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.
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","E"]
Explanation
Choice A rationale
Decreased sensation in the lower extremities is an expected effect of epidural anesthesia. Epidurals work by blocking nerve signals in the lower spinal cord, leading to a reduction in feeling and motor function in the legs.
Choice B rationale
Respiratory depression is a serious complication of epidural anesthesia, although rare. The anesthetic can potentially migrate higher in the spinal cord and affect the nerves that control breathing. This requires immediate intervention by the anesthesiologist. Normal respiratory rate for an adult is 12-20 breaths per minute.
Choice C rationale
A blood pressure of 108/62 mm Hg is within the normal range for an adult and is not a cause for immediate concern in a client with an epidural. While hypotension can occur with epidurals, this value is stable. Normal systolic blood pressure is typically 90-120 mm Hg, and normal diastolic blood pressure is 60-80 mm Hg.
Choice D rationale
A sustained fetal heart rate of 150 bpm is within the normal range for a fetus during labor, which is typically 110-160 bpm. This finding does not indicate immediate distress requiring anesthesiologist intervention.
Choice E rationale
Slurred speech is not an expected effect of a properly placed epidural. It could indicate that the local anesthetic has migrated systemically, potentially affecting the central nervous system. This warrants immediate assessment by the anesthesiologist.
Correct Answer is B
Explanation
Choice A rationale
Betamethasone does not directly increase the fetal heart rate. Factors influencing fetal heart rate include fetal oxygenation, maternal hydration, and medications affecting the maternal or fetal autonomic nervous system. Normal fetal heart rate ranges from 110 to 160 beats per minute.
Choice B rationale
Betamethasone is a corticosteroid administered to pregnant women at risk of preterm delivery to accelerate fetal lung maturity. It stimulates the production of surfactant, a lipoprotein that reduces surface tension in the alveoli, preventing collapse upon expiration and improving the neonate's ability to breathe independently.
Choice C rationale
Betamethasone does not halt cervical dilation. Cervical dilation is primarily influenced by uterine contractions and the presenting fetal part. Medications like tocolytics, such as terbutaline or magnesium sulfate, are used to inhibit uterine contractions in preterm labor.
Choice D rationale
Betamethasone is not used to stop preterm labor contractions. Its primary purpose is to enhance fetal lung maturation. Tocolytic medications are the class of drugs used to attempt to delay or stop preterm labor contractions, allowing time for corticosteroids to be administered.
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