A nurse is assisting with the care of a client who is in the latent stage of labor and has pelvic pain with contractions.
Which of the following actions should the nurse take?
Apply fundal pressure during contractions.
Instruct the client to change positions frequently.
Tell the client to push during contractions.
Encourage the client to soak in a hot bath.
The Correct Answer is B
Explanation
B. Instruct the client to change positions frequently
Encouraging the client to move around, walk, change positions during labour can help relieve discomfort, promote optimal fetal positioning positions, or use a birthing ball can help alleviate pelvic pain and potentially facilitate the progress of labour.
Applying fundal pressure during contractions in (option A) is not necessary during the latent stage of labour. Fundal pressure is typically used in the active stage of labour to assist with the descent and positioning of the baby's head.
Telling the client to push during contractions in (option C) is not appropriate during the latent stage of labour. Pushing is typically reserved for the second stage of labour when the cervix is fully dilated.
Encouraging the client to soak in a hot bath in (option D) is not recommended during labour, particularly in the hospital setting. Immersion in hot water (e.g., a hot bath) can increase the risk of infection and is generally not recommended until after the birth of the baby
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
During an external chemical disaster, it is crucial to minimize the exposure of clients to the hazardous substance. Moving clients to a room above ground level with few windows can help reduce the risk of exposure to the chemical and its fumes. This is because many hazardous chemicals tend to be denser than air and may settle closer to the ground. Choosing a room above ground level and with fewer windows can provide a safer environment.
Turning on fans in the facility to circulate air can actually worsen the situation by spreading the chemical and its fumes throughout the facility, potentially exposing more individuals.
Covering the electrical outlets with wet towels is not directly related to preparing for an external chemical disaster. It may be more relevant during a fire emergency to prevent the spread of flames, but not for chemical exposure.
Opening the fireplace dampers in the day room can allow the entry of outside air and potentially introduce more of the hazardous substance into the facility.
Correct Answer is C
Explanation
A.If the client is independent, give them privacy to bathe, if they prefer. If leaving a client unattended, check on them every 5 minutes or more frequently as needed. Ensure the client knows how to use safety items such as shower chairs and grab bars.
B.Adding bath oil to the water after the client is in the tub can create a slippery surface, increasing the risk of falls. Bath oil should be added before the client enters the tub or avoided if there is a risk of slipping.
C.Draining the tub water before the client gets out helps prevent slips and falls that can occur if the client attempts to exit the tub while the water is still present. This practice enhances safety by reducing the risk of accidents.
D.Tub baths or very warm showers can lead to a person feeling faint, nauseous, or tired. Baths should not last longer than 20 minutes and should be discontinued at the first sign of patient discomfort, weakness, or complaints of feeling faint.
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