A nurse is caring for a patient who has postpartum psychosis. Which of the following actions is the nurse’s priority?
Reinforce the need to take antipsychotics as prescribed.
Monitor the infant for indications of failure to thrive.
Ask the patient if they have thoughts of harming themselves or their infant.
Review the client’s medical record for a history of bipolar disorder.
The Correct Answer is C
Choice A rationale
While taking antipsychotics is important, the nurse’s immediate priority should be to assess for harm to the patient or infant, which poses an immediate danger.
Choice B rationale
Monitoring the infant’s health is important but secondary to ensuring the patient and infant's immediate safety from potential harm due to psychosis.
Choice C rationale
Assessing thoughts of harm is crucial in postpartum psychosis as it helps in identifying immediate risks to the patient and infant, allowing for timely interventions.
Choice D rationale
Reviewing the medical record for bipolar disorder is important for treatment planning but not as immediately critical as assessing for thoughts of harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Amniotic fluid embolism is characterized by the sudden onset of respiratory distress due to the entry of amniotic fluid into the maternal circulation.
Choice B rationale
Maternal bradycardia is not a specific symptom of amniotic fluid embolism and may be related to other cardiovascular conditions.
Choice C rationale
Category 1 fetal heart tracing indicates normal fetal heart rate and is not associated with amniotic fluid embolism.
Choice D rationale
Acute, continuous abdominal pain could indicate other obstetric emergencies but is not specifically linked to amniotic fluid embolism symptoms like respiratory distress.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
CBC will detect abnormalities such as anemia or infection, which may correlate with preeclampsia or HELLP syndrome.
Choice B rationale
Elevated AST and ALT levels indicate liver damage, a potential sign of severe preeclampsia or HELLP syndrome.
Choice C rationale
Serum creatinine helps assess kidney function, as preeclampsia can impair renal perfusion leading to elevated levels.
Choice D rationale
Fetal ultrasound assesses fetal growth, amniotic fluid volume, and placental function, critical in monitoring preeclampsia.
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