While waiting for the placenta to deliver during the third stage of labor, the nurse must assess the new mother's vital signs every 15 minutes.
What sign would indicate impending shock?.
Bradypnea and hypertension.
Tachycardia and a falling blood pressure.
Tachypnea and a widening pulse pressure.
Bradycardia and auscultation of fluid in the base of the lungs.
The Correct Answer is B
Choice A rationale:
Bradypnea and hypertension are not typically signs of impending shock.
Choice B rationale:
Tachycardia and a falling blood pressure are classic signs of shock as the body tries to compensate for the decreased blood flow.
Choice C rationale:
Tachypnea and a widening pulse pressure can be signs of shock, but they are not as indicative as tachycardia and a falling blood pressure.
Choice D rationale:
Bradycardia and auscultation of fluid in the base of the lungs are not typically signs of impending shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The best contraceptive is indeed one that the couple will use correctly and consistently, as effectiveness largely depends on correct use.
Choice B rationale:
No contraceptive method is 100% effective, so this statement could give false assurance.
Choice C rationale:
While cost and convenience are important factors, they should not be the only considerations when choosing a contraceptive.
Choice D rationale:
Some effective contraceptives do require a prescription, so this statement could limit the couple’s options.
Correct Answer is D
Explanation
Choice A rationale:
Notifying the primary care provider is important but not the immediate next step. The nurse has other immediate responsibilities to ensure the safety of the mother and baby.
Choice B rationale:
A vaginal exam could introduce bacteria into the uterus and is not the immediate next step after rupture of membranes.
Choice C rationale:
Changing the linen saver pad is not the immediate next step. While it might be necessary for the comfort of the mother, it does not address the potential risks associated with rupture of membranes.
Choice D rationale:
Checking the fetal heart rate is the correct next step. This ensures that the baby is not in distress following the rupture of membranes.
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