A nurse is assisting with the care of a client who is in active labor. Which of the following data is the priority
for the nurse to collect following an amniotomy?
Amniotic fluid color
The client's temperature
Frequency of contractions
Fetal heart rate
The Correct Answer is D
The priority data for the nurse to collect following an amniotomy is the fetal heart rate. This is an important nursing intervention to assess fetal well-being and identify any potential complications.
a) Assessing the color of the amniotic fluid is important, but it is not the highest priority.
b) Monitoring the client's temperature is important, but it is not the highest priority.
c) Assessing the frequency of contractions is important, but it is not the highest priority.
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Related Questions
Correct Answer is D
Explanation
d. Increased joint stiffness due to loss of elasticity in joint cartilage.
Explanation:
The correct answer is d. Increased joint stiffness due to loss of elasticity in joint cartilage.
When teaching an older adult client about age-related changes, it is important for the nurse to provide accurate and relevant information. Joint stiffness is a commonly experienced age-related change that occurs due to the natural loss of elasticity in joint cartilage. As people age, their joints may become stiffer and less flexible, making movements and activities more challenging.
Option a is not the correct answer. Increased nail growth due to the buildup of calcium deposits is not an expected age-related change. Nail growth is primarily determined by factors such as genetics, overall health, and nutritional status, rather than calcium deposits.
Option b is not the correct answer. Increased perspiration due to overproduction by the sweat glands is not an expected age-related change. In fact, older adults may experience a decrease in the production of sweat, which can make them more susceptible to heat-related illnesses and dehydration.
Option c is not the correct answer. Increased cardiac output due to weakened heart walls is not an expected age-related change. With aging, the heart muscles may become stiffer and less efficient, leading to a decrease in cardiac output rather than an increase.
By focusing on the expected age-related change of increased joint stiffness due to loss of elasticity in joint cartilage, the nurse can provide accurate information and help the older adult client understand and manage this common aspect of the aging process.
Correct Answer is ["A","B","D","F"]
Explanation
Answer: A, B, D, F
Rationale:
A. "The ECT procedure will cause you to have a brief seizure.":
This statement is accurate as electroconvulsive therapy (ECT) intentionally induces a controlled seizure, which is thought to positively impact brain chemistry and alleviate symptoms of major depressive disorder. Educating the client about this aspect helps demystify the procedure and reduces anxiety.
B. "You will not be awake during the ECT procedure.":
The client receives general anesthesia before ECT, so they will be unconscious during the procedure. This reassurance can help alleviate fears associated with being awake and experiencing discomfort during the procedure.
C. "You will be placed on a ventilator to help you breathe during the ECT procedure.":
During ECT, clients do not require a ventilator, although they may receive oxygen support. An anesthetic and muscle relaxant are administered, and while the client’s breathing is closely monitored, a ventilator is unnecessary for this brief procedure.
D. "You will probably sleep the rest of the day following the ECT procedure.":
Many clients feel drowsy and need extra rest after ECT due to the effects of anesthesia and the brief seizure. Informing the client helps them prepare for this common effect and sets realistic expectations for their recovery period.
E. "It should only take one ECT treatment to bring you out of your depression.":
ECT is typically given as a series of treatments over several weeks to achieve lasting improvement in depressive symptoms. One treatment alone is usually insufficient, so this statement could mislead the client regarding the treatment plan.
F. "Some clients experience temporary memory loss following ECT therapy.":
Temporary memory loss, especially of recent events, is a known side effect of ECT. This side effect is generally transient but can help the client to be aware of this possibility, helping them to anticipate and manage any concerns post-treatment.
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