Take full exam for free

A nurse is caring for a client in the fourth stage of labor after a vaginal delivery.

History and Physical:

BP: 144/92 mmHg.

Pulse: 99 bpm.
Respirations: 17/min.

Pulse Ox: 97%.

Temperature: 100.4 F (38.0 C).

Pain score: 1/10.

The nurse should first address the client's ____________ (assessment finding), followed by the client's ____________ (assessment finding).

A nurse is caring for a patient with HELLP syndrome.
Which of the following findings are consistent with a diagnosis of HELLP syndrome?

A nurse is caring for a client during the second trimester of pregnancy.After reviewing the client's blood work, the nurse notes the client is rubella non-immune.
When should the client be offered the rubella immunization?

A nurse is assessing a client who is 2 hr postpartum and received spinal anesthesia for a cesarean birth.
Which of the following findings requires immediate intervention by the nurse?

A nurse is caring for a 28-year-old postpartum female client in the postpartum unit.

Medical History:

The client is on postpartum day 1. She is breastfeeding her newborn every 4 to 5 hours for 30 to 40 minutes each time. She reports some nipple discomfort during the feedings. The nurse assisted the client with positioning and latch and recommended the client awaken the newborn to feed every 3 hours during the day. The newborn voided twice and passed two meconium stools in the past 24 hours.

Vital Signs:

Blood Pressure: 120/80 mmHg

Pulse: 80 bpm

Respirations: 16/min

Temperature: 36.8°C (98.2°F)

Pulse Ox: 99%

Nurses Notes: On postpartum day 2, the client reports breastfeeding every 3 to 4 hours and experiencing nipple discomfort during some feedings. No physical findings of nipple trauma are noted, and the breasts are soft. The client denies feelings of fullness. The newborn voided twice and passed three meconium stools in the second 24 hours of life. Discharge teaching was provided to the client regarding breastfeeding.

Querry: Which of the following statements by the client indicates an understanding of the discharge teaching? Click to highlight the client statements that indicate an understanding of the discharge teaching.

A nurse is assisting a teenage client with breastfeeding.
The client asks, "How will I know when to feed my baby?" The nurse educates the client on infant feeding cues. Which of the following is a newborn feeding cue?

A nurse is caring for a client who experienced a cesarean birth due to dysfunctional labor. The client states that she is disappointed that she did not have natural childbirth. Which of the following responses should the nurse make?
A. "It sounds like you are feeling sad that things didn't go as planned.”.

A nurse in the labor and delivery unit is caring for a client who is undergoing external fetal monitoring. The nurse observes that the fetal heart rate begins to slow at the start of a contraction and the nadir is at the same time as the peak of the contraction. The FHR returns to the FHR baseline at the same time that the contraction ends. The nurse should document this finding as which of the following?

A nurse is providing care to a woman who is at 36 weeks of gestation and in preterm labor with ruptured membranes.
The nurse determines that the client's oral temperature is 39.0 C (102.2 F). Besides notifying the provider, which of the following is an appropriate nursing action?

A nurse is caring for a newborn 4 hours after birth.
Which of the following actions should the nurse include in the plan of care to prevent jaundice?

A nurse is caring for a newborn client. The assessment findings include a high-pitched cry, increased muscle tone, frequent yawning, poor feeding with projectile vomiting, and tachypnea.
What condition does the nurse suspect?