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A nurse on a postpartum unit is caring for a client.

Exhibits

Complete the following sentence by using the lists of options.

The client is most likely experiencing

as evidenced by the client's .
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}

Rationale for Correct Choices

  • Endometritis: This uterine infection is common after cesarean delivery, especially with prolonged rupture of membranes. The client’s uterine tenderness, elevated fundus, boggy consistency, and foul-smelling lochia are hallmark signs of endometritis, making it the most likely diagnosis.
  • Uterus and lochia: The presence of a tender uterus that is elevated above the umbilicus and only firms with massage, combined with dark, malodorous lochia, strongly suggests infection of the uterine lining. These findings point specifically to endometritis rather than general postpartum changes.

Rationale for Incorrect Choices

  • Mastitis: Although the client reports heavy, warm breasts with nipple discomfort, there is no breast erythema, localized swelling, or high-grade fever typical of mastitis. These symptoms are likely due to engorgement related to lactation rather than infection.
  • Pneumonia: The client’s respiratory assessment shows clear lungs with only slight basal changes common postoperatively. There are no signs of cough, sputum production, hypoxia, or respiratory distress, which makes pneumonia an unlikely cause of her symptoms.
  • Fever: A temperature of 38.2°C is above normal, but mild postpartum fever can have various causes, including engorgement, dehydration, or early infection. Fever alone is not specific enough to confirm a diagnosis without targeted findings.
  • WBC count: Although an elevated WBC of 33,000/mm³ raises concern, postpartum leukocytosis can be physiologic or related to many infections. It is not diagnostic of endometritis without more specific correlating signs like uterine tenderness and abnormal lochia.


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Related Questions

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A,B"},"E":{"answers":"A"}}

Explanation

Rationale:

  • Parotid glands: Parotid gland enlargement is a typical finding in clients with bulimia nervosa due to repeated episodes of self-induced vomiting. The recurrent stimulation of salivary glands leads to painless swelling, often bilateral, and may also contribute to facial puffiness or a rounded appearance.
  • Potassium level: A potassium level of 3.0 mEq/L is low and may result from either bulimia nervosa or anorexia nervosa. In bulimia, this is typically due to purging through vomiting or laxative use; in anorexia, it stems from prolonged restriction, dehydration, and possible diuretic misuse. Both conditions increase the risk of cardiac complications.
  • Weight: The client’s weight of 61.8 kg with a BMI of 20.7 falls within the normal range and is more consistent with bulimia nervosa. Individuals with anorexia nervosa usually present with a significantly lower body weight and BMI, typically below 18.5, due to extreme caloric restriction and prolonged starvation.
  • Sodium level: A sodium level of 134 mEq/L is slightly low and can occur in both bulimia nervosa and anorexia nervosa. In bulimia, frequent vomiting may cause sodium loss, while in anorexia, hyponatremia can develop from malnutrition, dehydration, or excessive water intake in attempts to suppress appetite or manipulate weight.
  • Hand findings: Calluses on the index and middle fingers, known as Russell’s sign, are associated with bulimia nervosa. These result from repeated trauma during induced vomiting episodes, as the hand comes into contact with the teeth. This finding is a classic physical sign of chronic purging behavior.

Correct Answer is C

Explanation

Rationale:

A. Hematuria: Blood in the urine can occur with sickle cell disease due to renal papillary necrosis, but it is not specific to acute chest syndrome and does not require immediate emergency action in this context.

B. Sneezing: Sneezing is typically associated with upper respiratory infections or allergies and is not indicative of acute chest syndrome. It is not a critical symptom in this scenario.

C. Substernal retractions: Substernal retractions are a sign of respiratory distress and can indicate acute chest syndrome a life-threatening complication of sickle cell anemia. It involves pulmonary infiltration and can rapidly progress to hypoxia and respiratory failure, requiring urgent intervention.

D. Temperature 37.9° C (100.2° F): While fever in a sickle cell client should be closely monitored and reported, this temperature is low-grade. Alone, it does not immediately signal acute chest syndrome without accompanying respiratory symptoms.

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