Which client requires immediate intervention by the labor and delivery nurse?
1. Client at 8 cm, systolic blood pressure has increased 35 mm Hg
2. Client who delivered 1 hour ago with WBC of 50,000
3. Client at 5 cm with a respiratory rate of 22 between contractions
4. Client in active labor with polyuria
2
Explanation: 2. The white blood cell (WBC) count increases to 25,000/mm3 to 30,000/mm3 during labor and early postpartum. This count is abnormally high, and requires further assessment and provider notification.
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A patient has suffered a major trauma, resulting in activation of the intrinsic and extrinsic coagulation pathways. What laboratory result would most likely interfere with normal coagulation?
A) Normal fibrin level B) Normal platelet count C) Elevated phospholipids D) Critical hypocalcemia
The nurse is assessing a client who is 20 weeks pregnant. Which health issue should the nurse recognize as increasing this client's risk for the development of eclampsia?
A) Treatment for vitamin D deficiency B) Surgery for ruptured appendix 1 year prior C) Fibrocystic breast disease D) Obesity
Critical thinking, exercise
The client asks the nurse why an x-ray with contrast medium is needed. How should the nurse respond?
1. Replaces poor radiography 2. Visualizes internal structures 3. Enhances the x-ray accuracy 4. Has client speak to radiologist