A nurse is caring for a client who is 2 weeks postpartum following a cesarean birth. Which of the
following clinical findings should the nurse identify
... [Show More] as an indication of postpartum infection?
Unilateral breast pain
A nurse is assessing a client who has preeclampsia during a prenatal visit. Which of the following findings
should the nurse report to the provider?
Urine protein of 3+
A nurse is providing teaching about the expected effects of magnesium sulfate to a client who is at 28
weeks gestation and has preeclampsia. Which of the following responses by the nurses is appropriate?
“This medication prevents seizures.”
A nurse is teaching a prenatal class regarding false labor. Which of the following information should the
nurse include?
“Your contractions will become temporarily regular.”
A nurse manager is revising a maternal unit policy to ensure proper identification of newborns. Which of
the following should the nurse include in the policy?
Obtain an imprint of the infant’s feet prior to taking him to the nursery
A nurse is caring for a client who delivered by cesarean birth 6 hrs. ago. The nurse notes a steady trickle
of vaginal bleeding that does not stop with fundal massage. Which of the following actions should the
nurse take?
Administer 500 mL lactated ringer’s IV bolus
A nurse is providing discharge instructions to a client who is postpartum and has engorged breasts.
Which of the following nonpharmacological comfort measures should the nurse include in the teaching?
Apply cabbage leaves after feedings
A nurse is calculating the estimated date of birth using Nagele’s rule for a client who is pregnant and
whose last menstrual cycle started June 21. Which of the following is the estimated date of delivery in
the next year?
March 28
A nurse is caring for a client immediately following the delivery of a stillborn fetus. Which of the
following actions should the nurse take?
Prepare the client for what to expect the fetus to look like.
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A nurse is observing an adolescent client who is offering her newborn a bottle while he is lying in the
bassinet. When the nurse offers to pick the newborn up and place him in the client’s arms, the mother
states, “No, the baby is too tired to be held.” Which of the following actions should the nurse take?
Demonstrate how to hold the newborn and allow the client to practice
A nurse is caring for a client who is in labor. Which of the following findings should prompt the nurse to
reassess the client.
Progressive sacral discomfort during contractions
A nurse is assessing a client who is at 27 weeks of gestation and has preeclampsia. Which of the
following findings should the nurse report to the provider?
Platelet count 60,000/mm
HELLP Syndrome
A nurse in a clinic is preparing to measure the fundal height of a client who is pregnant. Which of the
following actions should the nurse take?
Measure from the upper border of the symphysis pubis to the upper border of the fundus
A nurse is caring for a client who is at 20 weeks of gestation and reports constipation. Which of the
following recommendations should the nurse make to help relieve this common discomfort of
pregnancy?
Drink 2 to 3 L of water each day
A nurse is assessing the fetal heart rate for a client who is at 38 weeks of gestation. When using an
ultrasound device, the nurse hears blood rushing through the umbilical vessels in synchronization with
the fetal heartbeat. Which of the following terms should the nurse use to document this finding? Funic
soufflé
Funic soufflé
Swishing of blood sound through umbilical cord (fetus)
A nurse manager in a newborn nursery is reviewing infection control procedures with a group of newly
hired nurses. Which of the following instructions should the nurse manager include in the teaching?
Place newborn bassinets at least 3 feet apart
A nurse is caring for a client who is receiving magnesium sulfate by continuous IV infusion. The nurse
notes a respiratory rate of 8/min and absent DTR’s. Which of the following medications should the nurse
administer?
Calcium gluconate
A nurse is caring for a client who is 8 hrs. postpartum following vaginal delivery and is unable to void.
Which of the following interventions should the nurse use to promote voiding? [Show Less]