A postoperative cesarean client, who was diagnosed with severe preeclampsia in labor and delivery, is transferred to the postpartum unit. The nurse is reviewing the client's doctor's orders. Which of the following medications that were ordered by the doctor should the nurse question?

Correct Answer: B

Rationale: In this scenario, the nurse should question the order for magnesium sulfate (option B) for the postoperative cesarean client with severe preeclampsia. Magnesium sulfate is commonly used in the management of severe preeclampsia during labor and delivery to prevent seizures (eclampsia). However, once the patient has transitioned to the postpartum unit, magnesium sulfate is typically discontinued unless there are specific ongoing indications. Option A, Methergine, is a medication used to prevent or control postpartum hemorrhage by causing uterine contractions. This medication is commonly ordered post-cesarean to help the uterus contract and prevent excessive bleeding. Option C, Advil (ibuprofen), is a nonsteroidal anti-inflammatory drug that is often prescribed postoperatively for pain relief and inflammation control, which is appropriate for a postoperative patient. Option D, Morphine sulfate, is a potent opioid analgesic that may be ordered for pain management postoperatively, especially after a cesarean delivery. Educationally, it's crucial for nurses to understand the rationale behind medication orders and to be vigilant in assessing the appropriateness of each medication for the specific clinical situation of the patient. In this case, recognizing the transition from labor and delivery to the postpartum unit and understanding the indications for each medication is essential for safe and effective patient care.

Correct Answer: A

Rationale: In this scenario, option A is the correct answer indicating poor mother-infant bonding. The mother's statement of being tired and requesting the baby to be fed in the nursery suggests a lack of interest in caring for the infant, which can be indicative of poor bonding. Option B demonstrates the mother acknowledging the baby's physical features, which shows some level of engagement and recognition of the baby. Option C indicates a positive act of naming the baby after a family member, which reflects a connection and thoughtfulness towards the infant. Option D highlights the mother's effort to breastfeed the baby, showing a willingness to provide care and nurture, although she seeks assistance with swaddling, which is common for new mothers. Educationally, this question highlights the importance of assessing mother-infant bonding in the postpartum period. It emphasizes the need for healthcare providers to be vigilant for signs of poor bonding, as it can impact the overall well-being of both the mother and the baby. Recognizing these signs early allows for timely interventions and support to strengthen the bond between the mother and infant.

Correct Answer: B

Rationale: The correct answer is B) INR (international normalized ratio) of 2.5. In the context of a client on Coumadin post-pulmonary embolism after a cesarean delivery, the INR value of 2.5 indicates that the medication is effective in achieving the desired anticoagulant effect. INR is used to monitor the effectiveness of warfarin therapy, with a target range typically between 2.0 to 3.0 for conditions like pulmonary embolism. Option A (PT of 12 sec) is within the normal range, but PT alone is not as specific or sensitive as the INR for monitoring warfarin therapy. Option C (Hematocrit 55%) and D (Hemoglobin 10 g/dL) are not directly related to monitoring the effectiveness of Coumadin therapy in this scenario. Educationally, understanding the significance of monitoring INR in patients on warfarin is crucial for healthcare professionals managing postpartum clients with thromboembolic complications. This knowledge ensures safe and effective anticoagulant therapy to prevent complications like recurrent thromboembolism. Regular monitoring and interpretation of INR values are essential to adjust the dosage of Coumadin for optimal therapeutic outcomes.

Correct Answer: D

Rationale: In this scenario, the most appropriate intervention regarding infant feeding when a breastfeeding woman needs to undergo a hemorrhoidectomy is to have the baby bottle-fed milk that the mother has stored (Option D). This choice is the best because it ensures that the infant continues to receive the benefits of breastmilk while the mother is temporarily unable to breastfeed due to the surgery. Option A, weaning the baby to formula, is not recommended as it can disrupt the established breastfeeding relationship, reduce the mother's milk supply, and deprive the baby of the unique nutrients and antibodies found in breastmilk. Option B, having the baby stay in the hospital room with the mother, may not be feasible during the postoperative period when the mother may not be able to care for the infant adequately due to her recovery needs. Option C, having the woman pump and dump her milk for two weeks, is unnecessary and can lead to a decrease in the mother's milk supply as breastfeeding works on a supply-demand basis. It also unnecessarily deprives the infant of valuable breastmilk. Educationally, this scenario highlights the importance of considering the well-being of both the mother and the infant in situations where breastfeeding may be temporarily interrupted. It emphasizes the need for healthcare providers to support breastfeeding mothers in maintaining their milk supply and providing breastmilk to their infants even during times of medical interventions.

Correct Answer: B

Rationale: The correct answer is B) Avoid overeating dark green, leafy vegetables. Warfarin is an anticoagulant medication that works by inhibiting vitamin K-dependent clotting factors. Dark green, leafy vegetables are high in vitamin K, which can counteract the effects of warfarin, leading to potential fluctuations in the client's international normalized ratio (INR) levels. Therefore, it is crucial for patients on warfarin therapy to maintain consistent levels of vitamin K intake by avoiding sudden increases or decreases in consumption of these foods. Option A) Take only ibuprofen for pain is incorrect because ibuprofen is not typically contraindicated with warfarin therapy. However, it is essential to monitor for bleeding symptoms due to the combined risk of bleeding associated with both medications. Option C) Drink grapefruit juice daily is incorrect as grapefruit juice can interact with various medications, but it does not have a direct impact on warfarin metabolism or efficacy. Option D) Report any decrease in urinary output is not directly related to warfarin therapy post-pulmonary embolism after a cesarean delivery. While monitoring urine output is important for overall health assessment, it is not specifically pertinent to the management of warfarin therapy in this scenario. In an educational context, teaching patients about the dietary considerations while on warfarin therapy is crucial to ensure the medication's effectiveness and reduce the risk of complications. It is essential for healthcare providers to provide comprehensive education to patients to empower them to manage their condition effectively and avoid potential drug interactions or adverse effects.