Editing Maternal and Newborn Nursing – LPN Practice Questions (section)

==Question 7==
An LPN takes vital signs on a client who is 36 hours postpartum and obtains a temperature of 100.8 degrees F (38.2 degrees C). The client's fundus is firm, and she reports mild perineal soreness. What should the LPN do?
# Encourage additional oral fluids and recheck in 4 hours.
# Report the temperature to the registered nurse.
# Document the finding as normal postpartum dehydration.
# Administer an as-needed antipyretic and continue routine care.

'''Answer:''' 2 (B). Report the temperature to the registered nurse.

''Rationale:'' A temperature of 100.4 degrees F (38 degrees C) or higher '''after''' the first 24 hours postpartum suggests puerperal infection and must be reported so the RN can complete a full assessment and notify the provider. Sources of postpartum infection include endometritis, urinary tract infection, wound or episiotomy infection, and mastitis. Option 1 delays evaluation. Option 3 is incorrect because dehydration is only an accepted explanation for a mildly elevated temperature within the '''first''' 24 hours. Option 4 treats a symptom and may mask a developing infection without the RN or provider knowing.