Nokea
The husband of the postpartum client diagnosed with moderate postpartum depression (PPD) asks the nurse about the treatments his wife will require. The nurse’s response should be based on knowing that which treatments are included in the initial collaborative plan of care? Select all that apply.
- A. Antidepressant medication
- B. Individual or group psychotherapy
- C. Removal of the infant from the home
- D. Sedative-hypnotic agents
- E. Electroconvulsive therapy (ECT)
Correct Answer: A,B
Rationale: SSRIs are first-line agents for treating moderate PPD. Individual or group psychotherapy is a treatment for moderate PPD. If the client is displaying rejection of or aggression toward the infant, she should not be left alone with the infant, but the infant does not need to be removed from the home. Hypnotic agents are medications that promote sleep, but they are not to be used during the postpartum period. If sleep deprivation is occurring, a TCA may be prescribed. ECT would not be used in the initial treatment of moderate PPD. If puerperal psychosis develops, ECT is a treatment option.
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Before hospitalization, an adolescent client had decided to give up her newborn for adoption. The client had an uncomplicated vaginal delivery and is still committed to her decision. Which intervention should the nurse exclude?
- A. Offer to the client a transfer to a different unit within the hospital.
- B. Talk to the client about having possible feelings of ambivalence.
- C. Initiate a case management or social work consult for the client.
- D. Notify her family to ensure that support is available upon her discharge.
Correct Answer: D
Rationale: Offering to transfer the client is appropriate and would not be excluded. The postpartum unit may be filled with sounds and sights that may distress the client. It would be appropriate for the nurse to discuss possible ambivalence with the client, as she may have increased feelings of attachment, love, and grief after delivery. Having those feelings does not necessarily mean that the client has made the wrong decision. Initiating a case management or social work consult is appropriate and would not be excluded. The client may not have support systems available because she may not have disclosed her pregnancy to others. The adolescent may not have disclosed the pregnancy to family. Although it would be appropriate for the nurse to explore the client’s support system with the client, the nurse should not contact the client’s family.
Using Naegele's Rule, the nurse can assume the client's expected delivery date to be approximately which date?
- A. 13-Nov
- B. 23-Nov
- C. 3-Dec
- D. 20-Dec
Correct Answer: C
Rationale: Naegele's Rule: Subtract 3 months from the first day of the last menstrual period (March 13) and add 7 days, resulting in December 3.
Which statement by the client indicates a need for additional teaching regarding chlamydial infection?
- A. My sex partner(s) will require treatment as well.
- B. I will have to have a cesarean birth to protect my baby.
- C. The physician will treat the infection with an antibiotic.
- D. My Pap smear results may show abnormal cells.
Correct Answer: B
Rationale: Chlamydia does not typically require a cesarean birth; antibiotics treat the infection, and partners need treatment to prevent reinfection.
Which instruction is most appropriate for a client with a history of preterm birth?
- A. Monitor for uterine contractions
- B. Avoid prenatal vitamins
- C. Limit fluid intake
- D. Resume normal activity levels
Correct Answer: A
Rationale: Monitoring for uterine contractions is critical for a client with a history of preterm birth to detect early signs of preterm labor.
The clinic nurse reviews the laboratory results illustrated from the postpartum client who is 3 days postdelivery. What should the nurse do in response to these results?
- A. Document the laboratory report findings
- B. Assess the client for increased lochia
- C. Assess the client’s temperature orally
- D. Notify the health care provider immediately
Correct Answer: A
Rationale: The only action required is to document the findings; all values are within expected parameters. Nonpathological leukocytosis often occurs during labor and in the immediate postpartum period because labor produces a mild pro-inflammatory state. WBCs should return to normal by the end of the first postpartum week. Hct and Hgb will begin to decrease on postpartum day 3 or 4 from hemodilution. Assessing the client’s lochia is unnecessary with these results. Assessing the client’s temperature is unnecessary with these results. Notifying the HCP is unnecessary with these results.