A nurse is assisting with the care of a client who is at 28 weeks of gestation.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
The Correct Answer is []
- Potential Condition: Placenta previa
- This condition is characterized by the placenta covering the cervix, which can lead to painless, bright red vaginal bleeding during the second or third trimester.
- Actions to Take:
1. Insert a large-bore peripheral IV catheter.
- This is a precautionary measure to ensure that there is immediate venous access for fluid and blood product administration if necessary.
2. Reinforce with the client to maintain bed rest.
- Limiting physical activity can help reduce the risk of further bleeding.
- Parameters to Monitor:
1. Vaginal bleeding
- Monitoring the amount, color, and frequency of bleeding is crucial to assess the ongoing blood loss and stability of the condition.
2. Fetal well-being
- Regular monitoring of fetal heart rate and movement is important to ensure the fetus is not in distress.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Petroleum jelly should be applied to prevent the diaper from sticking to the circumcision site, but it will not stop bleeding. Bright red blood oozing indicates that immediate action is needed to control bleeding.
B. Securing a clean diaper snugly could apply pressure but may not be the most effective method for controlling bleeding. It is more important to manage the bleeding directly by applying pressure.
C. Rinsing the newborn's penis with cool water is not an appropriate action for controlling bleeding. Cool water might be used for cleaning but does not address the issue of bleeding from the circumcision site.
D. Applying gentle pressure using a sterile dry gauze pad is the correct action to manage the bleeding. This method helps to control the bleeding by providing direct pressure to the site, which is crucial for addressing the issue.
Correct Answer is D
Explanation
A. Wearing an underwire bra is not recommended for breastfeeding mothers, especially those with inverted nipples, as it can cause pressure and discomfort, potentially leading to blocked milk ducts and mastitis.
B. Applying breast cream regularly is not specifically beneficial for inverted nipples. It can help with nipple soreness or dryness, but it does not aid in drawing out inverted nipples.
C. Plastic-lined breast pads can help with leakage but do not address the issue of inverted nipples. They do not assist in reshaping or encouraging the protrusion of the nipples.
D. Placing breast shells in the bra can help draw out inverted nipples by applying gentle, consistent pressure around the areola, which encourages the nipples to protrude, making breastfeeding easier for the newborn.
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