A client has been receiving magnesium sulfate for severe preeclampsia for 12 hours. Her reflexes are 0 and her respiratory rate is 10. Which of the following situations could be a precipitating factor in these findings?

Correct Answer: B

Rationale: In this scenario, option B, "Urinary output 240 mL/12 hr," is the correct answer as a precipitating factor for the client's findings. A decreased urinary output indicates renal impairment, which can lead to magnesium sulfate toxicity. Magnesium sulfate is used to prevent seizures in severe preeclampsia; however, in excessive amounts, it can depress the central nervous system, causing decreased reflexes and respiratory depression. Option A, "Apical heart rate 104 bpm," is incorrect as it is within the normal range and not directly related to the client's current presentation. Option C, "Blood pressure 160/120," while indicative of hypertension, is not the precipitating factor for the client's decreased reflexes and respiratory rate. Option D, "Temperature 100°F," is also not directly related to the client's symptoms. Educationally, understanding the effects and side effects of medications used in the management of preeclampsia, such as magnesium sulfate, is crucial for nurses and healthcare providers caring for postpartum clients. Monitoring urinary output, reflexes, and respiratory status is essential to prevent and detect potential complications related to medication toxicity.

Correct Answer: D

Rationale: In the postpartum period, it is essential for nurses to be vigilant for signs of puerperal infection, as prompt recognition and treatment are crucial. The correct answer is D) Malodorous lochial discharge. This symptom is indicative of a possible uterine infection, as foul-smelling lochia can be a sign of endometritis, a common puerperal infection. Option A) Temperature of 100.2°F could be seen as a normal finding in the immediate postpartum period due to physiological changes, such as milk coming in, and may not necessarily indicate infection. Option B) White blood cell count of 14,500 cells/mm3 is slightly elevated but not specific to puerperal infection, as WBC count can be elevated post-delivery. Option C) Diaphoresis during the night is a common postpartum symptom due to hormonal shifts and is not a specific indicator of puerperal infection. It is important for nurses to understand the normal postpartum changes to differentiate them from signs of infection to provide appropriate care and intervention for the mother. Educationally, nurses need to be taught to assess and differentiate between normal postpartum occurrences and signs of complications like puerperal infection. Understanding the significance of malodorous lochia as a potential indicator of infection can lead to early intervention, preventing the escalation of complications and promoting the well-being of the postpartum woman.

Correct Answer: C

Rationale: In a 3-week-multigravid postpartum client with postpartum depression, the nurse should expect to observe feelings of failure as a mother. This is the correct answer because postpartum depression often manifests as feelings of inadequacy, guilt, and worthlessness, leading the mother to believe she is not capable of being a good mother. Option A, feelings of infanticide, is incorrect as this is a severe symptom of postpartum psychosis, not postpartum depression. Option B, difficulty with breastfeeding latch, is a common challenge in the postpartum period but is not specifically associated with postpartum depression. Option D, concerns about sibling jealousy, may be a valid concern for some mothers but is not typically a significant behavior seen in postpartum depression. Educationally, understanding the behavioral manifestations of postpartum depression is crucial for healthcare providers to provide appropriate support and interventions for mothers experiencing this condition. By recognizing the signs and symptoms, healthcare professionals can offer timely and effective care to promote the well-being of both the mother and the newborn.

Correct Answer: C

Rationale: The correct answer is C: "The best way to keep your baby from getting sick is for you to keep breastfeeding him rather than switching him to formula." Explanation: Breastfeeding provides the baby with essential antibodies and nutrients that can help protect against illnesses. By continuing to breastfeed, the mother passes on her immune system's defense mechanisms to the baby, reducing the chances of the baby getting sick. Breast milk is a complete source of nutrition and immune protection for infants, making it the best option for their overall health, especially when the mother is sick. Option A is incorrect because while boiling water is important for formula preparation to prevent infections like diarrhea, it is not necessary in this scenario. Option B is incorrect because while pumping breast milk is essential for maintaining milk supply, it is not the best solution in this situation where breastfeeding is still the optimal choice. Option D is unnecessary and may cause unnecessary alarm as wearing a surgical mask is not typically recommended unless the mother is showing symptoms of a contagious illness like the flu. In an educational context, it is crucial to emphasize the importance of breastfeeding for both the baby's and the mother's health. Educating mothers about the benefits of breastfeeding, especially during times of illness, can help them make informed decisions that promote the well-being of their child. It is also essential to provide support and resources to help mothers continue breastfeeding successfully, even during challenging times.

Correct Answer: C

Rationale: In caring for a postoperative cesarean client who is obese and insulin-dependent, it is crucial for the nurse to carefully monitor for wound dehiscence. Rationale for the correct answer (Option C): Wound dehiscence is a serious complication in obese and diabetic patients due to impaired wound healing, increased risk of infection, and compromised tissue integrity. The combination of obesity and diabetes further exacerbates these risks, making wound dehiscence a significant concern that can lead to severe complications if not promptly detected and managed. Rationale for incorrect options: A) Failed lactogenesis: While important for postpartum care, failed lactogenesis is not typically directly related to obesity or diabetes in the immediate postoperative period following a cesarean section. B) Dysfunctional parenting: This is not a physiological complication related to the client's medical conditions or postoperative status. D) Projectile vomiting: While vomiting can be a concern postoperatively, projectile vomiting is not specifically associated with obesity or diabetes in this context. Educational context: Understanding the specific risks and complications associated with obesity and diabetes in the postpartum period is essential for nurses caring for these patients. Monitoring for wound dehiscence, in particular, is critical due to the increased vulnerability of these patients to wound-related complications. Early recognition and intervention can help prevent further issues and promote optimal healing outcomes for the client.