The practical nurse (PN) is caring for a client who delivered 6 hours ago. Assessment findings reveal a boggy uterus that is displaced above and to the right of the umbilicus. Which action should the PN take?
Encourage voiding.
Monitor vital signs.
Notify healthcare provider.
Inspect the perineal pad.
The Correct Answer is A
If the practical nurse (PN) is caring for a client who delivered 6 hours ago and assessment findings reveal a boggy uterus that is displaced above and to the right of the umbilicus, the PN should encourage the client to void. A full bladder can displace the uterus and prevent it from contracting properly, leading to a boggy uterus. Encouraging the client to void can help empty the bladder and allow the uterus to contract and return to its normal position. The other actions listed may also be appropriate in some situations, but encouraging voiding is the most appropriate action in this situation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Respiratory syncytial virus (RSV) is a highly contagious virus that can cause severe respiratory infections, especially in infants and young children. RSV is easily spread through contact with respiratory secretions from infected individuals, and can survive on surfaces for several hours. Therefore, it is important to avoid exposing other children to RSV, especially those who are under 6 months old or have a weakened immune system. The practical nurse (PN) should advise the mother not to take her infant to the birthday party to prevent the spread of RSV to other children. The PN can provide education on how to prevent the spread of RSV, such as washing hands frequently, avoiding close contact with sick individuals, and covering the mouth and nose when coughing or sneezing.
Correct Answer is C
Explanation
The practical nurse should report to the charge nurse that the client is near delivery, as the client's signs indicate that she is in the transition phase of labor and is likely to deliver soon. The PN should also assess the client's vital signs, fetal heart rate, and pain level, and prepare the delivery equipment.
The husband can be asked to provide emotional support to the client during labor.
The rapid response team may be called in case of a medical emergency, but this is not indicated based on the information given.
Checking the time, the last PRN narcotic analgesic was given is also not indicated at this point, as the client is close to delivery and may not have time for medication to take effect.
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