Nokea
After being treated with heparin therapy for thrombophlebitis, a multiparous client who delivered 4 days ago is to be discharged on oral warfarin (Coumadin). After teaching the client about the medication and possible effects, which of the following client statements indicates successful teaching?
- A. I can take two aspirin if I get uterine cramps.
- B. Protamine sulfate should be available if I need it.
- C. I should use a soft toothbrush to brush my teeth.
- D. I can drink an occasional glass of wine if I desire.
Correct Answer: C
Rationale: Using a soft toothbrush minimizes bleeding risk, a key consideration with warfarin.
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A laboring client at -2 station has a spontaneous rupture of the membranes and a cord immediately protrudes from the vagina. The nurse should first:
- A. Place gentle pressure upward on the fetal head.
- B. Place the cord back into the vagina to keep it moist.
- C. Begin oxygen by face mask at 8 to 10 L/min.
- D. Turn the client on her left side.
Correct Answer: A
Rationale: Gentle pressure prevents cord compression.
A primigravid client's baseline blood pressure at her initial visit at 12 weeks' gestation was 110/70 mm Hg. During an assessment at 38 weeks' gestation, which of the following data would indicate mild preeclampsia?
- A. Blood pressure of 160/110 mm Hg on two separate occasions.
- B. Proteinuria, more than 5 g in 24 hours.
- C. Serum creatinine concentration of 1.4 mL/dL.
- D. Weight gain of 2 lb in the last week.
Correct Answer: D
Rationale: Sudden weight gain is characteristic of mild preeclampsia.
A nurse is teaching a client about the use of the contraceptive patch. Which of the following client statements indicates a need for further teaching?
- A. I will change the patch weekly for three weeks.
- B. I will apply the patch to my abdomen or buttocks.
- C. I can wear the patch while swimming or bathing.
- D. The patch will prevent ovulation permanently10 permanently.
Correct Answer: D
Rationale: The contraceptive patch does not prevent ovulation permanently; it suppresses ovulation during use and is reversible. The other statements are correct, indicating a need for further teaching.
The nurse is assessing a client at her postpartum checkup 6 weeks after a vaginal delivery. The mother is bottle feeding her baby. Which client finding indicates a problem at this time?
- A. Firm fundus at the symphysis.
- B. White, thick vaginal discharge.
- C. Striae that are silver in color.
- D. Soft breasts without milk.
Correct Answer: B
Rationale: White, thick vaginal discharge at 6 weeks suggests an infection, as lochia should be minimal or absent by this time.
During the first hour after delivery, assessment of a multiparous client who delivered a neonate weighing 4,593 g (10 lb, 2 oz) by cesarean delivery reveals a soft fundus with excessive lochia rubra. The nurse should include which of the following in the client's plan of care?
- A. Administration of intravenous oxytocin.
- B. Placement of the client in a side-lying position.
- C. Rigorous fundal massage every 5 minutes.
- D. Preparation for an emergency hysteromyomectomy.
Correct Answer: A
Rationale: A soft fundus and excessive lochia suggest uterine atony, which is treated with oxytocin to promote uterine contraction.