A nurse is administering a 500 mL bolus of lactated Ringer's for a client who is in labor and has a prescription for spinal anesthesia. Which of the following findings indicates that the IV bolus was effective?
Report of perineal pain as 0 on a scale of 0 to 10.
Increased urinary output.
Blood pressure 110/70 mm Hg.
Report of relief of pruritus.
The Correct Answer is C
Choice A rationale:
Report of perineal pain as 0 on a scale of 0 to 10 is not an indication that the IV bolus was effective. It could be related to the spinal anesthesia, not the IV fluid administration.
Choice B rationale:
Increased urinary output is not a direct indication that the IV bolus was effective. It could be related to other factors such as fluid balance or kidney function.
Choice C rationale:
A blood pressure of 110/70 mm Hg is within the normal range and indicates that the IV bolus was effective in preventing hypotension, which can occur with spinal anesthesia.
Choice D rationale:
Report of relief of pruritus is not an indication that the IV bolus was effective. It could be related to other factors such as medication administration or resolution of an allergic reaction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Removing the diaphragm 2 to 4 hours after intercourse is incorrect because the diaphragm should be left in place for at least 6 hours after intercourse to prevent pregnancy.
Choice B rationale:
Inserting the diaphragm up to 6 hours before intercourse is correct. This allows time for the spermicide to become effective.
Choice C rationale:
Washing the diaphragm with detergent soap between uses is incorrect. Detergent soap can degrade the material of the diaphragm.
Choice D rationale:
Applying a vaginal lubricant to the diaphragm prior to insertion is incorrect. Lubricants can interfere with the effectiveness of the spermicide.
Correct Answer is A
Explanation
Choice A rationale:
Hypnosis can be beneficial if practiced during the prenatal period. It helps the woman to enter labor with a positive mindset and better control over pain.
Choice B rationale:
Hypnosis can indeed work for controlling pain associated with labor when practiced correctly.
Choice C rationale:
Synchronized breathing is not necessarily required during hypnosis. It’s more about focus and relaxation.
Choice D rationale:
Focusing on controlling body functions can be helpful during hypnosis, but it’s not the primary goal of hypnosis.
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