Nokea
The nurse prepares a client for lumbar epidural anesthesia. Before anesthesia administration, the nurse instructs the client to assume which of the following positions?
- A. Sitting with back arched.
- B. Lying flat on back.
- C. Side-lying with knees bent.
- D. Prone with head elevated.
Correct Answer: A
Rationale: The sitting position with the back arched (e.g., 'shrimp' position) provides optimal access to the lumbar spine for epidural placement. Other positions do not facilitate needle insertion as effectively.
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A 28-year-old multigravida at 37 weeks' gestation arrives at the emergency department with a blood pressure of 160/104 mm Hg and +3 reflexes without clonus. The client is diagnosed with severe preeclampsia. The nurse collaborates with the health care provider to develop a plan of care that care will first include:
- A. Administration of glucocorticoids(Betamethasone).
- B. Vaginal or cesarean delivery of the fetus.
- C. Prevention of seizures with phenytoin (Dilantin).
- D. Reduction of fluid retention with thiazides.
Correct Answer: B
Rationale: Delivery is the definitive treatment for severe preeclampsia.
The nurse should do which of the following actions first when admitting a multigravid client at 36 weeks' gestation with a probable diagnosis of abruptio placentae?
- A. Prepare the client for a vaginal examination.
- B. Obtain a brief history from the client.
- C. Insert a large-gauge intravenous catheter.
- D. Prepare the client for an ultrasound scan.
Correct Answer: C
Rationale: Establishing IV access is critical in managing abruptio placentae.
A primigravid client at 36 weeks' gestation with premature rupture of the membranes is to be discharged home on bed rest with follow-up by the home health nurse. After instruction about care while at home, which of the following client statements indicates effective teaching?
- A. "It is permissible to douche if the fluid irritates my vaginal area."
- B. "I can take either a tub bath or a shower when I feel like it."
- C. "I should limit my fluid intake to less than 1 quart daily."
- D. "I should contact the doctor if my temperature is 100.4° F or higher."
Correct Answer: D
Rationale: Contacting the doctor for fever is appropriate.
Four hours after cesarean delivery of a neonate weighing 4,000 g (8 lb, 13 oz), the primiparous client asks, "If I get pregnant again, will I need to have a cesarean?" When responding to the client, the nurse should base the response to the client about vaginal birth after cesarean delivery (VBAC) on which of the following?
- A. VBAC may be possible if the client has not had a classic uterine incision.
- B. A history of rapid labor is a necessary criterion for VBAC.
- C. A low transverse incision contraindicates the possibility for VBAC.
- D. VBAC is not possible because the neonate was large for gestational age.
Correct Answer: A
Rationale: VBAC is often possible with a low transverse incision, unlike a classic vertical incision.
A 24-year-old client is discussing contraception options with the nurse and expresses interest in an intrauterine device (IUD). Which of the following statements by the client indicates a need for further teaching?
- A. I understand the IUD can remain in place for several years.
- B. The IUD will prevent ovulation each month.
- C. I may experience heavier menstrual periods with the copper IUD.
- D. The IUD does not protect against sexually transmitted infections.
Correct Answer: B
Rationale: The IUD does not primarily prevent ovulation; it works by affecting sperm movement and preventing fertilization (copper IUD) or thinning the uterine lining (hormonal IUD). The other statements are correct, indicating a need for further teaching about its mechanism.