A nurse is caring for a female client who is 3 days postpartum in the postpartum unit.
Which of the following actions should the nurse take?
Instruct the client to stop breastfeeding.
Obtain a prescription for a broad-spectrum antibiotic.
Initiate airborne isolation precautions.
Place the client on strict bedrest.
The Correct Answer is B
Choice A rationale: Stopping breastfeeding is not indicated in postpartum infections unless the infection is a contraindication such as HIV or active tuberculosis. Breastfeeding promotes uterine contraction by releasing oxytocin, which helps reduce bleeding and promotes healing. Additionally, breast milk provides immunological benefits to the newborn. The client’s infection appears localized to the uterus (endometritis), and there is no evidence breastfeeding worsens maternal infection or neonatal risk here.
Choice B rationale: Initiating broad-spectrum antibiotics is scientifically appropriate for suspected postpartum endometritis, especially with fever >38°C, tachycardia, foul-smelling lochia, and abdominal tenderness. These antibiotics target polymicrobial infections commonly involving aerobic and anaerobic bacteria, preventing progression to sepsis. Timely antibiotic therapy reduces maternal morbidity and accelerates recovery. Normal temperature is 36.5–37.5°C; this client’s rising fever to 38.9°C indicates infection requiring treatment.
Choice C rationale: Airborne isolation precautions are unnecessary because common postpartum infections such as endometritis are not transmitted via airborne routes but rather by endogenous flora or direct contamination. Airborne pathogens include tuberculosis, varicella, and measles, none of which are suggested by this client’s presentation or history. Implementing unnecessary airborne precautions wastes resources and increases patient isolation without scientific benefit.
Choice D rationale: Strict bedrest is not routinely indicated in postpartum infections unless severe systemic illness is present. Early mobilization improves circulation, reduces risk of venous thromboembolism, and promotes pulmonary function, especially when respiratory rate is elevated at 24/min. The client is alert and breastfeeding, suggesting stable condition. Prolonged immobility increases risks without benefits in mild-to-moderate infection management.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Group B Streptococcus (GBS) colonization in a pregnant client does not typically necessitate a cesarean birth. The primary concern with GBS is the risk of vertical transmission to the neonate during vaginal birth, which can lead to severe neonatal infections like sepsis, meningitis, or pneumonia. Cesarean section is generally reserved for obstetric indications and does not eliminate the risk of GBS transmission if membranes rupture.
Choice B rationale
Intravenous antibiotic prophylaxis is the cornerstone of preventing neonatal GBS disease in colonized mothers. The recommended antibiotics, typically penicillin or ampicillin, are administered during labor once ruptured membranes or active labor commence. This intrapartum treatment significantly reduces bacterial colonization in the birth canal, thereby minimizing the neonate's exposure to the bacteria during passage.
Choice C rationale
A vaginal culture for GBS is typically performed between 36 and 37 weeks of gestation as part of routine prenatal screening. If the client has already been screened and identified as GBS positive at 36 weeks, repeating the culture during active labor is not indicated as the colonization status is already known, and the focus shifts to prophylaxis.
Choice D rationale
Metronidazole is an antibiotic primarily effective against anaerobic bacteria and certain parasites. It is not the drug of choice for Group B Streptococcus prophylaxis. Penicillin or ampicillin are the preferred antibiotics for GBS intrapartum prophylaxis due to their effectiveness against GBS and their favorable safety profile for both the mother and the fetus.
Correct Answer is C
Explanation
Choice A rationale
A positive phenylketonuria (PKU) test indicates an inability to metabolize the amino acid phenylalanine, not galactose. Galactosemia is a separate metabolic disorder characterized by the body's inability to break down galactose, a sugar found in milk. Both are inborn errors of metabolism, but their biochemical pathways and dietary interventions differ significantly.
Choice B rationale
A positive PKU test does not indicate a slow metabolism in general. Instead, it specifically points to a deficiency in the enzyme phenylalanine hydroxylase (PAH), which is necessary for converting phenylalanine into tyrosine. This enzymatic defect leads to an accumulation of phenylalanine in the blood and tissues, which can become neurotoxic if untreated.
Choice C rationale
A positive finding for phenylketonuria (PKU) signifies a genetic disorder where the body lacks or has insufficient amounts of the enzyme phenylalanine hydroxylase. This enzyme is crucial for metabolizing the essential amino acid phenylalanine into tyrosine. Without proper enzyme function, phenylalanine accumulates in the blood, leading to neurotoxic effects if a specialized diet is not initiated promptly.
Choice D rationale
A positive PKU finding, if left untreated, directly leads to severe intellectual disability and other neurological problems due to the accumulation of phenylalanine, which is toxic to the developing brain. Therefore, it indicates an increased risk for neurologic anomalies if the condition is not managed through a strict low-phenylalanine diet from early infancy. .
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