During an assessment 30 minutes following delivery, the nurse notes the fundus is firm, the perineal pad is saturated, and bleeding occurs in a trickle. What should the nurse suspect on the basis of these assessment findings?
a. Inverted uterus c. Retained placental fragments
b. Lacerations d. Uterine atony
B
A firm fundus and bleeding occurring in a trickle is characteristic of cervical or perineal lacerations. With an inverted uterus, the uterus is not firm. Retained placental fragments do not manifest as a trickle of bleeding. The uterus is firm following massage, so uterine atony is incorrect.
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The nurse would understand the need for additional teaching for home management for a client who had hip replacement when the client states, "I will:
1. Sit down in a chair to reach items below the waist height.". 2. Use a shower chair and raised toilet seat when performing hygiene.". 3. Have a ‘reacher' to access things on the floor.". 4. Remove loose carpets or objects in walkways.".
You are the nurse employed in an acute care hospital. The head nurse states that you will be caring for 12 clients with the help of two nurse assistants. This is considered to be what type of nursing care delivery?
A) Primary care B) Tertiary care C) Team nursing D) Modular nursing
In narcotic withdrawal, the speed of onset and the duration of symptoms are most highly related to the
A. duration of the effect of the narcotic b. method of administration c. body fat content of the person using the opioid d. height/weight ratio of the individual
After frequent examinations a patient is diagnosed with amyotrophic lateral sclerosis (ALS). Which test results should the nurse review as confirmation of this diagnosis? (Select all that apply.)
a. Nerve biopsy b. Electroencephalogram c. Nerve conduction velocity d. Analysis of cerebrospinal fluid e. CT scan of the brain and spinal cord