A nurse is assessing self-management skills for a client who has preeclampsia without severe features. Which of the following client statements should the nurse recognize as an indication the client is coping effectively?

"I need to be discharged now due to household responsibilities."

"I am so bored of being on restricted activity."

"I am using a notebook to record questions for my providers."

"I don't want any visitors while I'm here."

Answer and Explanation

The Correct Answer is C

Rationale:
A. "I need to be discharged now due to household responsibilities.": This statement reflects denial of the seriousness of preeclampsia and poor coping, as the client is prioritizing home duties over health. Clients with preeclampsia require rest, monitoring, and adherence to medical advice to prevent complications such as eclampsia or HELLP syndrome.

B. "I am so bored of being on restricted activity.": Expressing boredom is a normal emotional reaction but does not indicate effective coping. It shows frustration with activity limitations rather than acceptance and constructive adaptation to the treatment plan.

C. "I am using a notebook to record questions for my providers.": Keeping a notebook demonstrates proactive engagement and self-management. This behavior reflects effective coping, as the client is taking responsibility for understanding their condition and participating in care decisions to promote safety and adherence.

D. "I don't want any visitors while I'm here.": Avoiding social support may indicate withdrawal or emotional distress. Isolation can hinder coping and increase anxiety, whereas maintaining open communication and support networks usually improves adjustment to the condition.

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Correct Answer is A

Explanation

Rationale:
A. INR: The International Normalized Ratio (INR) is used to monitor the effectiveness and safety of warfarin therapy. It standardizes prothrombin time results, allowing clinicians to determine whether the client’s anticoagulation is within the therapeutic range to prevent clotting without causing excessive bleeding.

B. Factor VIII: Factor VIII is a clotting factor assessed in hemophilia or other coagulation disorders. It is not used to monitor warfarin therapy and does not indicate the therapeutic effect of anticoagulation.

C. Bleeding time: Bleeding time measures platelet function and vascular integrity, but it does not assess the anticoagulant effect of warfarin. It is unrelated to monitoring warfarin dosing.

D. aPTT: Activated partial thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. It does not provide information about the client’s warfarin anticoagulation status.

A. Provide a pacifier for nonnutritive sucking. B. Warm the formula in the microwave prior to administration. C. Change the gastrostomy tube every 3 days. D. Place the infant in a supine position after the feeding.

Correct Answer is A

Explanation

Rationale:
A. Provide a pacifier for nonnutritive sucking: Offering a pacifier promotes nonnutritive sucking, which supports oral motor development and provides comfort for the infant during gastrostomy tube feedings. This practice can help the infant transition more easily to oral feeding later.

B. Warm the formula in the microwave prior to administration: Warming formula in the microwave is unsafe because it can create hot spots that may burn the infant’s mouth or esophagus. Formula should be warmed using a bottle warmer or by placing the container in warm water.

C. Change the gastrostomy tube every 3 days: Routine gastrostomy tube replacement every 3 days is unnecessary and can cause trauma. Tubes are generally changed according to manufacturer recommendations or when malfunction or blockage occurs.

D. Place the infant in a supine position after the feeding: Infants should be kept in an upright or semi-upright position during and after feedings to reduce the risk of aspiration. Supine positioning increases the likelihood of reflux and respiratory complications.

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A nurse is assessing self-management skills for a client who has preeclampsia without severe features. Which of the following client statements should the nurse recognize as an indication the client is coping effectively?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing laboratory results for a client who is taking warfarin. Which of the following laboratory tests determines if the dose of medication is within the recommended target range?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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