When assessing a recently delivered, multigravida client, the nurse finds
that her vaginal bleeding is more than expected. Which factor in this
client's history is related to this finding?
She received butorphanol 2 mg IVP during
labor. The second stage of labor lasted 10
minutes.
She is a gr...
NUR 2520 HESI All Exam Questions Lates t Update (With Attempted Answers and Correct Answers Verified With Rationales) When assessing a recently delivered, multigravida client, the nurse finds that her vaginal bleeding is more than expected. Which factor in this client's history is related to this finding? She received butorphanol 2 mg IVP during labor. The second stage of labor lasted 10 minutes. She is a gravida 6, para 5. She is over 35 years of age. That's right! Rationale: Repeated gravid experiences cause the uterus to lose muscle tone (uterine atony) which is the most common cause of excessive bleeding following childbirth. 17s points An unconscious client is admitted to the intensive care unit and is placed on a ventilator. The ventilator alarms continuously and the client's oxygen saturation level is 62%. Which action should the nurse take first? Call respiratory therapy. Begin manual ventilation immediately. Monitor oxygen saturation levels every 5 minutes. Silence the alarm and call the technician. That's right! Rationale: Ventilators provide mechanical respirations. A constant alarm and low oxygen saturation indicates a malfunction or problem with the respirations being provided. The first action that must be taken is to begin manual ventilation until the problem has been resolved. 15s points The nurse has completed the diet teaching of a client who is being discharged following treatment of a leg wound. A high protein diet is encouraged to promote wound healing. Which lunch choice by the client indicates that the teaching was effective? A peanut butter sandwich with soda and cookies. A tuna fish sandwich with chips and ice cream. A salad with three kinds of lettuce and fruit. Vegetable soup, crackers, and milk. That's right! Rationale: In a high protein diet, a lunch with fish and dairy contains the highest amount of protein. For instance, four ounces of tuna contains 11 grams of protein, and ice cream 5 grams of protein per cup. 2m 2s points The nurse plans to collect a 24 -hour urine specimen for a creatinine clearance test. Which instruction should the nurse provide to the adult male client? Cleanse around the meatus, discard first portion of voiding, and collect the rest in a sterile bottle. Urinate at a specified time, discard this urine, and collect all subsequent urine during the next 24 hours. For the next 24 hours, notify nurse when the bladder is full, and the nurse will collect catheterized specimens. Urinate immediately into a urinal, and the lab will collect the specimen every 6 hours, for the next 24 hours. So close !
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