A nurse is reinforcing teaching about perineal care to a client who is 2 hr postpartum and has an episiotomy and hemorrhoids. Which of the following statements by the client indicates an understanding of the teaching?

"I will place a heat pack to the area several times a day.

"I will apply witch hazel pads after urination."

"I will use the numbing spray prior to cleansing the area."

"I will remain in the sitz bath for 10 minutes."

Answer and Explanation

The Correct Answer is B

A)   Incorrect- Applying a heat pack to the area might increase inflammation and discomfort. Heat is generally not recommended for healing episiotomies and hemorrhoids.
B)   Correct - "I will apply witch hazel pads after urination" is the correct statement. Witch hazel pads have a cooling and soothing effect that can provide relief from discomfort associated with episiotomies and hemorrhoids.
C)   Incorrect- Using a numbing spray before cleansing might not be necessary and could interfere with proper cleansing. It's generally recommended to cleanse the area before applying any products.
D)   Incorrect- Remaining in a sitz bath for 10 minutes is beneficial for perineal care, but it doesn't specifically address the use of witch hazel pads or understanding of the overall perineal care regimen. Furthermore, prolonged sitz baths, as can interfere with healing and increase the risk of infection.

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Correct Answer is B

Explanation

A) Incorrect- Foul-smelling vaginal discharge might indicate infection but is not the priority over the presence of meconium-stained amniotic fluid.
B) Correct- Fetal heart rate is important to monitor, but the presence of meconium- stained amniotic fluid has higher priority. fetal heart tones 98/min, because this indicates fetal distress and requires immediate intervention.
C) Incorrect - Amniotic fluid with meconium noted could indicate fetal hypoxia or distress, but it is not always a sign of a problem and depends on other factors such as gestational age and fetal activity.
D) Incorrect- Maternal temperature elevation might indicate infection but is not the priority over assessing the condition of the amniotic fluid and the baby.

A. Check urine for ketones. B. Administer glucagon C. Encourage an additional feeding. D. Recheck blood glucose in 4 hr.

Correct Answer is C

Explanation

A) Incorrect- Checking urine for ketones is not necessary if the newborn's blood glucose level is low but stable and the baby is asymptomatic.
B) Incorrect- Administering glucagon is not indicated for an asymptomatic newborn with a low but stable blood glucose level.
C) Correct - Encouraging additional feeding is appropriate for an asymptomatic newborn with a low blood glucose level. Regular feeding can help increase blood glucose levels.
D) Incorrect- Waiting 4 hours to recheck blood glucose might not be appropriate if the baby's blood glucose is currently low. Addressing the low blood glucose level is more immediate.

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A nurse is reinforcing teaching about perineal care to a client who is 2 hr postpartum and has an episiotomy and hemorrhoids. Which of the following statements by the client indicates an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a provider's office is collecting data from a client who is at 34 weeks of gestation and reports having a sudden gush of vaginal fluid. Which of the following manifestations is the priority?

Correct Answer is B

Explanation

A nurse is caring for a newborn whose mother has gestational diabetes. The newborn has a blood glucose level of 30 mg/dL and is asymptomatic. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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