A nurse is planning care for a client who is experiencing moderate vaginal bleeding due to a placental abruption. Which of the following interventions should the nurse include in the plan?
Check cervical dilation every 2 hr.
Initiate an IV with an 18-gauge catheter.
Monitor FHR hourly.
Obtain vital signs every 4 hr.
The Correct Answer is B
Choice A rationale:
Frequent cervical examinations may increase the risk of introducing infection or causing additional bleeding. Cervical examinations are not a priority in managing placental abruption.
Choice B rationale:
Placental abruption can lead to significant blood loss, and the client may require intravenous fluids and blood products to maintain hemodynamic stability. Initiating an IV with an 18-gauge catheter allows for rapid administration of fluids and blood products if needed.
Choice C rationale:
Monitoring fetal heart rate hourly is important, but addressing the mother's hemodynamic stability with IV fluids takes priority.
Choice D rationale:
Vital signs should be obtained more frequently than every 4 hours due to the risk of ongoing blood loss.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Sertraline is an antidepressant medication known as a selective serotonin reuptake inhibitor (SSRI). One of the potential side effects of SSRIs is sexual dysfunction, including erectile dysfunction.
Choice B rationale:
Vancomycin is an antibiotic and is not typically associated with erectile dysfunction.
Choice C rationale:
Topiramate is an anticonvulsant medication and is not typically associated with erectile dysfunction.
Choice D rationale:
Polyethylene glycol is a laxative and is not typically associated with erectile dysfunction.
Correct Answer is A
Explanation
Choice A rationale:
Following hypospadias repair, a urinary catheter is often placed to ensure proper healing. The duration of catheterization varies, but about 1 week is a common timeframe.
Choice B rationale:
Clamping the catheter tubing for extended periods is not a standard practice and can cause discomfort and complications.
Choice C rationale:
Applying antifungal ointment is not typically required after hypospadias repair.
Choice D rationale:
A prophylactic antibiotic is not typically prescribed for 6 weeks following hypospadias repair.
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