Try Naxlex NCLEX-RN (Free-Trial)

A nurse reviews the provider prescriptions and reassesses the client.
Exhibits
The nurse is continuing to care for the client. Which of the following actions should the nurse take? Select all that apply.

Initiate contact precautions.

Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr.

Monitor the height and tone of the client's fundus.

Request a prescription for terbutaline from the provider.

Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab,

Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage.

Instruct the client to wash her hands before and after changing her perineal pad.

Answer and Explanation

Correct Answer : C,E,F,G

Rationale:

A. Initiate contact precautions: Endometritis is not typically caused by a pathogen requiring contact precautions (like MRSA or C. difficile). Standard precautions are sufficient unless otherwise indicated.

B. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: The prescribed antibiotics (e.g., clindamycin) are generally considered safe for breastfeeding, and lactation should be encouraged unless specifically contraindicated.

C. Monitor the height and tone of the client's fundus: Fundal tenderness, foul-smelling lochia, and fever are signs of endometritis. Ongoing fundal assessment is important to evaluate uterine involution and identify potential complications like subinvolution or abscess formation.

D. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic used to relax the uterus in cases of hyperstimulation during labor not for treating uterine infection or postpartum discomfort.

E. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab: Culturing lochia helps identify the causative organism of the uterine infection and guide antibiotic therapy. This is a standard step in suspected endometritis cases.

F. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Positioning the client with the head elevated allows for better lochia drainage, preventing accumulation that could worsen infection or discomfort.

G. Instruct the client to wash her hands before and after changing her perineal pad: Good perineal hygiene helps prevent the spread of infection and supports recovery, especially in the context of suspected endometritis.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

Rationale:

A. The nurse explained the risks and benefits of the surgery: Explaining the risks and benefits of a surgical procedure is the responsibility of the surgeon, not the nurse. The nurse may clarify or reinforce information but does not provide the primary explanation.

B. The nurse explained the surgical procedure in detail: Nurses can offer general clarification, but it is the surgeon’s legal and ethical duty to explain the procedure in detail, including alternatives, risks, and benefits, as part of obtaining informed consent.

C. The client knows they may no longer refuse the procedure: Clients have the legal right to refuse a procedure at any time, even after signing consent. Consent is not binding and must remain voluntary and revocable until the procedure begins.

D. The client agreed to the procedure voluntarily: Informed consent requires that the client makes the decision freely, without coercion. Observing the client voluntarily agree to the procedure meets this core legal and ethical requirement of informed consent.

A. Expresses pain freely and loudly B. Prefers foods that maintain a balance of hot and cold within the body. C. Prefers to make direct eye contact with health care personnel D. Tends to be very expressive with gestures and body language

Correct Answer is B

Explanation

Rationale:

A. Expresses pain freely and loudly: Many Chinese American clients may view overt pain expression as a loss of control or dignity. Cultural norms often encourage stoicism, and clients may underreport pain unless directly asked in a sensitive and respectful manner.

B. Prefers foods that maintain a balance of hot and cold within the body: Traditional Chinese medicine emphasizes balance, particularly of hot and cold elements, especially during the postpartum period. Clients may prefer warm foods and drinks to restore balance and promote healing after childbirth.

C. Prefers to make direct eye contact with health care personnel: In Chinese cultural contexts, direct eye contact can be considered disrespectful or confrontational, especially toward authority figures. Avoiding eye contact may be a sign of respect rather than disinterest.

D. Tends to be very expressive with gestures and body language: Chinese American clients may communicate in a more reserved and controlled manner, often minimizing the use of expressive gestures. Nonverbal communication may be subtle, requiring attentive observation.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse reviews the provider prescriptions and reassesses the client.Exhibits The nurse is continuing to care for the client. Which of the following actions should the nurse take? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is witnessing a surgeon obtain informed consent from a client. Which of the following legal requirements is met by this action?

Correct Answer is D

Explanation

A nurse is planning care for a client who is Chinese American and reports adhering to Chinese cultural postpartum practices. Which of the following should the nurse anticipate?

Correct Answer is B

Explanation

A nurse is caring for a postpartum client in an outpatient setting. Exhibits Complete the following sentence by using the lists of options. The client is at highest risk for developing dropdown evidenced by the client's dropdown.

A nurse is caring for a client who has expressive aphasia. Which of the following actions should the nurse take to assist the client in overcoming communication barriers?

A nurse is caring for a client who has a Clostridium difficile infection. Which of the following actions should the nurse take? (Select all that apply.)

A nurse is caring for a client who has an end-stage lung disease. The client requests not to be resuscitated if their condition worsens. Which of the following actions should the nurse take?

A nurse in an acute care facility is caring for a toddler. Exhibits For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.

A nurse is assessing a 1-month-old infant at a pediatric office. Which of the following findings requires a referral for further care?

A nurse is assessing a client who has heart failure. The client has moist lung sounds, bounding pulse, increased blood pressure, and pitting peripheral edema. Which of the following is the nurse's priority intervention?

A nurse reviews the provider prescriptions and reassesses the client.
Exhibits
The nurse is continuing to care for the client. Which of the following actions should the nurse take? Select all that apply.