The practical nurse (PN) is assigned to assist in the care of a laboring client at 42-weeks gestation. While providing perineal care, the PN observes the umbilical cord protruding from the vagina. Which action should the PN take?

Support the client's upper body and knees with pillows.

Encourage the client to push with the next contraction.

Assist the team to prepare for a possible cesarean delivery.

Gently wrap the cord with a dry sterile dressing.

Answer and Explanation

The Correct Answer is C

The umbilical cord prolapse is an emergency situation that requires immediate intervention. The PN should not attempt to push the cord back into the vagina or cover it with a dry sterile dressing. Instead, the PN should notify the healthcare provider and the obstetrical team and assist in preparing for an emergency cesarean delivery.

Option A and B may be appropriate in some situations, but they are not the priority in this scenario.

Therefore, options A, B, and D are not answers because they do not address the immediate emergency of umbilical cord prolapse.

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Correct Answer is A

Explanation

Explanation: Acute otitis media is a common childhood illness that refers to an infection of the middle ear. It occurs when the Eustachian tube, which connects the middle ear to the back of the throat, becomes blocked and ﬂuid accumulates in the middle ear. This ﬂuid provides a breeding ground for bacteria, leading to infection and inﬂammation. Symptoms of acute otitis media can include ear pain, fever, irritability, and difficulty hearing. It is important for the PN to provide accurate information to the mother and to explain the treatment plan, which may include antibiotics and pain relief measures, as prescribed by the healthcare provider.

A. Current administration of analgesics or antianxiety medications. B. History of situational depression related to major life events. C. Previous episodes of frequent falls. D. The client's history of alcohol abuse.

Correct Answer is A

Explanation

The practical nurse (PN) should obtain information about the client's current medications, including any analgesics or antianxiety medications that may be contributing to the confusion. These medications can cause cognitive impairment and confusion, especially in older adults. It is important to assess the client's mental status and identify any potential causes of confusion, as this can indicate a change in the client's condition that requires further evaluation and intervention.

Option B is incorrect as it refers to a history of situational depression, which may not be relevant to the current situation.

Option C is also incorrect as it refers to previous falls, which may not be related to the current confusion.

Option D is incorrect as it refers to the client's history of alcohol abuse, which may be important to know but is not the most relevant information to obtain in this situation.

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The practical nurse (PN) is assigned to assist in the care of a laboring client at 42-weeks gestation. While providing perineal care, the PN observes the umbilical cord protruding from the vagina. Which action should the PN take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The mother of a 3-year-old asks the practical nurse (PN) to clarify the healthcare provider's diagnosis of acute otitis media. Which is the most accurate explanation?

Correct Answer is A

Explanation

An older female client is admited to the orthopedic unit following surgical repair of a fractured hip. On the second postoperative day, the client becomes confused and repeatedly asks the practical nurse (PN) where she is. Which information should the PN obtain before reporting to the charge nurse?

Correct Answer is A

Explanation

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