You are assuming the care of a patient admitted for a fetal demise at 30 weeks gestation. Which is the most therapeutic response to the patient? (Select onE.:

At least you are young and can have another chilD.

I am so sorry for your loss. My heart hurts for you. Can you tell me a little bit about your baby?

There was probably something wrong and God has a way of taking care of these things.

Don't cry, be strong for your family.

Answer and Explanation

The Correct Answer is B

Choice A: At least you are young and can have another child is not a therapeutic response, as it minimizes the patient's grief and implies that the baby is replaceablE. The nurse should acknowledge the patient's loss and avoid making assumptions or judgments.

Choice B: I am so sorry for your loss. My heart hurts for you. Can you tell me a little bit about your baby? is a therapeutic response, as it expresses empathy and compassion and invites the patient to share their feelings and memories. The nurse should listen actively and respectfully and use the baby's name if the patient has given onE.

Choice C: There was probably something wrong and God has a way of taking care of these things is not a therapeutic response, as it rationalizes the patient's loss and imposes the nurse's religious beliefs. The nurse should respect the patient's spirituality and avoid making statements that may cause guilt or anger.

Choice D: Don't cry, be strong for your family is not a therapeutic response, as it discourages the patient from expressing their emotions and places unrealistic expectations on them. The nurse should support the patient's coping and encourage them to seek help from their family and friends.

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Correct Answer is ["A","C","D"]

Explanation

Choice A: Amniotic fluid in the vaginal vault indicates that the client's membranes have ruptured, which is a sign of labor. The fluid should be clear and odorless. The nurse should assess the fetal heart rate and monitor for signs of infection or cord prolapsE.

Choice B: Pain just above the navel is not a sign of labor. It may indicate other conditions such as gastritis, gallstones, or pancreatitis. The pain of labor is usually felt in the lower back and abdomen and radiates to the thighs.

Choice C: Cervical dilation is a sign of labor. It indicates that the cervix is opening and thinning to allow the passage of the fetus. The nurse should measure the cervical dilation in centimeters and document the progress of labor.

Choice D: Contractions every 3 to 4 minutes are a sign of labor. They indicate that the uterus is contracting and pushing the fetus downwarD. The nurse should assess the frequency, duration, and intensity of the contractions and monitor the fetal responsE.

A. Heart rate of 99 B. Respiratory rate of 9 C. BP of 99/69 D. Temperature of 99.9

Correct Answer is B

Explanation

Choice A reason: This is not the most concerning vital sign because a heart rate of 99 is within the normal range for an adult. The nurse should monitor the patient's heart rate and rhythm, but it is not a sign of magnesium toxicity or adverse effects.

Choice B reason: This is the most concerning vital sign because a respiratory rate of 9 is below the normal range for an adult and indicates respiratory depression, which is a sign of magnesium toxicity. The nurse should stop the infusion, notify the provider, and prepare to administer calcium gluconate as an antidotE.

Choice C reason: This is not the most concerning vital sign because a BP of 99/69 is within the normal range for an adult. The nurse should monitor the patient's blood pressure and fluid status, but it is not a sign of magnesium toxicity or adverse effects.

Choice D reason: This is not the most concerning vital sign because a temperature of 99.9 is within the normal range for an adult. The nurse should monitor the patient's temperature and infection signs, but it is not a sign of magnesium toxicity or adverse effects.

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You are assuming the care of a patient admitted for a fetal demise at 30 weeks gestation. Which is the most therapeutic response to the patient? (Select onE.:

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Naxlex Comprehensive Predictor Exams

A nurse is assisting a nurse midwife in examining a client who is a primigravida at 40 weeks of gestation and states that she thinks she is in labor.Which of the following findings confirm that the client is in labor? (Select all that apply):

Correct Answer is ["A","C","D"]

Explanation

Your patient is receiving magnesium sulfate for neuroprotection and preterm labor at 1 gram/hour. The most concerning vital sign below is:

Correct Answer is B

Explanation

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