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A postpartum client presents with persistent, severe perineal pain and swelling following a vaginal delivery. On assessment, the nurse notes ecchymosis and tenderness of the perineum. Which nursing action is most appropriate?
- A. Applying ice packs to the perineum for pain relief
- B. Encouraging the client to sit on a donut cushion
- C. Notifying the healthcare provider immediately
- D. Administering additional analgesic medication
Correct Answer: C
Rationale: The most appropriate nursing action in this situation is to notify the healthcare provider immediately. The client presenting with persistent, severe perineal pain and swelling, along with ecchymosis and tenderness of the perineum, could be indicative of complications such as a perineal hematoma. A perineal hematoma is a collection of blood in the perineal tissues and can be a serious postpartum complication requiring prompt medical attention. Therefore, it is crucial to alert the healthcare provider so that appropriate assessment, management, and treatment can be initiated promptly. Applying ice packs or encouraging the client to sit on a donut cushion may not be sufficient in this situation, and administering additional analgesic medication should be done only after the healthcare provider has assessed and determined the cause of the symptoms.
You may also like to solve these questions
Which of the following statements is INCORRECT of collaboration in a health care settings?
- A. Trust and respect are core values of a collaborative organization. -
- B. A shared vision is essential for collaboration in any health care operations.
- C. Successful conflict resolution can help collaborative teams overcome differences.
- D. Inter professional collaboration & multidisciplinary collaboration can be used interchangeably.
Correct Answer: D
Rationale: The correct answer is D because interprofessional collaboration and multidisciplinary collaboration are not interchangeable terms. Interprofessional collaboration involves professionals from different disciplines working together to provide comprehensive care, while multidisciplinary collaboration involves professionals from various disciplines working alongside each other but not necessarily working together in a coordinated manner. This distinction is crucial in healthcare settings to ensure effective teamwork and patient-centered care.
A: Trust and respect are core values of a collaborative organization - This statement is correct because trust and respect are essential for effective collaboration in healthcare settings.
B: A shared vision is essential for collaboration in any health care operations - This statement is correct as a shared vision helps align team members towards common goals.
C: Successful conflict resolution can help collaborative teams overcome differences - This statement is correct as resolving conflicts constructively can strengthen team dynamics and improve collaboration.
Which of the following conditions is characterized by inflammation of the glomeruli in the kidneys, leading to hematuria, proteinuria, and hypertension?
- A. Acute tubular necrosis
- B. Acute glomerulonephritis
- C. Chronic kidney disease
- D. Nephrotic syndrome
Correct Answer: B
Rationale: The correct answer is B: Acute glomerulonephritis. Glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys, leading to symptoms like hematuria (blood in urine), proteinuria (excess protein in urine), and hypertension (high blood pressure).
Acute tubular necrosis (A) involves damage to the renal tubules, not the glomeruli. Chronic kidney disease (C) refers to long-term kidney damage and may not always present with the classic symptoms mentioned. Nephrotic syndrome (D) involves excessive protein loss in urine but may not always involve inflammation of the glomeruli.
A patient with a history of nephrolithiasis presents with sudden-onset severe colicky flank pain radiating to the groin. On physical examination, there is tenderness over the costovertebral angle and hematuria. What is the most likely diagnosis?
- A. Acute pyelonephritis
- B. Renal artery embolism
- C. Renal colic due to ureteral calculus
- D. Renal infarction
Correct Answer: C
Rationale: The correct answer is C: Renal colic due to ureteral calculus. The sudden-onset severe colicky flank pain radiating to the groin along with tenderness over the costovertebral angle and hematuria are classic symptoms of kidney stones (ureteral calculus). The pain results from the obstruction of urine flow by the stone, leading to increased pressure and spasm in the ureter. Acute pyelonephritis (choice A) presents with fever, chills, and systemic symptoms. Renal artery embolism (choice B) typically presents with acute onset severe flank pain but is associated with risk factors like atrial fibrillation. Renal infarction (choice D) presents with sudden-onset severe flank pain but is less likely than ureteral calculus in a patient with a history of nephrolithiasis.
The PRIORITY nursing objective when caring a patient with a tracheostomy is _________.
- A. To increase tissue oxygenation
- B. To provide patent airway
- C. To decrease tissue oxygenation
- D. To improve ventilation
Correct Answer: B
Rationale: The correct answer is B: To provide a patent airway. When caring for a patient with a tracheostomy, ensuring a clear and unobstructed airway is the top priority to maintain adequate oxygenation and ventilation. This involves suctioning, maintaining proper tube placement, and monitoring for any signs of respiratory distress. Choices A, C, and D are incorrect as they do not address the immediate need for airway management, which is crucial for the patient's safety and well-being.
The Nurse asks Baste, who is being admitted in a district hospital with uncontrolled diabetes mellitus, about his employment status. She knows that _____.
- A. A person's compliance is affected by one's affected economic status
- B. Baste's employment will cause complication to his diabetes
- C. External variables have little effected on compliance
- D. Diabetes mellitus will affect his client's work condition
Correct Answer: A
Rationale: Rationale: A person's compliance with diabetes management can be influenced by economic status, as financial concerns can impact access to medications, healthy food, and healthcare. This can affect treatment adherence and overall health outcomes. Choice A is correct because addressing economic factors is important in promoting compliance. Choices B, C, and D are incorrect as they do not directly address the relationship between economic status and compliance with diabetes management.