A nurse is caring for the following four laboring patients. Which client should the nurse be prepared to monitor closely for signs of postpartum hemorrhage (PPH)? Select one that doesn't apply

Correct Answer: D

Rationale: In this scenario, option D is the correct answer. The nurse should be prepared to monitor client D closely for signs of postpartum hemorrhage (PPH) due to the risk factors associated with delivering a large-for-gestational-age baby at 42 weeks. Postpartum hemorrhage is more common in women who have delivered larger babies due to potential uterine atony or inability of the uterus to contract effectively after delivery. Additionally, the prolonged gestation increases the risk of uterine atony and subsequent PPH. Option A can be eliminated because delivering a fetal demise at 29 weeks does not typically increase the risk of PPH. Option B, a prolonged first stage of labor, may lead to exhaustion but is not a direct risk factor for PPH. Option C, a cesarean section for failure to progress, does not inherently increase the risk of PPH unless there are complications during or after the surgery. Educationally, understanding the risk factors for postpartum hemorrhage is crucial for nurses caring for laboring patients. By recognizing the factors that can contribute to PPH, nurses can provide appropriate monitoring, interventions, and support to prevent or manage this potentially life-threatening complication effectively.

Correct Answer: B

Rationale: In this scenario, the highest priority nursing diagnosis is B) Infection. The client's presentation with a hard, red, warm nodule in the breast, elevated temperature, history of mastitis, and severe pain indicates a potential breast infection, which requires immediate attention to prevent further complications like abscess formation or sepsis. Option A) Ineffective breastfeeding is incorrect as the primary concern here is addressing the infection to ensure the client's health and safety. Option C) Ineffective individual coping may be a secondary concern once the infection is under control. Option D) Pain is important, but treating the underlying infection takes precedence. Educationally, it is crucial for nurses to prioritize nursing diagnoses based on the urgency of the client's condition. Understanding the signs and symptoms of infections like mastitis in breastfeeding clients is essential for early identification and intervention to prevent serious complications. Nurses must be prepared to act swiftly in cases of suspected infections to provide appropriate care and support to their clients.

Correct Answer: A

Rationale: In the postpartum period, uterine atony can lead to excessive bleeding and poses a risk for injury to the mother. Massaging the atonic uterus helps to promote uterine contractions and prevent further bleeding. The correct answer, option A) Moderate lochia flow, indicates an improvement in the client's condition. Lochia is the postpartum vaginal discharge containing blood, mucus, and uterine tissue. A moderate flow suggests that the uterus is contracting effectively to control bleeding. Option B) Decreased pain level, while important for the client's comfort, does not directly indicate an improvement in uterine atony. Option C) Stable blood pressure is a crucial parameter to monitor but may not specifically reflect the resolution of uterine atony. Option D) Fundus above the umbilicus is actually a concerning finding as it suggests uterine atony as the fundus should be firm and at or below the level of the umbilicus in the immediate postpartum period. Educationally, understanding the significance of uterine atony and its management postpartum is vital for nurses caring for postpartum clients. Recognizing the signs of uterine atony, implementing appropriate interventions like uterine massage, and evaluating outcomes such as lochia flow are essential skills in preventing postpartum complications.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Reglan (metoclopramide). Reglan is a prokinetic agent that helps to increase gastric motility and reduce nausea and vomiting. In the case of the client who received an epidural for her operative delivery and has vomited twice since the surgery, Reglan would be the most appropriate medication to administer to help alleviate her symptoms. Option B) Demerol (meperidine) is a narcotic analgesic and is not indicated for treating nausea and vomiting. Option C) Seconal (secobarbital) is a barbiturate that is used for sedation and anxiety, not for managing nausea and vomiting. Option D) Benadryl (diphenhydramine) is an antihistamine that can help with allergies and insomnia but is not the best choice for treating postoperative nausea and vomiting. From an educational perspective, it is important for nurses to understand the rationale behind selecting the appropriate medication for managing common postpartum complications like nausea and vomiting. By knowing the pharmacological actions of different medications, nurses can provide safe and effective care to their postpartum clients. Understanding the correct use of medications in specific clinical situations is crucial for promoting positive patient outcomes and ensuring patient safety.

Correct Answer: A

Rationale: The correct answer is A) The woman should never be left alone with her infant. Postpartum psychosis is a severe condition that can lead to irrational thoughts and behaviors, including harm to oneself or the infant. It is crucial to ensure the safety of both the mother and the baby. Leaving the woman alone with her infant can pose a serious risk, so constant supervision and support are essential. Option B is incorrect because symptoms of postpartum psychosis can last much longer than one week. This condition requires immediate attention and ongoing treatment to ensure the well-being of the mother and her child. Option C is incorrect because clinical response to medications can vary from individual to individual. While medications may be a part of the treatment plan, they are not a guarantee of poor response. Option D is incorrect as vital sign assessments every two days may not be sufficient for monitoring the well-being of a woman with postpartum psychosis. Close monitoring and support are crucial in managing this condition effectively. Educationally, it is important for families to understand the seriousness of postpartum psychosis and the precautions needed to ensure the safety of both the mother and the infant. Providing this information can help families support the woman in getting the necessary treatment and care.