The nurse continues to care for the client.

Nurses' Notes Day 1, 0900:

Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 minutes, palpate strong, duration 30 seconds.
FHR baseline 145, minimal variability.

Cervical exam indicates 2 cm, 50% effaced, 0 station. Membranes intact.
CBC and urinalysis collected and sent to lab. Day 1,0930:
Peripheral IV initiated. Provider prescriptions received and implemented. Day 1, 1000:
Client voided and reports pain and dicomfort upon urination. Client states, "I've noticed burning wife I urinate for the past 2 days."

Which of the following actions should the nurse take? Select all that apply.

The correct answer is a. Moving both crutches with the stronger leg forward first.

Rationale for Choice C:

• Proper positioning of the hands on the grips and keeping the elbows slightly flexed helps ensure stability and control while using the crutches.

Rationale for Other Choices:

a.In a three-point gait, the client moves both crutches and the affected leg together, followed by the unaffected leg. The stronger leg does not move forward first.

b. Stepping with the affected leg first when going up stairs: This action is incorrect for the three-point gait. When ascending stairs, the client should move the stronger leg up first, followed by the crutches and the affected leg.

d. Supporting his body weight while leaning on the axillary crutch pads: This action is also correct for general crutch use, but it does not specifically address the weight-bearing restrictions and movement pattern of the three-point gait.

Additional Information:

• Practice and supervision:It's essential for the client to practice the three-point gait under the supervision of a healthcare professional to ensure proper technique and safety.
• Gradual progression:The client should gradually increase their distance and duration of crutch use as their strength and coordination improve.
• Pain management:Adequate pain management is crucial to allow the client to participate in rehabilitation and regain mobility.

A. Penicillin G should be infused slowly over a period of 10 to 15 minutes to prevent adverse reactions such as seizures.
B. Incorrect. Checking for a sulfa allergy is not relevant to the administration of penicillin, as sulfa and penicillin are different types of antibiotics.

C. Incorrect. Refrigeration is not typically required for penicillin G after reconstitution.

D. IDiarrhea can be a sign of a serious condition called antibiotic-associated colitis, which requires immediate medical attention.