Temp 98.6 (0)

Sp02 98% on RA

Exhibits

What three priority assessments will you make for this patient?

Abdominal girth q 2 hours.

Assess amount of bleeding

Pelvic exam for cervical dilation.

Fetal heart rate patterns

Maternal vital signs

Attach internal fetal scalp electrode.

Answer and Explanation

Correct Answer : B,D,E

A. Abdominal girth is not a primary concern for this patient. Monitoring for signs of abdominal distention and changes in the uterus is more relevant for conditions like preeclampsia or uterine rupture.

B. Assessing the amount of bleeding is essential as vaginal bleeding can indicate serious complications like placental abruption or previa.

C. A pelvic exam is not indicated without signs of cervical change or labor. The priority is to assess for active bleeding and fetal well-being.

D. Fetal heart rate patterns are crucial to assess the status of the fetus, particularly with the concern of placental issues.

E. Maternal vital signs are important to monitor to detect signs of shock or bleeding complications that may not be immediately obvious.

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Correct Answer is C

Explanation

A. While assessing blood pressure is important, the first priority is to address potential uterine atony, which is the most common cause of postpartum hemorrhage.

B. Bladder distention could be a contributing factor, but uterine massage is the first step to manage uterine tone and control bleeding.

C. Massaging the fundus is the first action to take when the patient is saturating a pad quickly after delivery, as this helps stimulate uterine contractions to control bleeding.

D. Preparing to administer oxytocic medication may be necessary if uterine massage does not effectively control bleeding, but it should come after assessing the uterus.

A. Gets it refitted each time she changes partners B. Leaves it in place for 6 hours after intercourse. C. Places lubricant inside of the diaphragm before insertion D. Leaves it in during her period

Correct Answer is B

Explanation

Rationale:

A. Refitting the diaphragm is recommended after significant weight change, not when changing partners.

B. Leaving the diaphragm in place for at least 6 hours after intercourse ensures effective contraception.

C. Lubricant is not placed inside the diaphragm but on the rim or used with spermicide.

D. Leaving the diaphragm in during menstruation increases the risk of toxic shock syndrome.

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Temp 98.6 (0) Sp02 98% on RA Exhibits What three priority assessments will you make for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A. A blood pressure of 94/60 is low but not typically a contraindication for Terbutaline administration.

Correct Answer is C

Explanation

The nurse teaches a couple that the diaphragm is an excellent method of contraception providing that the woman does which of the following?

Correct Answer is B

Explanation

Temp 98.6 (0) Sp02 98% on RA Exhibits What three priority assessments will you make for this patient?

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Temp 98.6 (0)

Sp02 98% on RA

Exhibits

What three priority assessments will you make for this patient?