A nurse is planning care for a client who is 2 hours postpartum following a cesarean birth. The client has a history of thromboembolic disease. Which of the following nursing interventions should be included in the plan of care?

Place 3 to 4 pillows under the client's knees when resting in bed.

Massage the client's posterior lower legs.

Have the client ambulate.

Apply warm, moist heat to the client's lower extremities.

Answer and Explanation

The Correct Answer is C

A.   Placing pillows under the client's knees may provide comfort but does not address the prevention of thromboembolic disease.
B.   Massaging the client's posterior lower legs may increase the risk of dislodging a clot in clients with a history of thromboembolic disease.
C. Having the client ambulate helps prevent venous stasis and reduces the risk of thromboembolic events.
D.   Applying warm, moist heat to the client's lower extremities may provide comfort but does not address the prevention of thromboembolic disease.

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Correct Answer is D

Explanation

A. A respiratory rate of 110/min is too high for a newborn and may indicate respiratory distress.
B. A respiratory rate of 100/min is too high for a newborn and may indicate respiratory distress.
C. A respiratory rate of 22/min is too low for a newborn.
D. A normal respiratory rate for a newborn is between 40 and 60 breaths per minute.

Correct Answer is ["120"]

Explanation

To calculate the infusion rate in gtt/min, the nurse needs to use the formula: gtt/min = (mL/hr x drop factor) / 60

Plugging in the given values, we get:

gtt/min = (120 mL/hr x 60 gtt/mL) / 60

gtt/min = 7200 gtt/hr / 60 gtt/min = 120 gtt/min

Therefore, the nurse should set the manual IV infusion to deliver 120 gtt/min.

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A nurse is planning care for a client who is 2 hours postpartum following a cesarean birth. The client has a history of thromboembolic disease. Which of the following nursing interventions should be included in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a newborn 1 hr after birth. Which of the following respiratory rates is within the expected reference range for a newborn?

Correct Answer is D

Explanation

Correct Answer is ["120"]

Explanation

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