A multiparous client, 28 hours after a cesarean birth, who is breastfeeding, has severe cramps or afterpains.
The nurse explains that these are caused by:

Choice A rationale

Positioning the newborn supine on a radiant warmer is appropriate for maintaining thermoregulation. However, applying only a sterile gauze dressing to a large abdominal wall defect that is not covered by a membrane does not adequately protect the exposed organs from contamination, drying, or injury. This increases the risk of infection and fluid loss.

Choice B rationale

Placing the newborn into a sterile bowel bag up to the axilla is the recommended immediate action for an abdominal wall defect such as gastroschisis (protrusion without a membrane). The sterile bag helps to maintain a moist environment, prevent heat and fluid loss, and protect the exposed organs from trauma and contamination until surgical repair can be performed.

Choice C rationale

While breastfeeding promotes bonding and provides essential nutrients, it is not the priority action for a newborn with a large, uncovered abdominal wall defect immediately after birth. The immediate focus should be on protecting the exposed organs and stabilizing the newborn. Breastfeeding can be initiated once the newborn is stable and the abdominal defect is appropriately managed.

Choice D rationale

Providing intermittent suction via an orogastric tube may be necessary later to decompress the gastrointestinal system, but it is not the immediate priority for a newborn with a large, uncovered abdominal wall defect. The initial action should focus on protecting the exposed organs.

Choice A rationale

A platelet count of 50,000/mm³ is critically low (normal range is 150,000-450,000/mm³) in a client with pre-eclampsia. Thrombocytopenia is a serious complication of pre-eclampsia and can significantly increase the risk of bleeding and hemorrhage. This finding requires immediate reporting and intervention.

Choice B rationale

A hemoglobin level of 11 grams/dL is within the lower end of the normal range for postpartum women (typically 12-15 g/dL) and is not an immediate concern in the context of pre-eclampsia, unless there is a rapid decline or other concerning symptoms.

Choice C rationale

A creatinine level of 0.3 mg/dL is below the normal range for non-pregnant adults (typically 0.6-1.2 mg/dL) and might be lower in pregnancy due to increased glomerular filtration rate. While kidney function should be monitored in pre-eclampsia, this specific value is not immediately alarming.

Choice D rationale

A fasting blood glucose of 65 mg/dL is within the normal range (typically 70-100 mg/dL) and is not a typical finding that requires immediate reporting in pre-eclampsia, although gestational diabetes can sometimes coexist.