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A nurse is collecting data on a newborn who is 1 day old.Which of the following findings is a manifestation of dehydration?

A nurse is reinforcing teaching with a client who is pregnant and reports frequent heartburn.Which of the following recommendations should the nurse include in the teaching?

A nurse in a provider’s office is collecting data from a client who is at 34 weeks of gestation and reports having a sudden gush of vaginal fluid.Which of the following manifestations is the priority?

A nurse is assisting with the care of a postpartum client who delivered vaginally 8 hours ago in the maternity ward.

Exhibit 1: Vital Signs

0700:

• Temperature: 36.2°C (97.2°F)

• Heart rate: 80/min

• Respiratory rate: 16/min

• Blood pressure: 136/82 mm Hg

• Pulse oximetry: 99%

1100:

• Temperature: 37.2°C (99.0°F)

• Heart rate: 85/min

• Respiratory rate: 18/min

• Blood pressure: 136/86 mm Hg

• Pulse oximetry: 100%

Exhibit 2: Nurses’ Notes

0700: The client’s breasts are soft with intact nipples. The uterus is palpated firm, midline, and at the level of the umbilicus. There is a moderate amount of lochia rubra. The episiotomy site is well approximated with mild edema and ecchymosis. The client reports pain as 2 on a scale of 0 to 10. She is able to void spontaneously with no bladder distention. Deep tendon reflexes are 1+. Peripheral edema is 2+ in bilateral lower extremities.

1100: The client’s breasts are soft with intact nipples. The uterus is palpated soft with lateral deviation and 1 cm above the umbilicus. There is a large amount of lochia rubra. The episiotomy site is well approximated with mild edema and ecchymosis. The client reports pain as 3 on a scale of 0 to 10. Deep tendon reflexes are 1+. Peripheral edema is 2+ in bilateral lower extremities.

Question: Select the 3 findings that require immediate follow-up.

A nurse is caring for a client who inquires about available methods of contraception.Which of the following actions should the nurse take?

A charge nurse is discussing risk factors for postpartum hemorrhage with a newly licensed nurse.Which of the following conditions should the nurse include as a risk factor?

A nurse is contributing to the plan of care for a client who is postpartum and has mastitis.Which of the following actions should the nurse plan to take?

A nurse is caring for a client who is pregnant and has a vaginal culture that is positive for chlamydia.Which of the following medications should the nurse plan to administer?

A nurse is preparing to collect a specimen for newborn screening.Which of the following actions should the nurse take?

A nurse is reinforcing teaching with a newly licensed nurse concerning a client on a postpartum unit following a cesarean birth.Which of the following measures should the nurse include in the instructions to prevent thrombophlebitis?

A nurse is assisting with the care of a client who is in the third trimester of gestation.Which of the following statements by the client’s partner indicates effective adaptation to their new role?