A nurse is assisting in the care of a client who is in active labor and is to undergo an amniotomy. Which of the following actions should the nurse take? (Move the steps into the box, placing them in the order of performance. Use all the steps.)
Obtain a baseline reading of the FHR and contraction pattern.
Document the procedure in the electronic medical record.
Pass the sterile hook to the provider.
Position the client with a rolled towel under her hips
Check the fluid for color, odor, and consistency
The Correct Answer is A,D,C,E,B
- A. Obtain a baseline reading of the FHR and contraction pattern.
- Establishing a baseline of fetal heart rate (FHR) and contraction pattern is crucial to assess for any immediate changes following the amniotomy.
- D. Position the client with a rolled towel under her hips.
- Positioning the client with a rolled towel under her hips helps to relieve pressure on the vena cava, improve uterine blood flow, and optimize fetal positioning.
- C. Pass the sterile hook to the provider.
- The sterile hook is used to break the amniotic sac, and the nurse should pass it to the provider during the procedure.
- E. Check the fluid for color, odor, and consistency.
- After the amniotomy, the nurse should assess the amniotic fluid for color (should be clear), odor (should be odorless), and consistency to check for any signs of meconium or infection.
- B. Document the procedure in the electronic medical record.
- The nurse should document the amniotomy procedure and any findings (e.g., FHR changes, amniotic fluid assessment) in the medical record after the procedure has been completed.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Store the dentures in a dry denture cup on the bedside table after cleaning.: Dentures should not be stored in a dry cup as this can lead to drying out and warping of the dentures. They should be stored in water or a denture solution to keep them moist.
B. Place a towel in the sink when cleaning the dentures.: This is correct. Placing a towel in the sink is a safety precaution to prevent dentures from breaking if they are accidentally dropped while being cleaned. It also helps prevent damage from impact with hard surfaces.
C. Remove the lower dentures before the upper dentures.: There is no specific order required for removing dentures, as both upper and lower dentures should be removed carefully and cleaned.
D. Use a circular motion to cleanse the biting surface of the dentures.: A circular motion is not the best technique for cleaning dentures. Instead, the dentures should be brushed gently with a soft toothbrush, focusing on cleaning all surfaces, including the biting surfaces, using a back-and-forth motion.
Correct Answer is A
Explanation
A. Docusate is correct. Docusate is a stool softener, and it does not have a significant effect on blood clotting. Therefore, it is considered safe for use with warfarin, which requires careful monitoring to avoid interactions that may increase bleeding risks.
B. Ibuprofen is incorrect. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID. that can increase the risk of bleeding when used with warfarin by inhibiting platelet aggregation and affecting clotting factors.
C. Aspirin is incorrect. Aspirin also inhibits platelet function, increasing the risk of bleeding when combined with warfarin. This combination should be avoided unless specifically prescribed.
D. Omeprazole is incorrect. Although omeprazole is often used to treat gastrointestinal issues, it may interact with warfarin and affect its metabolism. This interaction can increase the risk of bleeding, and caution is recommended when using these medications together.
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