longer over time.
Choice B is incorrect because true labor contractions are usually not relieved by walking.
Choice C is incorrect because, during true labor, the cervix dilates to allow for the baby to pass through the birth canal.

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The nurse is monitoring a client who is 3 hours postpartum. On assessment, the nurse notes a temperature of 102.4°F. Which action should the nurse prioritize?

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The nurse is monitoring a client who is 3 hours postpartum. On assessment, the nurse notes a temperature of 102.4°F.

Which action should the nurse prioritize?