The practical nurse (PN) determines that a client who is one day postpartum has a moderate amount of lochia rubra and the uterus is firm, dextroverted, and three fingerbreadths above the umbilicus. Which should be the PN's initial action?

Provide a stool softener for constipation.

Assess the bladder for distension.

Check the hemoglobin to determine uterine hemorrhage.

Massage the uterus to decrease atony.

Answer and Explanation

The Correct Answer is B

Correct Answer: B.
A.   Providing a stool softener for constipation might be necessary postpartum but isn't the initial action indicated by the client's current status.
B.   Assessing the bladder for distension is crucial because a distended bladder can displace the uterus and impede its ability to contract properly, leading to uterine atony and increased bleeding.
C.   Checking the hemoglobin to determine uterine hemorrhage is important but might not be the initial step needed based on the client's condition.
D.   Massaging the uterus to decrease atony is a potential intervention, but assessing for bladder distension takes priority in this scenario to prevent uterine displacement.

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Correct Answer is A

Explanation

A. "May I sit with you for a while?" - This response offers companionship and emotional support without pushing the resident to engage in an activity or prying into his feelings. It respects his desire for solitude while providing the option for company if he wishes.
B. "Why do you want to stay in your room today?" - This might be perceived as intrusive and pushy, potentially making the resident more withdrawn.
C. "Come into the recreation area. We have your favorite card game and I will play it with you." - While well-intentioned, this suggestion may not align with the resident's current emotional state or desire for solitude.
D. "I know you are sad about not seeing your family as often, but they are visiting as much as they can." - This response acknowledges the resident's feelings but may not address his immediate need for companionship or support.

A. Encourage the client to resume normal activities after medication administration. B. Implement ongoing assessments for signs of shallow or slow breathing. C. Observe the client for involuntary movements of the lips and tongue. D. Assess the skin daily for areas of ecchymosis or other signs of bleeding.

Correct Answer is B

Explanation

A. Encourage the client to resume normal activities after medication administration. - This action could exacerbate the injury and pain and isn't appropriate after pain medication for a fracture.
B. Implement ongoing assessments for signs of shallow or slow breathing. - Hydrocodone, an opioid, can cause respiratory depression. Regular monitoring for respiratory changes is crucial.

C. Observe the client for involuntary movements of the lips and tongue. - This might indicate adverse reactions but is not the most critical concern after administering hydrocodone/acetaminophen.
D. Assess the skin daily for areas of ecchymosis or other signs of bleeding. - While monitoring for bleeding is important, it's not the immediate concern following administration of hydrocodone/acetaminophen.

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The practical nurse (PN) determines that a client who is one day postpartum has a moderate amount of lochia rubra and the uterus is firm, dextroverted, and three fingerbreadths above the umbilicus. Which should be the PN's initial action?

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Naxlex Comprehensive Predictor Exams

A chronically depressed older male resident of a long-term care facility has become more reclusive and today refuses to leave his room. His family has away and are unable to visit as much as in the past. Which comment by the practical nurse (PN) is likely to be most helpful to this client?

Correct Answer is A

Explanation

The practical nurse (PN) is caring for a client with fractured metatarsals after slamming a hand in the car door. After administering the prescribed hydrocodone/acetaminophen for pain, which intervention should the PN include in the client's care?

Correct Answer is B

Explanation

The practical nurse (PN) overhears a female client with Cushing's syndrome telling her family in a very loud and angry voice to leave her room and not to come back. The response by the PN is based on recognizing which common manifestation of the syndrome.

The practical nurse (PN) observes two unlicensed assistive personnel (UAP) turning an older client who had a hip arthroplasty with prosthesis placement four hours ago. Which observation by the PN indicates that the UAPS needs additional information about the turning procedure?

Which client finding should the practical nurse (PN) report to the registered nurse (RN) immediately?

Before administering zolpidem at bedtime, which client assessment should the practical nurse (PN) complete?

The practical nurse (PN) is caring for a newborn whose mother has poorly controlled type 1 diabetes mellitus and observes the newborn is grunting with mild sternal retractions. The PN should recognize the newborn is exhibiting signs of which condition?

At bedtime, a female client with dementia becomes increasingly confused and agitated because she believes that someone is standing behind the privacy curtain. Which action should the practical nurse (PN) take?

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