A 25-year-old primigravida client is in the first stage of labor. She and her husband have been holding hands and breathing together through each contraction. Suddenly, the client pushes her husband's hand away and shouts,
"Don't touch me!" This behavior is most likely:
a. abnormal labor.
b. a sign that she needs analgesia.
c. normal and related to hyperventilation.
d. common during the transition phase of labor.
ANS: D
The transition phase of labor is often associated with an abrupt change in behavior, including increased anxiety and irritability. This change of behavior is an expected occurrence during the transition phase. If she is in the transitional phase of labor, analgesia may not be appropriate if the birth is near. Hyperventilation will produce signs of respiratory alkalosis.
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A) True B) False
The nurse recognizes that a patient arriving in the emergency room with symptoms of dizziness, staggering gait, and nystagmus may indicate:
A) Intoxication B) A cerebellar tumor C) A cerebellopontine tumor D) An occipital lobe tumor
The client has myasthenia gravis. The highest priority client teaching is:
a. instructing the client to take the drug on a strict schedule to avoid respiratory muscle weakness. b. informing the client if a dose of the drug is missed to double the drug dose when the next dose is scheduled. c. instructing the client that if muscle weakness occurs, to rest, and if it persists to call the healthcare provider the next day. d. informing the client that if respiratory distress occurs, rest, double the drug dose, and call the healthcare provider.
The client has been placed on tetracycline (Sumycin) for acne control. In planning a dosage schedule, the nurse anticipates that the client will be taking:
a. low doses over a period of months. b. low doses for 3 to 4 weeks. c. high doses for 10 days to 2 weeks. d. high doses for at least 1 year.