A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured spontaneously. The nurse's priority must be to:
Select one:
Prepare the woman for imminent birth
Assess the fetal heart rate and pattern
Notify the woman's primary health care provider
Document the characteristics of the fluid.
The Correct Answer is B
a. This may be necessary once fetal heart rate and pattern have been assessed, but it is not the initial priority.
b. This is the priority as it will help determine the next steps in the management of labor.
c. This may be necessary once fetal heart rate and pattern have been assessed, but it is not the initial priority.
d. This may be done after assessing the fetal heart rate and pattern, but it is not the initial priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
a. A negative rubella titer indicates that the client is not immune to rubella.
b. Rubella vaccine is contraindicated during pregnancy.
c. A negative rubella titer does not indicate whether the client is currently experiencing a rubella infection.
d. A negative rubella titer means that the client does not have antibodies against the rubella virus, which can cause congenital defects in the fetus if the mother gets infected during pregnancy. Therefore, the client should receive the rubella vaccine after delivery, when it is safe to do so.
Correct Answer is B
Explanation
a. While breast self-examination (BSE) can be done at any time, the best time is 5 to 7 days after menses ceases when the breasts are less likely to be tender or swollen.
b. This is the best time for BSE when the breasts are least likely to be tender or swollen.
c. This is not the best time for BSE.
d. This is not the best time for BSE.
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