A client is being assessed for postpartum infection. Which of the following findings should indicate to the healthcare provider that the client requires further evaluation for endometritis?

Correct Answer: B

Rationale: Pelvic pain is a common symptom of endometritis, which is an infection of the uterine lining. It is an important finding that warrants further evaluation. Localized area of breast tenderness may indicate mastitis, vaginal discharge with a foul odor could suggest a vaginal infection, and hematuria points towards a urinary tract issue, but they are not specific to endometritis.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Abruptio placentae. Abruptio placentae is a condition where the placenta partially or completely peels away from the uterine wall before delivery. This can cause severe abdominal pain and vaginal bleeding, which are symptoms the client is experiencing. Let's discuss why the other options are incorrect: A) Placenta previa involves the placenta partially or fully covering the cervix, usually presenting with painless vaginal bleeding. This is not consistent with the client's symptoms of abdominal pain. B) Prolapsed cord is when the umbilical cord descends through the cervix ahead of the baby, which can lead to fetal distress but does not typically cause maternal abdominal pain. C) Incompetent cervix is characterized by painless cervical dilation in the second trimester, not typically causing sudden abdominal pain and bleeding in the third trimester. Educationally, understanding these differential diagnoses is crucial for nurses caring for pregnant clients. Recognizing the signs and symptoms of complications like abruptio placentae is vital for timely intervention, which can significantly impact maternal and fetal outcomes. This case emphasizes the importance of thorough assessment and critical thinking in maternal care to provide safe and effective nursing interventions.

Correct Answer: D

Rationale: In the scenario described, the client is experiencing heavy vaginal bleeding, which is concerning for placenta previa. The appropriate nursing action in this situation is to prepare for a cesarean birth. Placenta previa is a condition where the placenta partially or completely covers the cervix, which can lead to life-threatening bleeding during labor. It is crucial to avoid vaginal examinations or initiation of pushing as these actions can exacerbate bleeding. A magnesium sulfate infusion is not indicated in the management of placenta previa. Therefore, the priority intervention is to prepare for a cesarean birth to ensure the safety of the mother and the baby.

Correct Answer: C

Rationale: Polyhydramnios refers to the presence of an excessive amount of amniotic fluid around the fetus. This condition can result from various causes, such as maternal diabetes, fetal anomalies, or genetic disorders. It can lead to complications during pregnancy and delivery, such as preterm labor, placental abruption, or fetal malpresentation. Understanding this diagnosis is crucial for providing appropriate care and monitoring to ensure the best outcomes for both the mother and the fetus.

Correct Answer: A

Rationale: The correct answer is hyperinsulinemia. In infants born to mothers with poorly controlled diabetes, the excess glucose crosses the placenta, leading to fetal hyperglycemia. This results in fetal hyperinsulinemia, which in turn can cause macrosomia (large birth weight), increasing the risk of respiratory distress syndrome due to the immature lungs' inability to handle the increased workload. Hyperinsulinemia, not increased deposits of fat, brachial plexus injury, or increased blood viscosity, is the most likely cause of respiratory distress in this scenario.