A nurse is collecting data from a client who is 1 day postpartum.
Which of the following findings requires immediate intervention by the nurse?

Decreased urge to void.

Displaced fundus from the midline.

Fundal height below the umbilicus.

Increased urine output.

Answer and Explanation

The Correct Answer is B

Choice A rationale

A decreased urge to void is a common postpartum finding due to the effects of anesthesia and the trauma of childbirth. It does not require immediate intervention unless it leads to bladder distention.

Choice B rationale

A displaced fundus from the midline, especially if it is accompanied by a boggy uterus, indicates uterine atony, which can lead to postpartum hemorrhage. Immediate intervention is required to prevent severe blood loss.

Choice C rationale

A fundal height below the umbilicus is an expected finding 1 day postpartum as the uterus begins to involute. This does not require immediate intervention.

Choice D rationale

Increased urine output is common in the postpartum period as the body eliminates excess fluid accumulated during pregnancy. This is not a cause for immediate concern.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice C rationale

Postpartum blues are characterized by tearfulness, insomnia, lack of appetite, and a feeling of letdown. These symptoms are common and usually resolve within a few weeks without medical intervention.

Choice A rationale

The letting-go phase occurs when the woman has assumed responsibility for caring for herself and her infant. It is not associated with the symptoms described.

Choice B rationale

Postpartum fatigue can cause tiredness and lack of energy but does not typically include tearfulness and a feeling of letdown.

Choice D rationale

Postpartum psychosis is a severe mental health condition that includes symptoms such as hallucinations, delusions, and severe mood swings. It is not characterized by the milder symptoms described. .

A. Measure leg circumferences. B. Massage the affected extremity. C. Apply cold compresses to the affected extremity. D. Allow the client to ambulate.

Correct Answer is A

Explanation

Choice A rationale

Measuring leg circumferences is a crucial intervention for a client with thrombophlebitis. This helps in monitoring for any increase in swelling, which can indicate worsening of the condition or the development of complications such as deep vein thrombosis (DVT). Regular measurement allows for early detection and timely intervention.

Choice B rationale

Massaging the affected extremity is contraindicated in clients with thrombophlebitis. Massage can dislodge a thrombus, leading to a potentially life-threatening pulmonary embolism. Therefore, this intervention should be avoided.

Choice C rationale

Applying cold compresses to the affected extremity is not recommended for thrombophlebitis. Cold compresses can cause vasoconstriction, which may worsen the condition by reducing blood flow and increasing the risk of clot formation.

Choice D rationale

Allowing the client to ambulate is not advisable in the acute phase of thrombophlebitis. Ambulation can increase the risk of thrombus dislodgement and subsequent pulmonary embolism. Bed rest with the affected limb elevated is usually recommended until the acute phase resolves.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is collecting data from a client who is 1 day postpartum.Which of the following findings requires immediate intervention by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with the care of a postpartum client who is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown.Which of the following conditions are associated with these manifestations?

Correct Answer is C

Explanation

A nurse is contributing to the plan of care for a client who is postpartum and has thrombophlebitis.Which of the following nursing interventions should the nurse recommend?

Correct Answer is A

Explanation

A nurse is assisting a client out of bed for the first time since delivery.The client becomes frightened when she passes a large amount of lochia.Which of the following responses should the nurse make?

A nurse is collecting data from a client who is postpartum.Which of the following findings should alert the nurse to the possibility of a postpartum complication?

A client who is 7 days postpartum calls the provider’s office and reports pain, swelling, and redness of her left calf.Besides the client seeing the provider, which of the following interventions should the nurse suggest?

A nurse is collecting data from a client who is 1 day postpartum.Which of the following findings requires immediate intervention by the nurse?

A new mother who is bottle feeding says that she is happy to not have to use birth control for several months after having a baby.What should the nurse say in response?

A nurse is collecting data from a client who is 12 hours postpartum following a spontaneous vaginal delivery.The nurse should expect to find the uterine fundus at which of the following positions on the client’s abdomen?

A nurse is caring for a client who is 2 weeks postpartum.The client tells the nurse, “I feel really down and sad lately.I have no energy and I feel like I’m going to cry.”. Which of the following actions should the nurse take first?

A nurse is collecting data from a postpartum client and finds a large amount of lochia rubra with several clots on the client’s perineal pad.Which of the following actions should the nurse take first?

A nurse is collecting data from a client who is 1 day postpartum.
Which of the following findings requires immediate intervention by the nurse?