During a postpartum assessment, the nurse suspects a vaginal or cervical laceration. This conclusion is based on which assessment(s)? (Select all that apply.)
a. Bright red vaginal bleeding
b. Firmly contracted uterus
c. Perineal pain
d. Dark red vaginal bleeding
e. Pulse rate of 100 beats/minute
ANS: A, B, E
Bright red vaginal bleeding in the presence of a firmly contracted uterus is suggestive of a laceration. A pulse rate of 100 beats/minute may be an early sign of shock. Perineal pain may be associated with a hematoma or episiotomy. Dark red vaginal bleeding is characteristic of lochia.
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A client has mastoiditis. The nurse assesses most carefully for which manifestations? (Select all that apply.)
a. Red and bulging eardrum b. A crackling sound upon yawning c. Enlarged lymph nodes behind the ear d. Low-grade fever and malaise e. Diminished hearing f. Loss of appetite
The nurse knows that the two factors that often determine the type of depression from which a patient suffers are:
A) The amounts of mania and sadness B) The presence or absence of anger and guilt C) The severity and duration of symptoms D) The patient's gender and age
Which activities related to urinary elimination may be delegated to a nursing assistant?
a. Catheterization b. Positioning the patient c. Evaluating alternatives to catheter use d. Assessing urinary drainage
A major contributor to costs in the Medicaid program is
a. Nursing home care b. Family planning c. Physician services d. Home care