Author Question: The most appropriate nursing action for the client complaining of continuous headache 24 hours ... (Read 36 times)

MGLQZ · **on:** Jun 28, 2018

The most appropriate nursing action for the client complaining of continuous headache 24 hours postpartum after a normal vaginal birth is to:

a. encourage bed rest.
b. administer analgesic.
c. assess blood pressure.
d. assess for pitting edema.

Question 2

A high-risk labor client progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean section.

Which finding in the immediate postoperative period indicates that the client is at risk of developing HELLP syndrome?

a. Platelet count of 50,000/mL
b. Liver enzyme levels within normal range
c. Negative for edema
d. No evidence of nausea or vomiting

djofnc · **Reply #1 on:** Jun 28, 2018

Answer to Question 1

ANS: C
The first indication of preeclampsia is usually hypertension. Continuous headache indicates poor cerebral perfusion and may be a precursor of seizures; encouraging bed rest, administering an analgesic, and assessing for edema are not interventions to determine the source of the client's headache.

Answer to Question 2

ANS: A
HELLP syndrome is characterized by hemolysis, elevated liver enzyme levels, and a low platelet count. A platelet count of 50,000/mL indicates thrombocytopenia.