A client whose cervix is dilated 8 cm is restless and frequently changing position in an attempt to get comfortable. Which nursing action is most important?
1. Leave the client alone so she can rest.
2. Ask the family to take a coffee and snack break.
3. Reassure the client that she will not be left alone.
4. Encourage the client to have an epidural for pain.
3
Explanation:
1. The client is in the transitional phase of the first stage of labor and will not want to be alone.
2. The client is in the transitional phase of the first stage of labor. The family members might want to take a break, but the client will not want to be alone.
3. Because the client is in the transitional phase of the first stage of labor, she will not want to be left alone; staying with the client and reassuring her that she will not be alone are the highest priorities at this time.
4. The client is in the transitional phase of the first stage of labor. There is no indication that the client wants pain relief.
You might also like to view...
A child with a serious fungal infection is receiving amphotericin B parenterally. Which of the following minerals will the patient most likely be required to receive?
A) Chloride B) Magnesium C) Glucose D) Sodium
The nurse is auscultating the heart of a client with pericarditis. In this client, S1 and S2 heart sounds can be described as:
a. more pronounced c. S1 absent b. muffled d. S2 absent
The patient with gastroesophageal reflux disease (GERD) should be instructed to eliminate which of these activities?
a. Swimming c. Golfing b. Weight lifting d. Walking
In developing role behavior, the child learns which of the following through substitution?
1. Internalizing beliefs and values of role models 2. Refraining from behavior even though tempted 3. Avoiding unacceptable behavior because it is punished 4. Engaging in an acceptable behavior instead of another unacceptable one