A nurse is caring for a client who delivered a newborn by cesarean birth 1 day ago. The client requests nonpharmacological interventions to manage pain when changing positions.

Which of the following responses should the nurse make?

"You can apply counterpressure to your back with each position change."

"You can splint the incision with a pillow when changing positions."

"You should change positions as little as possible."

"You should use patterned-paced breathing when changing positions."

Answer and Explanation

The Correct Answer is B

Splinting the incision with a pillow when changing positions can provide support and help minimize discomfort and pain in clients who have undergone a cesarean birth. It can help reduce strain on the incision site and provide a sense of stability and comfort.

"You can apply counterpressure to your back with each position change" may be helpful for managing back pain, but it does not specifically address the client's request for nonpharmacological interventions to manage pain when changing positions after a cesarean birth.

"You should change positions as little as possible" is not an appropriate response as it does not address the client's need to manage pain when changing positions. Encouraging movement and position changes, along with appropriate support, can aid in recovery and prevent complications such as blood clots and respiratory issues.

"You should use patterned-paced breathing when changing positions" is not specifically related to managing pain when changing positions after a cesarean birth. While breathing techniques can be useful for pain management during labor and certain procedures, it may not be the most effective strategy for managing pain when changing positions post-cesarean.

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Correct Answer is ["C"]

Explanation

A.Coiling the tubing on the bed above the collection bag is incorrect because it can cause urine to flow back into the bladder, increasing the risk of infection and compromising the effectiveness of the drainage system. The tubing should be kept below the level of the bladder to ensure proper drainage.

B.Instructing the client to hold the drainage bag at waist height when ambulating is incorrect because the drainage bag should always be kept below the level of the bladder to prevent urine from flowing back into the bladder, which could lead to a urinary tract infection (UTI).

C.Securing the tubing with adhesive tape to the lower abdomen is correct because it helps prevent accidental pulling or tugging on the catheter, which could cause discomfort or dislodgement. Properly securing the tubing also helps maintain a continuous flow of urine and reduces the risk of infection.

D.Collecting a sterile specimen from the urinary drainage bag is incorrect because urine in the drainage bag is not considered sterile. If a sterile specimen is needed, it should be obtained by cleaning the catheter's sampling port with an antiseptic solution and withdrawing urine directly from the port using a sterile syringe.

A. "I will give this medication to my child every 2 hours if he is wheezing." B. "It takes 2 months of scheduled use before this medications effective." C. "I can stop giving my child this medication if he is taking a steroid." D. "I will give this medication to my child once daily in the evening "

Correct Answer is D

Explanation

Montelukast is a medication commonly used for the maintenance treatment of asthma. It is not used for immediate relief of wheezing or acute symptoms. Instead, it is taken on a scheduled basis to help control and prevent asthma symptoms over time. The recommended dosing regimen for montelukast in children is once daily in the evening.

The statement about giving the medication every 2 hours if the child is wheezing is incorrect, as this medication is not meant to be used for immediate relief of symptoms. It is a preventive medication.

The statement about it taking 2 months of scheduled use before the medication is effective is incorrect. While it may take some time for the medication to reach its full effect, improvement in symptoms can often be seen within a few days to weeks of starting treatment.

The statement about stopping the medication if the child is taking a steroid is incorrect. Montelukast can be used in conjunction with other asthma medications, including steroids, as prescribed by the healthcare provider. It is important to follow the prescribed treatment plan and not discontinue any medication without consulting the healthcare provider.

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A nurse is caring for a client who delivered a newborn by cesarean birth 1 day ago. The client requests nonpharmacological interventions to manage pain when changing positions. Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has an indwelling catheter with a urinary drainage system. Which of the following actions should the nurse take?

Correct Answer is ["C"]

Explanation

A nurse is reinforcing teaching with a parent of a child who has asthma about the administration of montelukast. Which of the following statements by the parent indicates an understanding of the teaching?

Correct Answer is D

Explanation

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A nurse is caring for a client who delivered a newborn by cesarean birth 1 day ago. The client requests nonpharmacological interventions to manage pain when changing positions.

Which of the following responses should the nurse make?