Nokea
A postpartum client complains of persistent, heavy vaginal bleeding beyond the expected timeframe. Which nursing action is most appropriate?
- A. Encouraging the client to increase fluid intake
- B. Applying a cold compress to the perineum
- C. Assessing vital signs and uterine tone
- D. Administering pain medication as ordered
Correct Answer: C
Rationale: In a postpartum client complaining of persistent, heavy vaginal bleeding, the most appropriate nursing action is to assess vital signs and uterine tone. This is important to determine if the bleeding is within normal limits or if there is a potential postpartum hemorrhage (PPH) occurring. Monitoring vital signs can help identify signs of shock, while assessing uterine tone can help determine if the uterus is contracting effectively to control bleeding. Prompt assessment and early detection of PPH are crucial for effective management and prevention of complications. Encouraging increased fluid intake, applying a cold compress, and administering pain medication may be appropriate interventions in some situations, but assessing vital signs and uterine tone take priority in this scenario.
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Which of the following actions is recommended for managing a patient with a suspected snakebite?
- A. Applying a tourniquet proximal to the bite site.
- B. Immobilizing the affected limb at the level of the heart.
- C. Making an incision over the bite site to facilitate venom extraction.
- D. Transporting the patient to a medical facility for antivenom administration.
Correct Answer: D
Rationale: The correct answer is D: Transporting the patient to a medical facility for antivenom administration. This is recommended because antivenom is the definitive treatment for snakebites. Tourniquets (choice A) can worsen tissue damage and should be avoided. Elevating the limb (choice B) may not prevent venom spread. Making an incision (choice C) can lead to infection and increased venom absorption. Antivenom administration at a medical facility is crucial for proper management of snakebites.
Which of the following regulates the practice of the nursing profession?
- A. Department of Health
- B. Professional Regulation Commission
- C. Civil Service Commision
- D. Professional Regulatory Board of Nursing
Correct Answer: D
Rationale: The correct answer is D: Professional Regulatory Board of Nursing. This board is specifically tasked with regulating the practice of the nursing profession, ensuring that nurses adhere to ethical and professional standards. The Department of Health (A) focuses on public health policies, not individual professional regulation. The Professional Regulation Commission (B) oversees various professions but does not specialize in nursing. The Civil Service Commission (C) deals with civil service matters, not professional nursing regulation. Therefore, the Professional Regulatory Board of Nursing is the most appropriate choice for regulating the nursing profession.
A woman in active labor is receiving an epidural analgesic for pain relief. What assessment findings indicate a potential complication of epidural analgesia?
- A. Maternal hypotension
- B. Uterine hyperstimulation
- C. Fetal tachycardia
- D. Respiratory depression
Correct Answer: A
Rationale: One potential complication of epidural analgesia in labor is maternal hypotension. The epidural analgesic can cause vasodilation, leading to a decrease in blood pressure. Maternal hypotension can result in decreased placental perfusion, which may jeopardize fetal well-being. It is important for healthcare providers to monitor the maternal blood pressure closely and intervene promptly if hypotension occurs by providing IV fluids or administering medication to raise blood pressure. Uterine hyperstimulation, fetal tachycardia, and respiratory depression are not typically associated with epidural analgesia as complications.
Korino has been using meperidine and codeine for personal consumption. Which of the following does the nurse understand as the physiologic effect of these drugs?
- A. Increases sexual stimulation.
- B. Relieves pain by increasing pain threshold.
- C. Decrease craving for alcoholic intake.
- D. Heightens concentration and alertness
Correct Answer: B
Rationale: The correct answer is B: Relieves pain by increasing pain threshold. Meperidine and codeine are opioid analgesics that work by binding to opioid receptors in the brain and spinal cord, thus increasing the pain threshold and reducing the perception of pain. This leads to pain relief without necessarily affecting sexual stimulation (choice A), craving for alcohol (choice C), or concentration/alertness (choice D). The primary physiological effect of these drugs is to modulate the perception of pain, making choice B the most appropriate answer in this context.
There is an outbreak of measles in some areas of the community where Nurse Rona is assigned. Which of the following-steps of an outbreak investigation should Nurse Rona and her team begin ?
- A. Identify and count cases.
- B. Define and identify cases.
- C. Verify diagnosis
- D. Prepare for field work.
Correct Answer: A
Rationale: The correct answer is A: Identify and count cases. In the initial stages of an outbreak investigation, it is crucial to identify and count cases to understand the scope and magnitude of the outbreak. By counting cases, Nurse Rona and her team can track the spread of the disease, identify common characteristics among those affected, and determine the extent of the outbreak. This step helps in guiding further investigation and control measures.
Summary of other choices:
B: Define and identify cases - While defining cases is important, it is not the initial step in outbreak investigation.
C: Verify diagnosis - Verifying diagnosis is important but comes after identifying and counting cases.
D: Prepare for field work - Field work is important in outbreak investigations, but it typically comes after the initial step of identifying and counting cases.