Nokea
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.
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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.
The client, who is 12 days postpartum, telephones the clinic and tells the nurse that she is concerned that she may have an infection because her vaginal discharge has been creamy white for two days now. Which response by the nurse is correct?
- A. “You need to come to the clinic as soon as possible.”
- B. “You’ll need an antibiotic; which pharmacy do you use?”
- C. “Take your temperature and let me know if it is elevated.”
- D. “A creamy white discharge 10 days postpartum is normal.”
Correct Answer: D
Rationale: There is no need to be seen in the clinic; vaginal discharge that turns creamy white 10 days postpartum is normal. The client does not have an infection, and no antibiotic is necessary. There is no reason to take her temperature when the discharge is normal. Creamy white discharge 10 to 21 days postpartum is normal. Her lochia changed color on her 10th postpartum day.
The pregnant client tells the nurse that she smokes two packs per day (PPD) of cigarettes, has smoked in other pregnancies, and has never had any problems. What is the nurse’s best response?
- A. “I’m glad that your other pregnancies went well. Smoking can cause both maternal and fetal problems, and it is best if you could quit smoking.”
- B. “You need to stop smoking for the baby’s sake. You could have a spontaneous abortion with this pregnancy if you continue to smoke.”
- C. “Smoking can lead to having a large baby, which can make delivery difficult. You may even need a cesarean section.”
- D. “Smoking less would eliminate the risk for your baby, and you would feel healthier during your pregnancy.”
Correct Answer: A
Rationale: The nurse is acknowledging that the client did not experience problems with her other pregnancies but is also informing the client that smoking can cause maternal and fetal problems during pregnancy. Telling the client to stop smoking for the baby’s sake is confrontational, making the client less likely to listen to the nurse’s teaching. Although spontaneous abortion is associated with tobacco use during pregnancy, the nurse is using a scare tactic rather than therapeutic communication. Smoking can lead to a fetus that is small for gestational age, not a large baby. Decreasing her smoking intake should be suggested; however, it does not eliminate the risk to the baby completely.
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.