A 35-year-old postpartum client has the following assessment findings: Temperature 99.8 F (37.7 C), Heart Rate 80, Respiratory Rate 16, Blood Pressure 150/86, SpO2 100% on room air.
Based on these findings and the client's history of prolonged labor and being a primipara, which condition is the client most likely experiencing?

Placenta previa.

Placental abruption.

Postpartum hemorrhage.

Preeclampsia.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Placenta previa is a condition where the placenta implants in the lower part of the uterus, potentially covering the cervix. This typically presents with painless vaginal bleeding, not the elevated blood pressure seen in this client.

Choice B rationale

Placental abruption involves the premature separation of the placenta from the uterine wall. This often manifests with sudden abdominal pain, vaginal bleeding, and uterine tenderness, which are not the primary findings in this postpartum client.

Choice C rationale

Postpartum hemorrhage is excessive bleeding after childbirth, typically defined as more than 500 mL after vaginal delivery or 1000 mL after cesarean birth. While prolonged labor can increase the risk, the client's current vital signs do not indicate active hemorrhage.

Choice D rationale

Preeclampsia can occur postpartum, characterized by new-onset hypertension (blood pressure ≥ 140/90 mmHg) and proteinuria or other signs of end-organ damage within 4 weeks after delivery. This client's blood pressure of 150/86 mmHg, coupled with a history of prolonged labor and being a primipara (both risk factors for preeclampsia), makes this the most likely condition. Normal postpartum blood pressure typically returns to the client's baseline pre-pregnancy levels.

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Correct Answer is C

Explanation

Choice A rationale

Preterm labor is defined as labor that occurs between 20 and 37 weeks of gestation. The patient is already at 37 weeks' gestation, so preterm labor is not a complication to prevent.

Choice B rationale

Gestational diabetes is glucose intolerance that develops during pregnancy. While elevated blood pressure can sometimes be associated with gestational diabetes, magnesium sulfate is not a primary treatment or preventative measure for this condition. Management typically involves dietary changes, exercise, and sometimes insulin.

Choice C rationale

Magnesium sulfate is commonly administered in the setting of preeclampsia with severe features or eclampsia to prevent seizures. The patient's consistently elevated blood pressure readings (above 160/110 mmHg on multiple occasions) indicate severe hypertension, a key diagnostic criterion for preeclampsia with severe features, placing her at high risk for seizures (eclampsia). Magnesium sulfate acts as a central nervous system depressant, reducing neuronal excitability and thus the risk of seizures.

Choice D rationale

Fetal growth restriction (FGR) is a condition where the fetus does not grow at the expected rate in utero. While severe preeclampsia can contribute to FGR due to placental insufficiency, magnesium sulfate is not directly used to prevent fetal growth restriction. The primary focus of magnesium sulfate in this scenario is maternal seizure prophylaxis.

A. The client's vaginal pH may increase during menopause. B. The client's dietary habits and fluid intake. C. The client's history of sexually transmitted infections. D. The client's genitourinary disorder will be alleviated over time.

Correct Answer is A

Explanation

Choice A rationale

During menopause, estrogen levels significantly decline. Estrogen plays a crucial role in maintaining the acidic environment of the vagina, which inhibits the growth of pathogenic bacteria and yeast. A decrease in estrogen leads to a rise in vaginal pH (normal premenopausal pH is 3.8 to 4.5), making the vaginal environment less acidic and more susceptible to infections, including bacterial vaginosis and yeast infections, thus explaining the client's symptoms.

Choice B rationale

While dietary habits and fluid intake can influence overall health, they are not the primary factors directly causing the increased risk of vaginal itching, burning, and infections in a menopausal woman. Hormonal changes are the most significant contributing factor.

Choice C rationale

A history of sexually transmitted infections (STIs) is important to consider, but the onset of these symptoms three years into menopause suggests that hormonal changes related to estrogen deficiency are a more likely primary cause for the recurrent vaginal issues. While past STIs can sometimes have long-term effects, the timing aligns with menopausal changes.

Choice D rationale

The client's genitourinary disorder (specifically, the vaginal changes due to estrogen deficiency) will not alleviate over time without intervention. The decrease in estrogen is a permanent physiological change associated with menopause, and the associated symptoms often persist or worsen without treatment such as hormone therapy or other local treatments to restore vaginal health.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A 56-year-old menopausal woman reports to the registered nurse that she has been experiencing vaginal itching, burning, and an increase in vaginal infections over the past 3 years. What important factor should the nurse consider before responding to the client's concerns?

Correct Answer is A

Explanation

A nurse is caring for a client who is 3 days postpartum and is attempting to breastfeed.Which of the following findings indicate mastitis?

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor.The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication.The nurse should provide which of the following explanations?

Based on the client's assessment on 2/11 at 1200, indicate if the client's condition is improving, worsening or not related based on the condition.

Which interventions should the nurse include in the plan of care for a client with the nursing diagnosis of acute pain related to breast engorgement?

A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia.The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

A nurse is reviewing urinalysis and symptom findings to determine which support a suspected genitourinary or reproductive tract infection. Which of the following findings support the nurse’s suspicion? (Select all that apply.)

The nurse will implement the following interventions based on the fetal heart rate.(Select All that Apply.)

The nurse is reviewing fetal and maternal circulation with a group of nursing students.Which statement by a student demonstrates a need for further clarification?