QUESTIONS AND VERIFIED SOLUTIONS
◉ A community health nurse visits a family in which a 16-year-old
unmarried daughter is married with her first child and is at 32 weeks'
gestation. The client tells the nurse that she has been having intermittent
back pain since the night before. What is the priority nursing
intervention?
a. Teach the client how to perform pelvic rock exercises and observe for
correct feedback
b. Determine what physical activities the client has performed in the past
24 hours
c. Ask the clients mother to call an ambulance
d. Ask the client if she has experienced any recent changes in vaginal
discharge. Answer: Ask the client if she has experienced any recent
changes in vaginal discharge
◉ A client with HSV is receiving zidovudine during labor. Which
information should the nurse provide to the client.. Answer: This
treatment helps prevent the transmission of virus to the fetus.
◉ The nurse is preparing to draw blood from a newborn to obtain
hemoglobin and hematocrit levels. What is the best method to obtain this
, blood sample? Answer: Use a lancet to puncture the outer lateral aspect
of the heel
◉ In assessing a client diagnosed with preeclampsia who is receiving
magnesium sulfate, the nurse determines that her deep tendon reflexes
are 1+, respiratory rate is 12 breaths/ minute, urinary output is 90 ml in 4
hours; magnesium sulfate level is 9 mEq/L 4.5 mmo/L. Based on those
findings which intervention should the nurse implement.. Answer: Stop
the magnesium sulfate infusion immediately.
◉ The nurse is assessing a client at 29 weeks gestation. Which
assessment method would provide the most accurate determination of
fetal position.. Answer: Ultrasound
◉ A client in labor states, " I think my water just broke!" The nurse
notes that the umbilical cord is on the perineum. What action should the
nurse perform first? Answer: Place the client in Trendelenburg
◉ A client who is 14 days postpartum arrives to the clinic for a follow
up examination. The nurse is unable to palpate the uterine fundus.
Which action should the nurse take.. Answer: Document the normal
finding.
◉ Following an amniocentesis, the client verbalizes several complaints.
What reported finding indicates to the nurse the client is experiencing a