A nurse is assessing a client who is 6 hr postpartum and has endometritis. Which of the following findings should the nurse expect?
Temperature 37.4°C (99.3°F).
Uterine tenderness.
WBC Count 9,000/mm.
Scant lochia.
The Correct Answer is B
Choice A rationale:
A postpartum temperature of 37.4°C (99.3°F) is within the normal range. Mild temperature elevations can be expected in the immediate postpartum period without indicating infection.
Choice B rationale:
Uterine tenderness is a common finding in endometritis, which is an inflammation or infection of the inner lining of the uterus. The condition can cause pelvic pain and uterine tenderness.
Choice C rationale:
A white blood cell (WBC) count of 9,000/mm³ falls within the normal range for a postpartum client. In endometritis, an elevated WBC count would be expected due to the infection.
Choice D rationale:
Scant lochia (minimal vaginal discharge after childbirth) is a normal finding in the postpartum period and is not associated with endometritis. In endometritis, the lochia may be increased and foul-smelling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
This manifestation, urine output of 20 mL/hr, is an adverse reaction to magnesium sulfate administration. Magnesium sulfate can lead to decreased urine output, and it is essential for the nurse to monitor the client's urinary output closely. Low urine output may indicate decreased kidney function, which can be a sign of magnesium toxicity.
Choice B rationale:
Hypertension is expected in a client with preeclampsia, and magnesium sulfate is used to help manage and prevent seizures in these cases. While it is essential to monitor and manage hypertension during pregnancy, it is not considered an adverse reaction to magnesium sulfate.
Choice C rationale:
Hyperglycemia is not a common adverse reaction to magnesium sulfate. Magnesium sulfate may cause central nervous system depression, muscle weakness, and respiratory depression, but it does not typically cause hyperglycemia.
Choice D rationale:
A respiratory rate of 16/min is within the normal range for an adult and is not indicative of an adverse reaction to magnesium sulfate. Magnesium sulfate can cause respiratory depression at higher doses, but a respiratory rate of 16/min does not raise immediate concerns.
Correct Answer is A
Explanation
Choice A rationale:
Instructing the client to maintain scheduled mealtimes is essential for a postpartum client with type 1 diabetes mellitus who is breastfeeding. Consistent and balanced meals help stabilize blood glucose levels, especially in diabetic clients who need to manage their insulin.
Choice B rationale:
Checking blood glucose levels every 8 hours is not appropriate for a postpartum client with type 1 diabetes mellitus. Diabetic clients typically need to monitor their blood glucose more frequently, especially after meals and during breastfeeding.
Choice C rationale:
Instructing the client to take more insulin with each meal than she did prior to pregnancy is not accurate advice. The insulin requirements may change during pregnancy, but it is essential to follow the healthcare provider's guidance on adjusting insulin doses after delivery.
Choice D rationale:
Limiting carbohydrate intake to 30 grams per day is not suitable for a breastfeeding postpartum client with type 1 diabetes mellitus. Carbohydrates are a crucial source of energy, and breastfeeding mothers usually require more carbohydrates to support lactation and energy needs. Restricting carbohydrates to such a low level could be harmful.
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