A nurse is caring for a postpartum client, 2 days after birth. Which of the following expected findings does the nurse associate with the cardiovascular system changes in the postpartum period?
Temperature 99.0°F (37.3°C).
Respiratory rate of 18/min.
WBC 22,000/mm³.
Urinary retention.
The Correct Answer is C
Choice A rationale
A temperature of 99.0°F (37.3°C) is within the normal range and is not specifically associated with cardiovascular system changes in the postpartum period. It is a common finding and does not indicate any specific cardiovascular changes.
Choice B rationale
A respiratory rate of 18/min is within the normal range for adults and is not specifically associated with cardiovascular system changes in the postpartum period. It is a common finding and does not indicate any specific cardiovascular changes.
Choice C rationale
An elevated white blood cell (WBC) count of 22,000/mm³ is a common finding in the postpartum period due to the body’s response to the stress of childbirth. This leukocytosis is a normal physiological response and is associated with the cardiovascular system changes during this period.
Choice D rationale
Urinary retention is not specifically associated with cardiovascular system changes in the postpartum period. It can occur due to various reasons, including the effects of anesthesia or trauma during delivery, but it is not a direct result of cardiovascular changes.
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Correct Answer is D
Explanation
Choice A rationale
Pumping out the milk when breasts become engorged can provide temporary relief, but it can also stimulate further milk production, leading to continued engorgement. This is not recommended for clients who are not planning to breastfeed.
Choice B rationale
Not wearing a bra throughout the day can lead to discomfort and inadequate support for engorged breasts. Wearing a supportive bra, such as a sports bra, can help alleviate discomfort and provide necessary support.
Choice C rationale
Applying hot packs to the breasts can increase blood flow and exacerbate engorgement. Cold packs or ice packs are recommended to reduce swelling and provide relief from discomfort.
Choice D rationale
Avoiding stimulation to the nipples is an effective measure to reduce milk production and alleviate breast engorgement. This includes avoiding activities that may stimulate the nipples, such as pumping or hand expressing milk.
Correct Answer is C
Explanation
Choice A rationale
Long-acting reversible contraceptives, like an intrauterine device (IUD), are highly effective in preventing pregnancy. This statement is accurate and does not indicate a need for additional education.
Choice B rationale
Breastfeeding is not a form of contraception. This statement is correct as breastfeeding alone is not a reliable method of preventing pregnancy.
Choice C rationale
The statement “I will begin to use a barrier method after I start my first menstrual cycle” indicates a need for additional education. Ovulation can occur before the first postpartum menstrual cycle, so contraception should be used as soon as sexual activity resumes.
Choice D rationale
The withdrawal method is not very effective at avoiding pregnancy. This statement is accurate and does not indicate a need for additional education.