The nurse is caring for a laboring patient who is not reporting pain. What sign would alert the nurse of the need for pain relief?
Changing positions in bed
frequently asking for ice chips
Taking deep breaths
Facial grimacing
The Correct Answer is D
A. Changing positions in bed: This may indicate discomfort but not necessarily pain.
B. Frequently asking for ice chips: Suggests thirst or distraction, not pain.
C. Taking deep breaths: Often part of coping strategies, not a direct indicator of unrelieved pain.
D. Facial grimacing: A non-verbal cue strongly associated with pain or discomfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Cramping and backache with light spotting: These are classic signs of a threatened abortion, where the pregnancy is at risk but not yet lost.
B. Cervix is dilated: A dilated cervix indicates an inevitable or incomplete abortion, not a threatened one.
C. Passage of all products of conception has occurred: This describes a complete abortion.
D. Fetus died in utero but is not expelled: This describes a missed abortion, not a threatened abortion.
Correct Answer is A
Explanation
A. Assure the client that the score is within the expected range: A score of 8–10 on a biophysical profile indicates fetal well-being, requiring no intervention.
B. Offer the client orange juice and repeat the assessment in 1 hour: This is unnecessary since the score indicates no concern.
C. Administer oxygen and notify the provider: There is no indication of fetal distress.
D. Assist the client into a side-lying position: A position change is not needed as there is no evidence of compromise.
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