The nurse is caring for a client on the postpartum unit who had a vaginal delivery with epidural anesthesia 2 hours ago. 1. The client presses the call light and tells the nurse she needs to use the bathroom 2. The nurse arrives in the client's room 5 minutes later 3.
The client is getting out of bed alone What is the best response by the nurse?
Suggest catheterizing her this time to prevent the possibility of fainting
Ask the client to lie back down and get her a bedpan
Assist the client to the bathroom
Have the client sit dangling her legs over the side of the bed for 5 minutes
The Correct Answer is C
A. Catheterization may not be necessary at this time and can be uncomfortable for the client.
B. Using a bedpan may not be the most comfortable option for the client, who likely wants to ambulate.
C. Assisting the client to the bathroom is the best response to ensure her safety and prevent falls.
D. Dangling the legs over the side of the bed is not necessary in this situation and may not address the client's need to use the bathroom.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A. Preparing the client for emergency cesarean delivery is often necessary when a prolapsed umbilical cord is identified.
B. Positioning the client in a knee-chest position helps alleviate pressure on the umbilical cord, improving fetal oxygenation.
C. Inserting a vacuum suction catheter into the vagina and pushing the infant back into the uterus is not a recommended intervention for a prolapsed umbilical cord; this action may cause harm to the fetus.
D. Keeping a gloved hand in the vagina and pushing upward on the presenting part helps relieve pressure on the umbilical cord.
E. Contacting the provider and reporting a prolapsed umbilical cord is essential for prompt communication and decision-making.
Correct Answer is ["100"]
Explanation
To calculate the flow rate in mL/hr, we need to use the following formula:
Flow rate (mL/hr) = Dose (mU/min) x Volume (mL) / Concentration (units)
In this case, the dose is 2 mU/min, the volume is 1000 mL, and the concentration is 20 units. Plugging these values into the formula, we get:
Flow rate (mL/hr) = 2 x 1000 / 20 Flow rate (mL/hr) = 2000 / 20 Flow rate (mL/hr) = 100
Therefore, the flow rate in mL/hr is 100.
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