A nurse is collecting data from a client who is 2 days postoperative following a cesarean birth. Which of the following findings should the nurse report to the provider?

Left calf tenderness

Moderate lochia rubra

Urine output of 3,000 mL

Breast engorgement

Answer and Explanation

The Correct Answer is A

A.   Left calf tenderness can be a sign of deep vein thrombosis (DVT), which is a serious postoperative complication and should be reported to the provider.
B.   Moderate lochia rubra is an expected finding after a cesarean birth.
C.   A urine output of 3,000 mL is within normal range and does not warrant immediate reporting to the provider.
D.   Breast engorgement is an expected finding in the postpartum period, especially if the client is not breastfeeding. It does not require immediate reporting.

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Correct Answer is C

Explanation

A. Gingivitis is common during pregnancy and should be addressed but is not as urgent as dysuria.
B. Varicose veins, while uncomfortable, are not an immediate priority.
C. Dysuria (painful or difficult urination) can be a sign of a urinary tract infection, which is a concern during pregnancy. Prompt reporting and treatment are essential to prevent
complications.
D. Leukorrhea (an increase in vaginal discharge) is common in pregnancy and is not a cause for immediate concern.

A. “This infection can cause your baby to experience hearing loss at birth." B. “If you test positive for GBS, the provider will need to perform a cesarean birth." C. "You will be tested again for GBS at about 36 weeks of gestation." D. "You will take an antibiotic during the last 2 weeks of pregnancy to avoid transferring GBS to your baby."

Correct Answer is C

Explanation

A: This infection does not directly cause hearing loss at birth. Hearing loss in newborns can be associated with genetic factors, birth complications, and certain infections, but GBS is not known to be a direct cause of hearing impairment.

B: A positive GBS test result does not necessitate a cesarean birth. The standard management for GBS-positive mothers is the administration of intrapartum antibiotic prophylaxis, not cesarean delivery, unless there are other obstetric indications.

C: Testing for GBS is typically done between 36 and 37 weeks of gestation because this timing is close to delivery, when the test results are most predictive of the baby's risk of exposure during birth.

D: Antibiotics are not given during the last 2 weeks of pregnancy to prevent GBS transmission. Instead, they are administered during labor to ensure effective levels of the drug during delivery, which is the critical period for preventing transmission to the baby.

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A nurse is collecting data from a client who is 2 days postoperative following a cesarean birth. Which of the following findings should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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