What information about pain medication should postpartum discharge instructions include?

Correct Answer: A

Rationale: The correct answer is A because narcotic medications commonly cause constipation, a common side effect that postpartum patients should be aware of. It is important to include this information in discharge instructions to ensure patient safety and comfort. Choice B is incorrect because the discontinuation of iron supplements should be discussed with a healthcare provider, not automatically stopped after birth. Choice C is incorrect because some NSAIDs are safe to take while breastfeeding, and this blanket statement may not apply to all medications in this category. Choice D is incorrect because acetaminophen is generally considered safe for postpartum pain relief and should not be avoided without medical guidance.

Correct Answer: D

Rationale: The correct response by the nurse in this scenario is option D: "The physician should see you. Please go to the emergency department." This is the most appropriate because the client's symptoms of heavy bleeding postpartum could indicate a potential complication such as postpartum hemorrhage, which requires immediate medical attention to prevent serious consequences like excessive blood loss, infection, or even death. Option A is incorrect because it is not normal to have heavy bleeding 2 weeks postpartum, and mistaking this for menstruation could delay necessary medical intervention. Option B is also incorrect because complete bed rest is not the appropriate management for postpartum bleeding, which requires medical evaluation. Option C is incorrect as well, as the description of the client's symptoms does not suggest that the bleeding is related to stitches loosening during bowel movements. From an educational perspective, it is crucial for healthcare providers to recognize the signs and symptoms of postpartum complications such as postpartum hemorrhage and understand the urgency of seeking medical care in such cases. This scenario highlights the importance of prompt assessment and intervention in postpartum clients to ensure their safety and well-being. Healthcare professionals must be prepared to act swiftly and decisively in responding to postpartum concerns to optimize outcomes for both the mother and the newborn.

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: B

Rationale: The correct answer is B) Teach sitz bath use on the second postoperative day. Post-cesarean clients experience hormonal changes that affect their physical and emotional well-being. Teaching sitz bath use promotes perineal healing, reduces the risk of infection, and provides comfort. It also encourages self-care and empowers the client in her recovery process. Option A is incorrect as maintaining the client in a left lateral recumbent position is not typically necessary post-cesarean section. Option C is incorrect because performing active range-of-motion exercises may not be suitable immediately post-cesarean due to pain and the need for rest and healing. Option D is incorrect because assessing central venous pressure is not a standard nursing intervention for a post-cesarean client. This procedure is typically reserved for specific medical conditions and not routine postoperative care. Educationally, understanding the rationale behind each option helps nurses develop critical thinking skills in providing individualized care based on the client's needs and condition. It also emphasizes the importance of evidence-based practice in postpartum care.

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.