A nurse is assessing a 1 day-postpartum client who had a spontaneous vaginal delivery over an intact perineum. The fundus is firm at the umbilicus, lochia moderate, and perineum edematous. One hour after receiving ibuprofen 600 mg po, the client is complaining of perineal pain at level 9 on a 10 point scale. Based on this information, which of the following is an appropriate conclusion for the nurse to make about the client?

Correct Answer: C

Rationale: The correct answer is C) She may have a hidden laceration. In this scenario, the client's complaint of severe perineal pain despite receiving ibuprofen and the presence of edema suggest that there may be an underlying issue such as a hidden laceration that is causing the pain. It is crucial for the nurse to consider this possibility and further assess the client to rule out any complications that may require medical intervention. Option A) She should be assessed by her doctor is incorrect because the nurse should first assess the client herself to determine the cause of the pain before involving the doctor unnecessarily. Option B) She should have a sitz bath is incorrect as a sitz bath may provide comfort but it does not address the underlying issue of severe perineal pain that persists despite pain medication. Option D) She needs a narcotic analgesic is incorrect as the first step should be to investigate the cause of the pain rather than automatically escalating to a stronger pain medication. In an educational context, this question highlights the importance of thorough assessment and critical thinking in postpartum care. It emphasizes the need for nurses to consider all possible causes of a client's symptoms and to prioritize appropriate interventions based on assessment findings rather than jumping to conclusions or treatments. This scenario also underscores the significance of vigilance in detecting potential complications following childbirth, especially in cases where the client's symptoms are not improving as expected.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Foul-smelling lochia. This sign indicates a possible infection, specifically endometritis, which is a common complication postpartum. Rupture of membranes for an extended period increases the risk of infection. Reporting foul-smelling lochia promptly is crucial for early intervention to prevent serious complications like sepsis. Option B) Engorged breasts is a common postpartum occurrence due to increased blood flow and milk production and does not require immediate intervention unless associated with severe pain or signs of mastitis. Option C) Cracked nipples are common breastfeeding issues that can be managed with proper technique and support and do not pose immediate health risks. Option D) Cluster of hemorrhoids is not directly related to the prolonged rupture of membranes and spontaneous vaginal delivery scenario, and while uncomfortable, it does not require immediate intervention. Educationally, understanding the significance of different postpartum signs and symptoms is vital for nurses to provide safe and effective care. Recognizing abnormal findings promptly and taking appropriate actions can prevent complications and promote positive outcomes for both the mother and newborn.

Correct Answer: C

Rationale: In this scenario, the correct answer is option C: Fundus firm at umbilicus. Methergine is a medication commonly used to prevent or control postpartum hemorrhage by promoting uterine contractions. The firmness of the fundus at the level of the umbilicus indicates effective contraction of the uterus, which helps prevent excessive bleeding after childbirth. Option A: Blood pressure 120/80 is not a direct indicator of the effectiveness of Methergine in preventing postpartum hemorrhage. While stable blood pressure is important, it is not a specific indicator of the medication's effectiveness in this context. Option B: Pulse rate 80 bpm and regular is also not a direct indicator of the medication's effectiveness in preventing postpartum hemorrhage. A normal pulse rate is important but does not directly reflect uterine contraction and prevention of hemorrhage. Option D: Increase in prothrombin time is incorrect because an increase in prothrombin time would actually suggest a disturbance in the blood's ability to clot, which is not the desired effect of Methergine in this situation. Educationally, understanding the rationale behind the correct answer helps nurses recognize the appropriate assessment findings to monitor after administering Methergine in postpartum care. This knowledge is crucial for providing safe and effective care to postpartum patients and preventing complications such as postpartum hemorrhage.

Correct Answer: A

Rationale: The correct answer is A) The mother's nipples are soft to the touch. This indicates successful manual expression of breast milk. When the mother is able to express milk manually, it helps in relieving the engorgement, allowing for easier feeding for the baby. Soft nipples suggest effective milk removal from the breasts, improving milk flow and facilitating feeding. Option B) The baby swallows after every 5th suck is incorrect as it does not directly indicate successful manual expression by the mother. It focuses more on the baby's feeding pattern. Option C) The baby's pre- and postfeed weight change is 20 milliliters is incorrect as it pertains to the baby's weight change, not the mother's ability to express milk. Option D) The mother squeezes her nipples during manual expression is incorrect as it describes the action taken by the mother, not the outcome or success of the intervention. In an educational context, this question highlights the importance of recognizing and managing engorgement in breastfeeding mothers to ensure successful breastfeeding. Teaching mothers how to manually express milk can be a crucial skill to alleviate engorgement and improve breastfeeding outcomes for both mother and baby.

Correct Answer: A

Rationale: Placenta accreta is a serious obstetric complication where the placenta attaches too deeply into the uterine wall. In this scenario, the correct answer is A) Blood loss of 2000 mL. Placenta accreta can lead to significant blood loss during delivery due to the abnormal attachment of the placenta, which can cause difficulty in separating it from the uterine wall without excessive bleeding. Option B) Blood pressure of 160/110 is incorrect because while hypertension can be a complication of placenta accreta due to blood loss, it is not a direct result of the condition itself. Option C) Jaundice skin color is incorrect as it is not a typical symptom of placenta accreta. Jaundice is usually associated with liver or hemolytic disorders. Option D) Shortened prothrombin time is incorrect because placenta accreta is more likely to cause coagulation abnormalities resulting in prolonged, not shortened, prothrombin time. In an educational context, understanding the complications associated with placenta accreta is crucial for nurses caring for women during childbirth. Recognizing the signs and symptoms of this condition is essential for timely intervention and preventing severe maternal outcomes. By knowing the correct maternal complications, nurses can provide appropriate care and support to ensure the best possible outcomes for both the mother and the baby.