Nokea
A nurse is planning care for a client who is 1 hr postpartum and has peripartum cardiomyopathy. Which of the following actions should the nurse plan to take?
- A. Obtain a prescription for misoprostol.
- B. Assess blood pressure twice daily.
- C. Restrict daily oral fluid intake.
- D. Administer an IV bolus of lactated Ringer's.
Correct Answer: B
Rationale: The correct answer is B: Assess blood pressure twice daily. This is crucial as peripartum cardiomyopathy can lead to heart failure and hypertension, affecting the client's blood pressure. Monitoring blood pressure twice daily allows for early detection of any changes and timely intervention. Obtaining a prescription for misoprostol (A) is not indicated as it is used for preventing gastric ulcers, not related to peripartum cardiomyopathy. Restricting oral fluid intake (C) may worsen the client's condition as adequate hydration is important for cardiac function. Administering an IV bolus of lactated Ringer's (D) could potentially worsen fluid overload and exacerbate heart failure.
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A nurse is calculating the estimated date of delivery for a client who reports that the first day of her last menstrual period was August 10. Using Nägele’s Rule, which of the following is the client’s estimated date of delivery?
- A. May 13
- B. May 17
- C. May 3
- D. May 20
Correct Answer: B
Rationale: The correct answer is B: May 17. Nägele's Rule states to add 7 days to the first day of the last menstrual period, then subtract 3 months, and add 1 year. In this case, August 10 + 7 days = August 17. Subtracting 3 months gives us May 17. This date is the estimated date of delivery. Choice A (May 13) is incorrect as it does not follow Nägele's Rule. Choice C (May 3) is too early based on the calculation. Choice D (May 20) is too late as it exceeds the estimated date.
A nurse is teaching about clomiphene citrate to a client who is experiencing infertility. Which of the following adverse effects should the nurse include?
- A. Breast tenderness
- B. Tinnitus
- C. Urinary frequency
- D. Chills
Correct Answer: A
Rationale: The correct answer is A: Breast tenderness. Clomiphene citrate is a medication commonly used to treat infertility by inducing ovulation. One of its common side effects is breast tenderness due to its estrogenic effects. This occurs as a result of increased estrogen levels associated with the drug. Tinnitus (B), urinary frequency (C), and chills (D) are not typically associated with clomiphene citrate use. Tinnitus is more commonly linked to medications affecting the ear, urinary frequency is not a common side effect of clomiphene citrate, and chills are not a typical adverse effect of this medication.
A nurse is assessing a newborn who has neonatal abstinence syndrome. Which of the following findings should the nurse expect?
- A. Diminished deep tendon reflexes
- B. Excessive crying
- C. Decreased muscle tone
- D. Absent Moro reflex
Correct Answer: B
Rationale: The correct answer is B: Excessive crying. Neonatal abstinence syndrome is characterized by symptoms such as irritability, high-pitched crying, tremors, and poor feeding due to withdrawal from substances the mother used during pregnancy. Excessive crying is a common manifestation of this syndrome. Diminished deep tendon reflexes (A), decreased muscle tone (C), and absent Moro reflex (D) are not typically associated with neonatal abstinence syndrome. These findings may indicate other neurological or developmental issues.
A nurse is assessing a client who is 6 hr postpartum and has endometritis. Which of the following findings should the nurse expect?
- A. Temperature 37.4°C (99.3°F)
- B. WBC count 9,000/mm3
- C. Uterine tenderness
- D. Scant lochia
Correct Answer: C
Rationale: The correct answer is C: Uterine tenderness. Endometritis is characterized by inflammation of the inner lining of the uterus, which results in uterine tenderness. This finding is significant in postpartum clients as it indicates an infection in the uterus. A: Temperature within normal range is not a specific indicator of endometritis. B: WBC count within normal limits is not a specific indicator of endometritis. D: Scant lochia may be present in postpartum clients without endometritis.
The nurse is teaching the client about postpartum depression. The nurse should encourage the client to----------------- and ----------------- to help prevent postpartum depression.
- A. Engage in regular physical activity
- B. Maintain a strong support system
- C. Get adequate rest and sleep
- D. Eat a well-balanced diet
Correct Answer:
Rationale: Correct Answer: C: Get adequate rest and sleep
Rationale:
1. Sleep deprivation is a common trigger for postpartum depression.
2. Adequate rest and sleep help regulate mood and reduce stress levels.
3. Lack of sleep can worsen depressive symptoms.
4. Rest and sleep are essential for physical and emotional recovery postpartum.
Summary:
A: Engaging in physical activity is beneficial but not directly linked to preventing postpartum depression.
B: While a support system is important, it may not solely prevent postpartum depression.
D: Eating a well-balanced diet is crucial for overall health but not the primary focus for preventing postpartum depression.