A nurse is receiving report on four postpartum clients. Which of the following clients should the nurse plan to attend to first?

A client who reports changing their perineal pad every 4 hr.

A client who has a urine output of 750 mL in 6 hr.

A client who has 1+ deep tendon reflexes while receiving IV magnesium sulfate.

A client who reports abdominal cramping pain during breastfeeding.

Answer and Explanation

The Correct Answer is A

A. Changing a perineal pad only every 4 hours may indicate excessive bleeding or hemorrhage, which requires immediate assessment.
B. A urine output of 750 mL in 6 hours is within normal limits (about 125 mL/hr).
C. 1+ deep tendon reflexes indicate decreased reflexes, which is expected during magnesium sulfate therapy and generally not an immediate concern.
D. Abdominal cramping during breastfeeding is common due to uterine contractions and is usually not urgent.

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Correct Answer is D

Explanation

A. Breastfeeding is not contraindicated in mothers with hepatitis B if the newborn receives appropriate prophylaxis.
B. Airborne precautions are not necessary; hepatitis B is transmitted through blood and body fluids, not airborne droplets.
C. Bathing the newborn does not affect hepatitis B transmission risk and does not need to be delayed.
D. Administering hepatitis B immune globulin (HBIG) IM to the newborn within 12 hours of birth, along with the first dose of the hepatitis B vaccine, is essential to prevent vertical transmission of hepatitis B virus.

A. Inactivated influenza B. Human papillomavirus C. Measles, mumps, and rubella D. Varicella E. Diphtheria acellular pertussis

Correct Answer is ["A","E"]

Explanation

A. Inactivated influenza vaccine is safe and recommended during pregnancy to protect both mother and fetus.
B. Human papillomavirus (HPV) vaccine is not recommended during pregnancy.
C. Measles, mumps, and rubella (MMR) vaccine is a live vaccine and contraindicated during pregnancy.
D. Varicella vaccine is live and contraindicated during pregnancy.
E. The Tdap vaccine (diphtheria, acellular pertussis, tetanus) is recommended during each pregnancy, ideally between 27 and 36 weeks gestation to protect the newborn from pertussis.

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A nurse is receiving report on four postpartum clients. Which of the following clients should the nurse plan to attend to first?

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Naxlex Comprehensive Predictor Exams

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