The nurse is monitoring a client who is 3 hours postpartum. On assessment, the nurse notes a temperature of 102.4°F.
Which action should the nurse prioritize?
Continue to monitor for another hour.
Administer an antipyretic.
Assist the client in ambulation.
Notify the RN; she will notify the provider.
The Correct Answer is D
A postpartum fever is defined as a temperature greater than 100.4 degrees F (38.0 degrees C) on at least two occasions.
These fevers cannot be ignored as they can represent serious infections. The first task is to identify the source.
Choice A is not correct because continuing to monitor for another hour may delay necessary treatment.
Choice B is not correct because administering an antipyretic may only treat the symptom and not address the underlying cause of the fever.
Choice C is not correct because assisting the client in ambulation does not address the underlying cause of the fever.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Radiographs are vital to the diagnosis of Legg-Calve-Perthes disease.
Initial X-rays might look normal because it can take one to two months after symptoms begin for the changes associated with Legg-Calve-Perthes disease to become evident on X-rays.
The doctor will likely recommend several X-rays over time, to track the progression of the disease.
Bone biopsy is not a diagnostic procedure for Legg-Calve-Perthes disease.
MRI can visualize bone damage caused by Legg-Calve-Perthes disease more clearly than X-rays can but are not always necessary.
Genetic testing is not a diagnostic procedure for Legg-Calve-Perthes disease.
Correct Answer is B
Explanation
“6 weeks after fertilization.” Teratogens can begin affecting the developing embryo as early as 10 to 14 days after conception 1.
During embryonic development, there are periods when the developing organ systems show more sensitivity to teratogens.
Choice A is incorrect because 18 weeks after fertilization is not the earliest stage of pregnancy when exposure to a teratogenic agent could occur.
Choice C is incorrect because 12 weeks after fertilization is not the earliest stage of pregnancy when exposure to a teratogenic agent could occur.
Choice D is incorrect because this is not an incomplete question/stem.
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