A nurse is providing care for a group of postpartum clients. Which of the following clients should the nurse see first?

A client who is 4 hr postpartum and has a heart rate of 90/min

A client who is 4 days postpartum and has a WBC count of 18,000/mm3 (5,000 to 10,000/mm3)

A client who is 12 hr postpartum and has an oral temperature of 37.8° C (100° F)

A client who is 2 days postpartum and reports dysuria

Answer and Explanation

The Correct Answer is B

Rationale:

A. A client who is 4 hr postpartum and has a heart rate of 90/min: A heart rate of 90/min is within normal postpartum limits. This client is stable and does not require immediate assessment, making them a lower priority compared to clients showing signs of possible infection or complications.

B. A client who is 4 days postpartum and has a WBC count of 18,000/mm³ (5,000 to 10,000/mm³): An elevated WBC count 4 days postpartum can indicate a serious infection, such as endometritis or another postpartum infection. This client is at risk for rapid deterioration and requires immediate assessment and intervention.

C. A client who is 12 hr postpartum and has an oral temperature of 37.8° C (100° F): A mild temperature elevation shortly after birth can be expected due to normal postpartum physiologic changes. While it should be monitored, it is not as urgent as the markedly elevated WBC count indicating potential infection.

D. A client who is 2 days postpartum and reports dysuria: Dysuria may indicate a urinary tract infection, which requires evaluation, but this is less immediately threatening than a client with signs of systemic infection. This client should be assessed after clients with potential severe infection or hemodynamic instability.

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Correct Answer is D

Explanation

Rationale:

A. Provide 60 mL (2 oz) of fluid intake every 5 min.: Following gastric bypass surgery, the stomach pouch is very small and cannot tolerate large or frequent volumes. Giving 60 mL every 5 minutes places the client at high risk for nausea, vomiting, dumping syndrome, and anastomotic complications. Fluid intake must be introduced slowly in small sips.

B. Ambulate the client 48 hr after the procedure.: Early ambulation is essential to prevent postoperative complications such as atelectasis, venous thromboembolism, and delayed return of bowel function. Waiting 48 hours is too long; clients should begin ambulating on the day of surgery or within the first 24 hours to promote circulation.

C. Provide a soft diet on the first postoperative day.: After gastric bypass surgery, the digestive system needs time to heal and cannot tolerate solid or semi-solid foods. Clients begin with clear liquids and progress gradually to pureed, soft, and then solid diets over several weeks.

D. Measure and compare abdominal girth daily.: Monitoring abdominal girth helps detect postoperative complications such as internal bleeding, leaks, or ileus, which may present with distention or increased abdominal size. Regular measurement provides early recognition of changes that require prompt intervention.

A. 61-year-old male B. Has smoked 1 pack of cigarettes per day for 40 years. C. History of hyperlipidemia. D. Walks at least a mile three times a week. E. Reports drinking two to three beers each evening F. Client reports he follows the Dietary Approaches to Stop Hypertension (DASH) diet. G. Biological father has a history of hyperlipidemia and hypertension. H. Biological mother has history of renal failure requiring dialysis. I. BMI 30.5

Correct Answer is ["A","B","C","E","G","H","I"]

Explanation

Rationale for correct choices

• 61-year-old male: Advanced age and male sex increase the risk of cardiovascular complications such as coronary artery disease, heart failure, and stroke. Aging contributes to arterial stiffness, reduced cardiac reserve, and higher likelihood of comorbidities, all of which elevate the risk profile for this client.

• Has smoked 1 pack of cigarettes per day for 40 years: Chronic smoking is a major modifiable risk factor for atherosclerosis, myocardial infarction, stroke, and peripheral arterial disease. Long-term tobacco use promotes endothelial damage, increases LDL cholesterol, and impairs oxygen delivery, significantly increasing cardiovascular risk.

• History of hyperlipidemia: Elevated cholesterol and triglycerides predispose the client to plaque formation in arteries, contributing to atherosclerosis and cardiovascular disease. Hyperlipidemia is a key risk factor for complications such as myocardial infarction and stroke, especially when combined with other comorbidities.

• Reports drinking two to three beers each evening: Excessive alcohol consumption contributes to hypertension, cardiomyopathy, and arrhythmias. Chronic alcohol intake can also exacerbate hyperlipidemia and increase the risk of liver disease, compounding cardiovascular and systemic complications.

• BMI 30.5: A BMI above 30 classifies the client as obese, which increases the risk for hypertension, type 2 diabetes, heart disease, and stroke. Obesity contributes to metabolic syndrome and further stresses the cardiovascular system, making the client more prone to complications.

• Family history: Biological father with hyperlipidemia and hypertension, Biological mother with renal failure: A strong family history of cardiovascular and renal disease increases the client’s genetic susceptibility to these conditions. Inherited risk factors, when combined with lifestyle factors, significantly elevate the likelihood of developing complications such as heart failure, chronic kidney disease, or stroke.

Rationale for incorrect choices

• Walks at least a mile three times a week: Regular physical activity is protective, not a risk factor, for cardiovascular and metabolic complications. Exercise helps improve lipid profile, blood pressure, and overall cardiovascular health, mitigating some of the client’s other risk factors.

• Client reports he follows the DASH diet: Adhering to the DASH diet is a positive lifestyle behavior that reduces blood pressure, supports heart health, and lowers the risk of stroke or heart disease. It is not a risk factor; rather, it is a mitigating factor against cardiovascular complications.

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A nurse is providing care for a group of postpartum clients. Which of the following clients should the nurse see first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is returning to the unit following open gastric bypass surgery. Which of the following interventions should the nurse include in the client's plan of care?

Correct Answer is D

Explanation

Correct Answer is ["A","B","C","E","G","H","I"]

Explanation

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