A postpartum woman who delivered 24 hours ago denies excessive bleeding, pain, or burning.
She states she has not had a bowel movement since before delivery and that she has been "urinating so much over the past several hours.”. Which response by the nurse would be most appropriate?
"It's likely you have an infection. Let me get an order for a complete blood count and urine specimen.”.
"The anesthesia that you received is wearing off and your bladder is working again.”.
"Diuresis is a sign of postpartum hemorrhage. Let me assess your bleeding right now.”.
"It's a result of hormonal changes that cause the body to eliminate excess fluids accumulated during pregnancy.”. —
The Correct Answer is D
Choice A rationale
While postpartum women are at risk for infection, particularly endometritis or urinary tract infection (UTI), the described symptoms are not primarily suggestive of an established infection. Excessive urination (diuresis) is a normal physiological process in the puerperium, not a sign of infection. A complete blood count and urine specimen would be indicated if the patient had signs like fever (normal range 97.8-100.4°F), foul-smelling lochia, or dysuria, which are absent here.
Choice B rationale
General anesthesia can cause temporary bladder atony, leading to urinary retention, not diuresis. However, most women who deliver vaginally do not receive general anesthesia, and while regional anesthesia (e.g., epidural) can affect bladder sensation, the return of sensation would not immediately cause "urinating so much.”. Diuresis is primarily driven by fluid volume and hormonal changes, not solely by the wearing off of anesthesia.
Choice C rationale
Diuresis, defined as increased or excessive production of urine, is a normal and expected physiologic process beginning within 12 hours postpartum. It serves to eliminate the significant amount of extracellular fluid (up to 3000 mL) accumulated during pregnancy, not a sign of postpartum hemorrhage (PPH). PPH is indicated by heavy, excessive bleeding, boggy fundus, and often signs of hypovolemic shock.
Choice D rationale
This response is correct because postpartum diuresis is a natural physiological process caused by the reduction in plasma volume and the elimination of 2,000-3,000 mL of accumulated extracellular fluid. The decrease in pregnancy hormones, particularly estrogen and progesterone, and the excretion of retained sodium and water help return the maternal fluid balance to its non-pregnant state, resulting in increased urination. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The newborn metabolic screening (often called the heel stick test or tandem mass spectrometry) checks for dozens of inborn errors of metabolism and other genetic disorders, such as Phenylketonuria (PKU), congenital hypothyroidism, and Sickle Cell Disease. These are often asymptomatic at birth but cause severe, irreversible intellectual disability, organ damage, or death if not detected and treated early, often with simple dietary or hormonal interventions.
Choice B rationale
The newborn metabolic screening is distinct from a bilirubin test, which is performed to assess the risk of jaundice (hyperbilirubinemia). While bilirubin levels are often checked in the first 24-48 hours, the metabolic screen is a separate test that detects disorders caused by enzyme deficiencies or abnormal protein production, not bilirubin accumulation.
Choice C rationale
While data from screening programs contributes to public health research, the primary and mandatory purpose of newborn metabolic screening is clinical—to identify babies who have serious, preventable conditions. State laws mandate these screenings for the direct health benefit of the individual newborn, making participation non-voluntary in most places.
Choice D rationale
The metabolic screening tests for genetic and metabolic conditions, and endocrine disorders (like congenital hypothyroidism), but it is not a primary or direct test for the normal development of the newborn's immune system. Disorders specifically affecting the immune system, such as Severe Combined Immunodeficiency (SCID), are sometimes included in the expanded panels, but the test's scope is much broader.
Correct Answer is ["4.7"]
Explanation
Step 1 is: Convert infant weight from pounds to kilograms: 2.5 pounds÷ 2.2 pounds/kg = 1.13636 kg.
Step 2 is: Calculate the total daily fluid requirement in milliliters: 100 mL/Kg× 1.13636 kg = 113.636 mL/day.
Step 3 is: Calculate the hourly fluid rate in milliliters per hour: 113.636 mL/day÷ 24 hours/day = 4.7348 mL/hour.
Step 4 is: Round to the nearest tenth place: 4.7 mL/hour. The final calculated answer is 4.7. —.
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