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Exhibits

The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet.

Select the findings that will help the nurse determine what is causing the client's symptoms.

Rupture of membranes for 16 hours

Normal spontaneous vaginal birth

Breastfeeding 7 to 8 times a day for 10 minutes

Discharge hemoglobin of 9.2 g/dL (92 g/L)

Current vital signs

Shopping yesterday for 5 hours

Foul-smelling lochia rubra

Answer and Explanation

Correct Answer : A,D,E,F,G

A.   Rupture of membranes for 16 hours – The risk of postpartum infection, particularly endometritis, increases with prolonged rupture of membranes because bacteria can ascend into the uterus after the amniotic sac is broken. Although infection risk is higher after 18 hours, 16 hours still poses a concern, especially when combined with other signs of infection.
B.   Normal spontaneous vaginal birth – A vaginal delivery is a routine event that does not inherently increase the risk of infection unless complicated by prolonged labor, excessive blood loss, or retained placental fragments. While it is relevant to the patient’s history, it does not directly contribute to the current symptoms.
C.   Breastfeeding 7 to 8 times a day for 10 minutes – While frequent nursing can sometimes contribute to sore nipples, it does not directly indicate an infection unless there are additional signs of inadequate emptying or poor latch.
D.   Discharge hemoglobin of 9.2 g/dL (92 g/L) – A postpartum hemoglobin level lower than 11 g/dL suggests anemia, which can lead to fatigue, dizziness, and a weakened immune response. While anemia does not directly cause infection, it can contribute to the client’s symptoms of fatigue and dizziness and make it harder for the body to fight infections.
E.   Current vital signs – The presence of fever (101.2°F/38.4°C) and tachycardia (105 beats/min) indicates a systemic inflammatory response, strongly suggesting an active infection. Given the combination of fever, chills, and breast tenderness, mastitis is a likely concern. Additionally, the foul-smelling lochia raises suspicion for endometritis.
F.   Shopping yesterday for 5 hours – Being away from the baby for an extended period may have led to milk stasis, increasing the risk of mastitis. When milk is not regularly emptied, bacterial overgrowth can occur, leading to inflammation and infection, which aligns with the red, warm, firm area on the breast.
G. Foul-smelling lochia rubra – Lochia rubra persisting at two weeks postpartum, particularly with a foul odor, is a classic sign of endometritis, a postpartum uterine infection. Normal postpartum bleeding transitions from rubra to serosa, and foul-smelling discharge indicates bacterial overgrowth in the uterus, requiring prompt antibiotic treatment.

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

Explanation

Mastitis: Mastitis is an infection of breast tissue that occurs when milk stasis leads to bacterial overgrowth, usually caused by Staphylococcus aureus. The client's firm, red, warm area on the breast, fever (101.2°F), chills, body aches, and fatigue all strongly indicate mastitis rather than other breast conditions.
Engorgement: Engorgement occurs when the breasts overfill with milk, leading to swelling and tenderness. However, engorgement typically affects both breasts, does not cause fever or flu-like symptoms, and resolves with regular breastfeeding or pumping.
Blocked milk duct: A clogged duct occurs when milk flow is obstructed, leading to a tender lump in the breast. While a blocked duct can progress to mastitis, it does not cause fever or systemic symptoms unless infection develops. The presence of fever and flu-like symptoms in this client suggests mastitis, not just a blocked duct.
Inflammatory breast cancer: This rare but aggressive form of breast cancer causes redness, swelling, and skin thickening, but it is not associated with fever or acute symptoms like mastitis. It does not develop suddenly but rather progresses over time, making mastitis the more likely diagnosis in this case.
Abscess: If mastitis is not treated promptly, it can lead to a breast abscess, a localized collection of pus requiring drainage. Signs of progression to an abscess include fluctuant swelling, worsening pain, and persistent fever despite antibiotic treatment.
Breastfeeding intolerance: Mastitis can cause temporary discomfort during breastfeeding, but it does not lead to true breastfeeding intolerance. In fact, continued breastfeeding helps resolve mastitis by improving milk drainage.
Nipple thrush: Nipple thrush (Candida infection) causes burning pain and white patches in the infant’s mouth but is not a complication of mastitis, which is bacterial, not fungal.
Postpartum haemorrhage: Postpartum hemorrhage is caused by uterine atony, retained placenta, or coagulation disorders, not mastitis. Mastitis is localized to the breast and does not affect uterine bleeding.

A. 3.3 mL B. 1.9 mL C. 5.0 mL D. 0.8 mL

Correct Answer is A

Explanation

A. 3.3mL: The correct dose for infants is 10–15 mg/kg every 4–6 hours. If the infant weighs 7 kg, the correct dose is:Minimum dose: 10 mg × 7 kg = 70 mg. Maximum dose: 15 mg × 7 kg = 105 mg. Since the standard concentration is 160 mg/5 mL, the correct volume for 105 mg is 3.3 mL, making it the most appropriate dose.
B. 1.9 mL: This provides only about 61 mg of acetaminophen, which is below the recommended 10 mg/kg minimum dose, making it potentially ineffective.
C. 5.0 mL: This equates to 160 mg of acetaminophen, which exceeds the safe dose range for most infants, increasing the risk of liver toxicity.
D. 0.8 mL: This would provide only about 26 mg of acetaminophen, which is severely underdosed and unlikely to provide adequate pain relief.

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Exhibits The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet. Select the findings that will help the nurse determine what is causing the client's symptoms.

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Naxlex Comprehensive Predictor Exams

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

Explanation

Exhibits The nurse is reviewing the prescription and planning the appropriate pain management. Complete the following sentence by choosing from the lists of options. For best pain management, the nurse should give... of acetaminophen every 4 hours as scheduled.

Correct Answer is A

Explanation

Exhibits For each assessment finding, click to indicate whether findings from this client's assessment are generally associated with mastitis, endometritis, or could be a sign of both conditions. Each row must have only one response option selected.

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A child who weighs 25 kg receives a prescription for isoniazid 10 mg/kg/day by mouth once a day. The bottle is labeled "Isoniazid Oral Solution, USP 50 mg per 5 mL." How many mL should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest whole number.)

Albumin 25% IV is prescribed for a child with nephrotic syndrome. Which assessment finding indicates to the nurse that the medication is having the desired effect?

Exhibits Which description(s) by the client should help confirm that the mastitis has been resolved and breastfeeding/breast health is well maintained? Select all that apply.

Exhibits Review H and P, and nurse's note. Which action(s) is/are appropriate for the nurse caring for this child? Select all that apply.

An 8-year-old girl with precocious sexual development is being treated medically with injections of luteinizing hormone-releasing hormone (LHRH) to regulate the pituitary gland. Which statement by the parents indicates that they understand the treatment?

Exhibits

The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet.

Select the findings that will help the nurse determine what is causing the client's symptoms.