What action should a nurse take when caring for a client who is 1 hr postpartum and observes a large amount of lochia rubra and several small clots on the client’s perineal pad, with the fundus midline and firm at the umbilicus?
Notify the client’s provider.
Document the findings and continue to monitor the client.
Increase the frequency of fundal massage.
Encourage the client to empty her bladder.
The Correct Answer is B
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Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
While it’s true that any internal examination carries a risk of introducing infection, this is not the primary reason to avoid an internal examination in a client with placenta previa.
Choice B rationale
Initiating preterm labor is a concern with any internal examination, but it’s not the primary reason to avoid an internal examination in a client with placenta previa.
Choice C rationale
This is the correct answer. In a client with placenta previa, an internal examination could disturb the placenta and cause severe, potentially life-threatening bleeding.
Choice D rationale
While rupture of the membranes is a risk associated with internal examinations, it’s not the primary reason to avoid an internal examination in a client with placenta previa.
Correct Answer is ["A","C"]
Explanation
The correct answers are A. Transverse palmar creases and C. Protruding tongue.
Choice A rationale:
Transverse palmar creases, also known as a single palmar crease, are a common characteristic of Down syndrome. This feature is present in many individuals with the condition.
Choice B rationale:
Muscular hypertonicity (increased muscle tone) is not typical in Down syndrome. Instead, individuals with Down syndrome often have hypotonia (decreased muscle tone).
Choice C rationale:
A protruding tongue is a common characteristic of Down syndrome. This is due to a combination of factors, including a small oral cavity and low muscle tone.
Choice D rationale:
Large ears are not a typical feature of Down syndrome. Individuals with Down syndrome often have small or unusually shaped ears.
Choice E rationale:
Low birth weight is not specifically associated with Down syndrome. While some infants with Down syndrome may have low birth weight, it is not a defining characteristic.
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