A nurse is admitting a client who is 1 week postpartum and reports excessive vaginal bleeding. The nurse speaks a different language than the client. The client's partner and 10-year-old child are accompanying her. Which of the following actions should the nurse take to gather the client's admission data?

Ask a nursing student who speaks the same language as the client to translate.

Allow the client's partner to translate.

Request a female interpreter through the facility.

Have the client's child translate.

Answer and Explanation

The Correct Answer is C

A. Ask a nursing student who speaks the same language as the client to translate: This is not appropriate, as the nursing student may not be trained in medical terminology or confidentiality, which could lead to miscommunication and potential breaches of privacy.

B. Allow the client's partner to translate: While the partner may understand the language, this approach can create conflicts of interest, and they may not be able to convey the full medical context or sensitive information accurately.

C. Request a female interpreter through the facility: This is the best action. Using a trained, professional interpreter ensures that the communication is accurate and confidential, allowing the nurse to gather necessary admission data effectively while respecting the client's comfort and cultural needs.

D. Have the client's child translate: It is not appropriate to involve a child in medical discussions, as they may not fully understand the context or terminology and could feel overwhelmed by the responsibility.

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Correct Answer is D

Explanation

A) "Increased erythrocyte sedimentation rate.": An increase in the erythrocyte sedimentation rate (ESR) indicates inflammation or the presence of disease but does not reflect a response to epoetin alfa, which aims to increase red blood cell production.

B) "Increased neutrophil count.": Epoetin alfa primarily stimulates erythropoiesis (red blood cell production) and does not significantly affect neutrophil counts. Therefore, an increased neutrophil count is not a relevant therapeutic response.

C) "Increased platelet count.": Epoetin alfa is not directly aimed at increasing platelet counts. While it can have some indirect effects on platelets due to increased hematocrit, a higher platelet count alone does not indicate a therapeutic response to this medication.

D) "Increased hemoglobin level.": An increased hemoglobin level is the primary therapeutic target of epoetin alfa. This medication is used to treat anemia, particularly in patients with chronic kidney disease or those undergoing chemotherapy, by stimulating the production of red blood cells and thus raising hemoglobin levels.

A. Fetal anemia B. Maternal hypoglycemia C. Chorioamnionitis D. Maternal fever

Correct Answer is B

Explanation

A) Fetal anemia:Fetal anemia typically causes tachycardia (increased heart rate) rather than bradycardia (decreased heart rate). It is not a common cause of fetal bradycardia.

B) Maternal hypoglycemia:Maternal hypoglycemia can lead to decreased glucose availability for the fetus, resulting in fetal bradycardia. It is important to monitor and manage maternal blood glucose levels to ensure adequate fetal oxygenation and prevent bradycardia.

C) Chorioamnionitis:Chorioamnionitis, an infection of the amniotic fluid and membranes, usually causes fetal tachycardia rather than bradycardia. It is associated with an increased fetal heart rate due to the inflammatory response.

D) Maternal fever:Maternal fever is more likely to cause fetal tachycardia due to the increased metabolic rate and oxygen demand. It is not typically associated with fetal bradycardia.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is evaluating the laboratory values of a client who is receiving epoetin alfa. Which of the following findings indicates a therapeutic response to the medication?

Correct Answer is D

Explanation

A nurse is caring for a client who is in active labor and notes the FHR baseline has been 100/min for the past 15 min. The nurse should identify which of the following conditions as a possible cause of fetal bradycardia?

Correct Answer is B

Explanation

A nurse is planning a community health program about Parkinson's disease. Which of the following interventions should the nurse include as a tertiary prevention strategy?

A newly licensed nurse working at an HIV clinic is reviewing the responsibilities of her position at the clinic. Which of the following tasks should the nurse identify as tertiary prevention?

A nurse is caring for an adolescent client who has cystic fibrosis. Which of the following actions should the nurse instruct the client to take prior to initiating postural drainage?

A nurse is caring for a client who has a prescription for 1 unit of packed RBCs. Five minutes after beginning the transfusion, the client becomes febrile with chills. After stopping the transfusion, which of the following actions should the nurse take?

A nurse is developing a plan of care for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following actions should the nurse include in the plan?

A nurse is providing teaching to a client who is at 14 weeks of gestation about findings to report to the provider. Which of the following findings should the nurse include in the teaching?

A nurse is caring for a client who is experiencing increased intracranial pressure following a head injury. In which of the following positions should the nurse place the client?

A nurse is caring for a client who reports a headache and has a history of a peptic ulcer. Which of the following medications should the nurse administer?