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A nurse is reinforcing teaching about travel with a client who is pregnant.Which of the following instructions should the nurse include?

A.

Take a break and walk at least once every hour during long trips.

B.

Wear the shoulder harness snug across your stomach.

C.

Position the lap belt across your navel.

D.

Move your car seat forward, close to the steering wheel.

Answer and Explanation

The Correct Answer is A

Choice A rationale

 

Taking a break and walking at least once every hour during long trips helps improve circulation and reduces the risk of blood clots, which is particularly important during pregnancy.

 

Choice B rationale

 

Wearing the shoulder harness snug across the stomach is incorrect. The shoulder harness should be worn across the chest and between the breasts to avoid pressure on the abdomen.

 

Choice C rationale

 

Positioning the lap belt across the navel is incorrect. The lap belt should be placed under the belly, across the hips and pelvic bone, to avoid pressure on the uterus.

 

Choice D rationale

 

Moving the car seat forward, close to the steering wheel, is not recommended. Pregnant women should maintain a safe distance from the steering wheel to avoid injury in case of an accident.


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View Related questions

Correct Answer is A

Explanation

Choice A rationale

Checking the identity of individuals who come to remove the baby from the room is crucial for preventing infant abduction and ensuring the safety of the newborn.

Choice B rationale

Matching the bracelet on the baby with the footprint record each shift is not a standard practice for newborn identification and safety.

Choice C rationale

Scanning the baby’s identification bracelet each time they are checked on is not a common practice and may not be feasible.

Choice D rationale

Wearing an electronic bracelet when out of the room is a safety measure, but it does not replace the need for parents to verify the identity of individuals handling their baby.

Correct Answer is ["D","G","H"]

Explanation

Choice A rationale

Deep tendon reflexes of 1+ are considered within normal limits and do not require immediate follow-up. This finding is not indicative of any acute complications.

Choice B rationale

A blood pressure reading of 136/86 mm Hg is slightly elevated but not critically high. It does not indicate an immediate risk and can be monitored with routine care.

Choice C rationale

A pain rating of 3 on a scale of 0 to 10 is mild and manageable. It does not necessitate immediate follow-up unless there is a sudden and significant increase in pain.

Choice D rationale

A large amount of lochia rubra can be a sign of excessive bleeding and requires immediate follow-up to assess for postpartum hemorrhage. This finding is concerning and needs prompt attention.

Choice E rationale

Peripheral edema of 2+ in bilateral lower extremities is common in the postpartum period due to fluid shifts and should resolve naturally. It does not require immediate follow-up unless it worsens or is accompanied by other symptoms.

Choice F rationale

Soft breasts are normal postpartum when milk has not yet come in or if the client is not breastfeeding. This finding does not require immediate follow-up as it is a normal occurrence.

Choice G rationale

A soft uterine tone can indicate uterine atony, which can lead to hemorrhage. Immediate follow-up is necessary to prevent potential complications such as postpartum hemorrhage.

Choice H rationale

Lateral deviation of the uterus can indicate a displaced uterus, possibly due to a full bladder or other reasons, which requires prompt attention. This finding could lead to complications if not addressed promptly.

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