Nokea
A client is 1 day post-cesarean section with spinal anesthesia. Even though the nurse advised against it, the client has had the head of her bed in high Fowler's position since delivery. Which of the following complications would the nurse expect to see in relation to the client's action?
- A. Postpartum hemorrhage.
- B. Severe postural headache.
- C. Pruritic skin rash.
- D. Paralytic ileus.
Correct Answer: B
Rationale: High Fowler's position increases the risk of postural headaches.
You may also like to solve these questions
The nurse reviews postpartum discharge instructions regarding sexual health. What information is important to review?
- A. Place nothing in the vagina for 4–6 weeks.
- B. Pregnancy cannot occur until 3 months after birth.
- C. Sexual intercourse can resume after discharge from the facility.
- D. Postpartum persons do not have a need for sexual intimacy.
Correct Answer: A
Rationale: Rationale for Correct Answer (A):
- A: Correct because postpartum women should avoid placing anything in the vagina to prevent infection and allow healing.
- B: Incorrect because ovulation can occur before the first postpartum period.
- C: Incorrect because resuming sexual intercourse should be based on individual healing and comfort, not just discharge.
- D: Incorrect because sexual intimacy is a normal part of relationships and should be discussed postpartum for emotional well-being.
A client who received an epidural for her operative delivery has vomited twice since the surgery. Which of the following prn medications ordered by the anesthesiologist should the nurse administer at this time?
- A. Reglan (metoclopramide).
- B. Demerol (meperidine).
- C. Seconal (secobarbital).
- D. Benadryl (diphenhydramine).
Correct Answer: A
Rationale: Reglan treats nausea.
A breastfeeding mother who is 2 weeks postpartum is informed by her pediatrician that her 4-year-old has chickenpox (varicella). The mother calls the nursery nurse because she is concerned about having the baby in contact with the sick sibling. The mother had chickenpox as a child. Which of the following responses by the nurse is appropriate?
- A. The baby received passive immunity through the placenta
- B. plus the breast milk will also be protective.
- C. The baby should stay with relatives until the ill sibling recovers from the episode of chickenpox.
- D. Chickenpox is transmitted by contact route so careful hand washing should prevent transmission.
Correct Answer: A
Rationale: Maternal antibodies protect the baby, and breast milk enhances immunity.
What physiologic postpartum change occurs because the uterus shrinks in size, resulting in an increase in blood flow?
- A. Edema increases.
- B. Cardiac output increases.
- C. Temperature rises.
- D. Lochia increases.
Correct Answer: B
Rationale: The correct answer is B: Cardiac output increases. As the uterus shrinks in size postpartum, it stimulates an increase in blood flow to the area, leading to an increase in cardiac output to meet the demands. This is a normal physiologic response that helps to prevent excessive bleeding and promote healing. Edema increasing (A) is not directly related to the shrinking uterus. Temperature rising (C) is not a typical postpartum change due to uterine involution. Lochia increasing (D) is not a direct result of uterine shrinkage, but rather a normal discharge after childbirth.
A 40-week-gestation neonate is in the first period of reactivity. Which of the following actions should the nurse take at this time?
- A. Encourage the parents to bond with their baby.
- B. Notify the neonatologist of the finding.
- C. Perform the gestational age assessment.
- D. Place the baby under the overhead warmer.
Correct Answer: A
Rationale: Bonding is encouraged during periods of reactivity.