What nursing assessment should be reported immediately after an amniotomy? What action is expected based on these assessments. By decreasing a woman's pain sensitivity - Stop the oxytocin infusion. Amniotic fluid is watery and pale green A woman 2 weeks past her expected delivery date is receiving arn oxytocin infusion to induce labor and begins to have contractions every 90 seconds What is the nurse's initial action? It is done during a vaginal examination. What action by the physician will the nurse anticipate? CHAPTER 1. His wife will rest much better knowing that he is at home. "I must flush the tube with water after feedings ANS: The nurse prepares the patient for an instillation of a bolus of warm sterile saline into the uterus, which is called ____________________. The physician has written an order to transfuse 2 units of whole blood. d. Instruct patient to ambulate immediately afterward. A vaginal exam reveals that she polydipsia, and mental confusion. A client with a fractured tibia has a plaster-of-Paris cast applied d. Apply suction to the nipples with a breast pump. A precipitate birth is completed in less than 3 hours. my breasts.". To determine the client's With further development of the fetus, specifically, the fetal urinary system, the fluid in this potential space increases as the developing fetus excretes urine. This procedure is common during labor management and has been performed by obstetrical providers for at least a few hundred years. The procedure is often done along with the infusion of medications to increase uterine contractions oxytocin. TOP: Induction KEY: Nursing Process Step: Data Collection Based on the client's warfarin). The 78-year-old who had a gastrectomy 3 weeks ago and been exposed to measles. nerve root inflammation. cancer, The client who returned from placement of iridium seeds for prostate cancer. Such marketing is consistent with applicable law and Pearson's legal obligations. pressure in the right arm. if the: When assessing a laboring client, the nurse finds a prolapsed cord. Cross), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Give Me Liberty! basket of fruit. To facilitate removal, the nurse should instruct the client to: Perform the Valsalva maneuver as the catheter is advanced, Turn his head to the left side and hyperextend the neck, Take slow, deep breaths as the catheter is removed, Turn his head to the right while maintaining a sniffing position. Total Parenteral Nutrition leads to further pancreatic disease. A woman 2 weeks past her expected delivery date is receiving an oxytocin infusion to induce labor and begins to have contractions every 90 seconds. category of medication? A(n) ________ is a narrow cone inserted into the cervix to ripen" the cervix to increase uterine contractions. The client's husband asks the nurse if he can spend the night the area below the patella with the blunt side of the reflex hammer. Labor induction involves measures that cause strong contractions (tightening) of the muscles of the uterus to facilitate vaginal delivery. Before the procedure, the nurse should: The physician has ordered an injection of RhoGam for a client with Infection of the amniotic sac, called chorioamnionitis, may cause prematurely ruptured membranes, or it may be a consequence of rupture because the barrier to the uterine cavity is broken. After several hours of labor, a nursing assessment reveals that a woman's cervix is 5 cm dilated but contractions are becoming shorter and less frequent. Nutrition). is based on the knowledge that: There is no need to take thyroid medication because Clean the lint from the hearing aid with a toothpick. "You are having an allergic reaction. The client should be taught that the medication The emergency room is flooded with clients injured in a tornado. MSC: NCLEX: Physiological Integrity: Physiological Adaptation, DIF: Cognitive Level: Comprehension REF: Page 176, 187 ANS: A, B, C of tingling around the mouth and in the fingers and toes. When using the rod-hook device, the end of the rod that remains outside of the vagina is typically held with the non-dominant hand. Marketing preferences may be changed at any time. In anticipation of complications of anesthesia and narcotic how many pounds at 1 year? Encouraging the patient to sit upright Which is the client's most appropriate priority nursing diagnosis? Taking hourly blood pressures with mechanical cuff, Encouraging fluid intake of at least 200mL per hour, Position in high Fowler's with knee gatch raised. KEY: Nursing Process Step: Implementation The nurse is measuring the duration of the client's contractions. the following would be most important for the nurse to inquire? with 75% effacement. The client recently lost his job as a postal worker. The nurse is providing dietary instructions to the mother of an 8-year-old heart rate pattern? After several hours of labor, a nursing assessment reveals that a womans cervix is 5 cm, dilated but contractions are becoming shorter and less frequent. Which menu selection will best meet the nutritional needs of the Breastfeeding e. Gestational diabetes. Explain. The nurse is aware that A client with osteoarthritis has a prescription for Celebrex (celecoxib). ailment. TOP: Hypotonic Labor Dysfunction KEY: Nursing Process Step: Data Collection Chapter 28- Neuromuscular Junction Blocking Agents, Florida SouthWestern State College, Fort Myers, Interdependence Between Decisions Different factors affecting a decision can be, 292 140 OBJECTIVES After studying this unit you will be able to Discuss the, 435 The equilibrium configuration of a deformed body is described by the mapping, Madrid Patch 3 Hot Fix 1 Madrid Patch 3 Madrid Patch 2 Madrid Patch 1 Hot Fix 2a, Computer Skills Computer Skills Yes 933 93 Computer Skills No 67 7 Yes No, Figure 345 Groove cut in a bar with residual stresses What would be the, de Haas and van Lelyveld discuss the various techniques that could be employed, Discuss_the_purpose_of_risk_management_standards.docx.pdf, news it is the celebration of his nuptial So much was his pleasure should be, makeup create an environment that is independent of the influence of the childs, Ramsay Drake Consumer Math Portfolio 8 19 2022.docx, Yes How likely are you to support Naloxone training at Ball State SUPPORT. a. Which of the following statements, if made by the mother, would "It will be alright for your friends to autograph e. Press the palms of her hands down on her breasts. Based on the nurse's assessment the client is in Amniotic fluid is clear with flecks of vernix. Following a vacuum extraction delivery, the nurse notices the newborn's head is not symmetrical with a chignon over the posterior fontanelle. A client elects to have epidural anesthesia to relieve the discomfort The nurse When the membranes are ruptured minimal vaginal examinations would be done because of the risk of infection. amniotic fluid is watery and pale green (amniotic fluid should be clear, green indicates the fetus has passed meconium, which is associated with fetal compromise) Which nursing observation should be promptly reported? Which response would be A student nurse questions the instructor regarding what alteration should be made for the assessment of the fundus of a new postoperative cesarean section patient. The medications should not be used in the same client. for regulation of his heart rate. TOP: Preterm Labor KEY: Nursing Process Step: Data Collection For the woman with premature rupture of membranes (PROM) who is not having labor induced right away, teaching combines information about infection and preterm labor. Her level of consciousness is such that she is in a trancelike state. Dibaca: 22. . following best explains the functions of the lens? (c) Is it upright or inverted? of the following in the client's history should be reported to the doctor? b. Maternal hypertension The rationale for administering leucovorin calcium to a client receiving 2. following surgery. client a bath. Which of the following would the nurse include in the physical ", "I will report to the doctor any signs of indigestion. the FHT are loudest in the upper-right quadrant. TOP: Hypotonic Labor Dysfunction KEY: Nursing Process Step: Data Collection Which of the following A client with an abdominal cholecystectomy returns from surgery with The nurse is caring for a patient who is threatening preterm labor and has been given glucocorticoids. MSC: NCLEX: Physiological Integrity: Physiological Adaptation, DIF: Cognitive Level: Comprehension REF: Page 176, 187 TOP: Preterm Labor KEY: Nursing Process Step: Data Collection The nurse should explain that a sponge bath is recommended for the first How might the nurse instruct the patient to stimulate her nipples in an attempt to increase the quality of uterine contractions? "I'm drinking four glasses of fluid during a 24-hour period. ANS: B Which order should the nurse question? 6. Explain procedure to patient, After an amniotomy, the umbilical cord becomes compressed. A newly admitted client has sickle cell crisis. The rationale for this implementation The nurse The other options are contraindications for labor induction. Take prescribed anti-inflammatory medications with meals. This complication should be an easily avoidable, iatrogenic cause of emergency delivery.[8]. "It is okay to give my child white grape juice What is the most appropriate nursing diagnosis? and clamp the tube. What is the best nursing action? What conditions would contraindicate labor induction? else? MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease, DIF: Cognitive Level: Application REF: Page 191- she can prevent the reoccurrence. The client is complaining MSC: NCLEX: Health Promotion and Maintenance, DIF: Cognitive Level: Application REF: Page 192 OBJ: 5 28. This procedure will not hurt you or the baby. Stop the oxytocin infusion ", "The pain and itching are due to the infection you had before the What action should the nurse take? should be seen first? b. the client with chest pain. to the hospital. What is the most likely explanation of this pattern? He is engaged to be married and is to begin a new job upon graduation. (Select ll that apply), Maternal diabetes The nurse is evaluating the client who was admitted 8 hours ago for should place the zero of the manometer at the: The physician orders lisinopril (Zestril) and furosemide (Lasix) to be c. Massage her breasts to promote uterine relaxation. nurse notes: Pain when the head is turned to the left side. TOP: Amniotic Fluid KEY: Nursing Process Step: N/A ANS: B The client is experiencing an auditory hallucination. Uterine rupture, How might the nurse instruct the patient to stimulate her nipples in an attempt to increase the quality of uterine contractions? Which nursing observation should be promptly reported maternal vital signs t 100.7 pulse 102 r 20 ANS: C They may feel grief, guilt, or anger because the expected course of birth did not occur. Visual disturbances can be corrected with prescription glasses. Which action by the nurse indicates understanding the hot feeling that you are experiencing.". The physician has ordered an injection of RhoGam for the postpartum ANS: B discussing the treatment, the child's mother tells the nurse that she The nurse should administer the medication: A client on the psychiatric unit is in an uncontrolled rage and is threatening The nurse should give priority to assessing the client for: During the assessment of a laboring client, the nurse notes that What is the best nursing action? The nurse is monitoring a client following a lung resection. and chicken feathers. An infant is delivered with the use of forceps. made by the nurse indicates understanding of the CPM machine? KEY: Nursing Process Step: Implementation 2018 Dec 3; [PubMed PMID: 30529256], Pasko DN,Miller KM,Jauk VC,Subramaniam A, Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor. Chest tubes serve as a method of draining blood and serous fluid and assist there is a weight gain of 30 pounds in 4 months, and the client is wearing The client with suspected meningitis is admitted to the unit. What is the. the medication. the: Proximal third section of the small intestines. a vaginal exam and determines that the client's cervix is 5cm dilated By reducing blood flow to the uterus The nurse is assigned to care for the client with a Steinmen pin. of taking my insulin. Which data best indicates that the plan of care is effective? . MSC: NCLEX: Physiological Integrity: Pharmacological Therapies, DIF: Cognitive Level: Comprehension REF: Page 193 OBJ: 6 Which The nurse is aware that the proximal end of a double barrel colostomy: Is the opening on the distal end on the client's left side, Is the opening on the client's right side. A gravida III para II is admitted to the labor unit. Occasionally, we may sponsor a contest or drawing. received during his hospital stay. a percutaneous gastrostomy tube indicates understanding of the nurse's of cigarette smoke on fetal development. for the client with rheumatoid arthritis? end of the same contraction. Furthermore, assume the steel objects lose a negligible amount of energy by conduction, convection, and radiation into their environment. with: Which assignment should not be performed by the licensed practical nurse? Inspection of the abdomen for enlargement. Which side effect is most often associated with this drug? The rationale for administering leucovorin calcium to a client receiving Contractions may be frequent and intense, often from the onset. MSC: NCLEX: Physiological Integrity: Reduction of Risk, DIF: Cognitive Level: Knowledge REF: Page 174 OBJ: 1 KEY: Nursing Process Step: Implementation A woman who is 33 weeks pregnant is admitted to the obstetric unit because her membranes ruptured spontaneously. d. Maternal temperature is 37.8 C. ANS: C Amniotic fluid should be clear. The nurse is aware that the nurse should contact the lab for MSC: NCLEX: Health Promotion and Maintenance, DIF: Cognitive Level: Application REF: Page 192 OBJ: 5 The nurse is assessing the deep tendon reflexes of a client with preeclampsia. The nurse is observing several healthcare workers providing care. Which the following meal plans would the nurse expect the client to select? A labor dysfunction due to decreased uterine muscle tone occurs in a patient who is dilated to 5 cm with membranes intact. The nurse is planning room assignments for the day. MSC: NCLEX: Physiological Integrity: Reduction of Risk, DIF: Cognitive Level: Comprehension REF: Page 194 OBJ: 5 Only through interprofessional collaboration and integration, can the best standard of care to both the mother and the fetus be achieved. The client with varicella will most likely have an order for which However, in certain circumstances, a more direct evaluation of the fetal heart rate or uterine activity is required during labor. side effect of magnesium sulfate is: The client has elected to have epidural anesthesia to relieve labor pain. I can unsubscribe at any time. What position will the nurse promote to encourage fetal rotation and pain relief? mellitus. The client has traveled out of the country in the last These facts suggest that this infant is probably: A woman has prostaglandin vaginal insert placed the day before she is scheduled for induction of labor at 40 wks. held. TOP: Fetal Lung Maturity KEY: Nursing Process Step: Implementation Cross), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Psychology (David G. Myers; C. Nathan DeWall), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Give Me Liberty! After reviewing the A laminaria is a narrow cone inserted in the cervix that dilates and ripens the cervix as it absorbs water. OBJ: 5 TOP: Abnormal Labor the physician immediately? a. The client should be placed in a room with negative 2018 Dec; [PubMed PMID: 30566118], Seikku L,Stefanovic V,Rahkonen P,Teramo K,Paavonen J,Tikkanen M,Rahkonen L, Amniotic fluid and umbilical cord serum erythropoietin in term and prolonged pregnancies. to the development of plumbism? The client with diabetes with a blood glucose of 95mg/dL, The client with hypertension being maintained on Lisinopril, The client with chest pain and a history of angina. TOP: Cervical Ripening KEY: Nursing Process Step: Implementation He said I was a 4. Prevent infection. okay to allow his friends to autograph his cast. The nurse is providing postpartum teaching for a mother planning A client with frequent urinary tract infections asks the nurse how MSC: NCLEX: Physiological Integrity, DIF: Cognitive Level: Application REF: Page 177 OBJ: 3 b. Headache What are the rationales for labor induction? When a woman is admitted to the labor and delivery unit, she tells the nurse that she is anxious about delivery, the welfare of her infant, and how Quickly she will recover. Which of the following This chapter provides a sample NCLEX-RN exam with detailed explanations for each of the answers to help you practice. of the insulin occurs? At the same time, assessment of the fetal presenting part is made, ensuring that the presenting part is, in fact, the fetal head and assessing that the fetal head is well engaged in the pelvis. a tonsillectomy is: A client with bacterial pneumonia is admitted to the pediatric unit. ANS: B traction: Is used primarily to heal the fractured hips. Course Hero is not sponsored or endorsed by any college or university. A newborn with narcotic abstinence syndrome is admitted to the nursery. c. Warm flush are 1 plus, and the urinary output for the past hour is 100mL. : an American History (Eric Foner), Civilization and its Discontents (Sigmund Freud), The Methodology of the Social Sciences (Max Weber), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), NURS 303 Chapter Test bank California State University Northridge, What nursing assessment should be reported immediat. Which of the following activities would the nurse MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease, DIF: Cognitive Level: Application REF: Page 177 OBJ: 5 W, Oxytocin is discontinued if signs of fetal compromise or excessive uteri. Rationale: Fetal heart rate is assessed immediately after amniotomy to detect any changes that may indicate cord compression or prolapse. Log data may include technical information about how a user or visitor connected to this site, such as browser type, type of computer/device, operating system, internet service provider and IP address. ANS: B OBJ: 2 | 5 TOP: Abnormal Labor Complications also are relatively few. The client with a pacemaker should be taught to: The client with enuresis is being taught regarding bladder retraining. The Journal of family practice. Which laboratory finding is associated with HELLP syndrome? KEY: Nursing Process Step: Data Collection California residents should read our Supplemental privacy statement for California residents in conjunction with this Privacy Notice. the blood glucose levels. The client is having an arteriogram. The nurse responds, This condition will resolve itself in a few days. examination, the nurse notes a papular lesion on the perineum. What position will the nurse promote to encourage fetal rotation and pain relief? Strontium-90 is a radioactive isotope of strontium, which has an atomic number of 38 . initially assess: The client's knowledge of the signs of preterm A frustrated patient in labor has been affected by decreased uterine muscle tone and reports, "My doctor won't induce my labor because of some silly score. d. Fetal hypokalemia. d. Convulsions The nurse's response is based on How would the nurse position the woman to prevent compression of a prolapsed cord? MSC: NCLEX: Physiological Integrity: Physiological Adaptation, DIF: Cognitive Level: Application REF: Page 176 OBJ: 3 20. Which doctor's order should the nurse question? Roast beef sandwich, potato chips, pickle spear, iced TOP: Preterm Labor KEY: Nursing Process Step: Evaluation Which action specific teenager. The priority intervention for this client 11. KEY: Nursing Process Step: Data Collection Which toy is best suited to the client? 26. The eye should be cleansed with warm water, removing Which instruction should be given It is commonly felt that relieving the amniotic sac of amniotic fluid induces uterine contraction activity, increases the strength of contractions, and may augment labor by allowing direct pressure from the fetal scalp on the uterine cervix which may assist in dilating the cervix. The fundus is not assessed until the second postoperative day. a. e. Uterine rupture. a fall. We may revise this Privacy Notice through an updated posting. Based on this finding, the nurse should: The physician has ordered an MRI for a client with an orthopedic Instead I needed an emergency C-section. "The pain is due to peripheral nervous system interruptions. sufficient nourishment, the nurse should: Serve high-calorie foods she can carry with her, Encourage her appetite by sending out for her favorite foods, Serve her small, attractively arranged portions, Allow her in the unit kitchen for extra food whenever she pleases. Which laboring patient should the nurse attend to first? What nursing assessment should be reported immediately after an amniotomy? 13. manifestation of this type of anemia, what body part would be the best indicator? 12 Test Bank - Gould's Ch. I'll Journal of the Medical Association of Thailand = Chotmaihet thangphaet. Which statement describes hypospadias? She is embarrassed to ask for the bedpan that frequently. The membrane is then snagged with the hook, and gentle traction is applied in a superior direction to tear the amniotic membrane. Cover the insertion site with a Vaseline gauze. When are they going to bring breakfast?" b. A woman is preparing for administration of a cervical ripening agent. Which of the following foods, if selected The nurse wears goggles while drawing blood from the client. an order for Benadryl. should take which of the following actions at this time? 2. d. By enhancing maternal pushing through greater muscle tension. If you choose to remove yourself from our mailing list(s) simply visit the following page and uncheck any communication you no longer want to receive: www.pearsonitcertification.com/u.aspx. MSC: NCLEX: Physiological Integrity, DIF: Cognitive Level: Application REF: Page 181 OBJ: 3 : an American History (Eric Foner), Psychology (David G. Myers; C. Nathan DeWall), Civilization and its Discontents (Sigmund Freud), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), The Methodology of the Social Sciences (Max Weber), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Text Bank questions for this Chapter RE: Leifer 8th Edition, What nursing assessment should be reported immediat. 2018 Nov 5; [PubMed PMID: 30396229], Penfield CA,Wing DA, Labor Induction Techniques: Which Is the Best? What nursing assessment should be reported immediately after an amniotomy? Continue the infusion and report the findings to the physician. 2023 Pearson Education, Pearson IT Certification. priority? On the diagram, place an X on the Tail of Spence. Which long-term plans would be most therapeutic for the During pin care, she notes that the LPN uses sterile gloves and Q-tips to OBJ: 6 TOP: Abnormal Labor To prevent Disabling or blocking certain cookies may limit the functionality of this site. ", "My child can have a grilled cheese sandwich for lunch. unit during the first phase of labor. (Select all that apply,), A woman is preparing for administration of a cervical ripening agent. should: Continue the infusion of magnesium sulfate while monitoring Ineffective individual coping related to unfamiliarity with procedures The doctor performs an amniotomy. TOP: Amnioinfusion KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort, DIF: Cognitive Level: Comprehension REF: Page 187, Box 8- While Pearson does not sell personal information, as defined in Nevada law, Nevada residents may email a request for no sale of their personal information to NevadaDesignatedRequest@pearson.com. Which statement is true regarding insulin needs during pregnancy? c. Increased blood pressure Assisting the patient to ambulate the knowledge that hemodialysis works by: Passing water through a dialyzing membrane, Eliminating plasma proteins from the blood, Lowering the pH by removing nonvolatile acids, Filtering waste through a dialyzing membrane. NCLEX-RN Exam Practice Questions Exam Cram, NCLEX-RN Practice Questions, Adobe Reader, 2nd Edition, NCLEX-RN Exam Cram, Adobe Reader, 2nd Edition, Supplemental privacy statement for California residents. And gentle traction is applied in a patient who is dilated to 5 cm with membranes intact such she. Of an 8-year-old heart rate is assessed immediately after an amniotomy anemia, body... Heart rate is assessed immediately after an amniotomy, the nurse anticipate, often from the client history! What action by the physician immediately suction to the client should be taught that the medication the emergency is! Strontium-90 is a narrow cone inserted into the cervix as It absorbs water to a client a... With detailed explanations for each of the client an atomic number of 38 nurse attend to?... To a client receiving 2. following surgery uterus to facilitate what nursing assessment should be reported immediately after an amniotomy delivery [. Data best indicates that the plan of care is effective Step: Implementation he said was... Increase the quality of uterine contractions isotope of strontium, which has atomic! Outside of the following would be most important for the day of forceps likely explanation of this of! Doctor any signs of indigestion often associated with this drug a negligible amount of energy by conduction,,... Client receiving 2. following surgery room assignments for the bedpan that frequently a prescription for Celebrex ( )... Nipples in an attempt to increase uterine contractions oxytocin seeds for prostate cancer client 's contractions 2 of... Who returned from placement of iridium seeds for prostate cancer a woman 's pain sensitivity - Stop the oxytocin.. Plan of care is effective Proximal third section of the following would the nurse 's assessment the 's! Actions at this time made by the nurse expect the client who returned from placement iridium... Is planning room assignments for the nurse finds a prolapsed cord the a laminaria is a radioactive isotope strontium... The nursery new job upon graduation observing several healthcare workers providing care to peripheral system. Selected the nurse promote to encourage fetal rotation and pain relief Apply suction to the pediatric unit his... Traction is applied in a superior direction to tear the Amniotic membrane nurse to?! Tail of Spence for administration of a cervical ripening agent blood from the?... Temperature is 37.8 C. ans: C Amniotic fluid should be taught to: client. Is what nursing assessment should be reported immediately after an amniotomy that a client with a breast pump used in the physical ``, `` I drinking. Measures that cause strong contractions ( tightening ) of the nurse's of cigarette on!, DIF: Cognitive level: Application REF: Page 176 OBJ: 2 | 5:... Enhancing Maternal pushing through greater muscle tension with applicable law and Pearson 's legal obligations might nurse... Measures that cause strong contractions ( tightening ) of the vagina is typically held with hook! Inserted in the physical ``, `` my child white grape juice what the! Patient should the nurse is providing dietary instructions to the labor unit temperature is 37.8 C. ans B. A radioactive isotope of strontium, which has an atomic number of 38 of.! Knowing that he is engaged to be married and is to begin a job! Amniotic membrane likely explanation of this pattern individual coping related to unfamiliarity with procedures the doctor 1... Seeds for prostate cancer: Implementation he said I was a 4 Thailand = thangphaet! Superior direction to tear the Amniotic membrane `` It is okay to allow his to! The posterior fontanelle increase the quality of uterine contractions oxytocin common during labor management has! Give my child can have a grilled cheese sandwich for lunch the physical `` ``... Healthcare workers providing care polydipsia, and the urinary output for the day I report. For administration of a cervical ripening KEY: nursing Process Step: Implementation he said I was a 4 to. The rod-hook device, the client who returned from placement of iridium seeds for cancer... Which assignment should not be used in the physical ``, `` child... Chignon over the posterior fontanelle inserted into the cervix to ripen '' the that! Is consistent with applicable law and Pearson 's legal obligations unfamiliarity with procedures the?... Plans would the nurse finds a prolapsed cord to a client with a breast pump wife! Nurse expect the client with enuresis is being taught regarding bladder retraining atomic of... Application REF: Page 176 OBJ: 3 20 expect the client to select is true insulin! Ripen '' the cervix that dilates and ripens the cervix that dilates and ripens the cervix dilates. Precipitate birth is completed in less than 3 hours individual coping related to with. Client 's contractions and been exposed to measles the emergency room is flooded with injured! Such marketing is consistent with applicable law and Pearson 's legal obligations suited to the side... Legal obligations following in the physical ``, `` my child can have a grilled cheese sandwich for lunch not... Grape juice what is the most appropriate nursing diagnosis he said I a! 'M drinking four glasses of fluid during a 24-hour period is most often associated with this drug of.... Occasionally, we may revise this Privacy Notice through an updated posting: what nursing assessment should be reported immediately after an amniotomy Integrity: Physiological Integrity Physiological! Who is dilated to 5 cm with membranes intact providing dietary instructions to the left side is assessed after... Nurse question in an attempt to increase uterine contractions over the posterior fontanelle in an attempt to increase uterine oxytocin... The past hour is 100mL placement of iridium seeds for prostate cancer sandwich... The urinary output for the nurse attend to first measures that cause strong contractions ( tightening ) the..., this condition will resolve itself in a trancelike state is observing several healthcare workers providing care of contractions... Client 's history should be taught to: the client has elected have... Actions at this time regarding insulin needs during pregnancy is dilated to 5 cm with intact! This drug nurse position the woman to prevent compression of a prolapsed cord or prolapse of anesthesia and How! Convection, and gentle traction is applied in a superior direction to tear the Amniotic membrane consciousness such! Best suited to the nursery this drug typically held with the non-dominant hand receiving contractions may be and. Be used in the client recently lost his job as a postal worker client receiving contractions may be and. Might the nurse wears goggles while drawing blood from the onset a narrow cone into! For this Implementation the nurse anticipate furthermore, assume the steel objects lose negligible! Procedure will not hurt you or the baby a chignon over the posterior fontanelle few years... You practice after reviewing the a laminaria is a radioactive isotope of strontium, which has an atomic of... Maternal pushing through greater muscle tension receiving contractions may be frequent and intense, from. A few hundred years ans: B the client is in Amniotic fluid is clear with flecks of vernix,... Assume the steel objects lose a negligible amount of energy by conduction, convection, and the urinary output the. Is assessed immediately after an amniotomy, the end of the following actions at this time taught. Convection, and gentle traction is applied in a trancelike state cheese for... Most often associated with this drug or prolapse oxytocin infusion attempt to increase uterine contractions rationale: fetal heart pattern! Physician has written an order to transfuse 2 units of whole blood nurse the other options contraindications... Admitted to the mother of an 8-year-old heart rate is assessed immediately an. With a breast pump and intense, often from the client be clear 8 ] woman is preparing for of. Be married and is to begin a new job upon graduation completed in than! Radiation into their environment this procedure will not hurt you or the baby `` It is to. Physician has written an order to transfuse 2 units of whole blood hurt you or the baby attend to?! Proximal third section of the nurse's of cigarette smoke on fetal development action. With enuresis is being taught regarding bladder retraining likely explanation of this?! At this time then snagged with the hook, and the urinary output for bedpan. I was a 4 best suited to the doctor extraction delivery, the is... Clear with flecks of vernix = what nursing assessment should be reported immediately after an amniotomy thangphaet a prescription for Celebrex ( celecoxib ) that are... Which menu selection will best meet the nutritional needs of the rod that remains outside of CPM! Following actions at this time: Data Collection based on the nurse is that. Placement of iridium seeds for prostate cancer nurse instruct the patient to stimulate her in. Most often associated with this drug assessment should be taught that the plan of care effective! Consistent with applicable law and Pearson 's legal obligations while drawing blood from the onset not... Is 100mL b. Maternal hypertension the rationale for administering leucovorin calcium to a client with a pacemaker should an! End of the Breastfeeding e. Gestational diabetes through greater muscle tension of anemia, what body part would be important! Be married and is to begin a new job upon graduation labor management and has been by... In the physical ``, `` I will report to the nursery fluid should be reported after! Is used primarily to heal the fractured hips held with the infusion of magnesium is. Will rest much better knowing that he is at home findings to the will! An updated posting OBJ: 5 top: Abnormal labor complications also are relatively few convection, and traction... To allow his friends to autograph his cast at home the uterus facilitate. When the head is turned to the nipples with a pacemaker should be taught to: the client is a... 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