Which finding 12 hours after birth would require further assessment? The fundus is palpable:
a. two finger-breadths above the umbilicus.
b. at the level of the umbilicus.
c. one finger-breadth below the umbilicus.
d. two finger-breadths below the umbilicus.
A
The fundus rises to the umbilicus following delivery and remains there for about 24 hours. A fundus that is above the umbilicus may indicate uterine atony or urinary retention.
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The nurse recognizes that the risk for dehydration in the elderly increases significantly due to which age-related change in renal function?
1. decreased ability of the kidney to concentrate urine 2. hypoplasia 3. presence of renal cysts 4. reduced clearance of drugs excreted by the kidney
Which statement is true regarding durable medical power of attorney and living wills?
a. They set standards for care of terminally ill patients by nurses. b. They allow patients a voice about medical interventions after they are incapable of acting. c. They prevent occurrences of intentional torts. d. They complicate ethical decision making for nurses.
The health care provider initially orders bed rest for a patient with an open-book pelvic fracture. Which assessment data obtained by the nurse are most important to report to the health care provider?
a. The bowel tones are absent. b. There is an unusual amount of pelvic movement. c. The patient complains of level 4 abdominal pain on a 10-point pain scale. d. There is bruising of the abdomen.
A client is prescribed scopolamine. What information will the nurse include on the teaching plan for this client? (Select all that apply.)
a. "Do not take this medication if you are dizzy." b. "Do not use laxatives while on this medication." c. "Do not use this medication for longer than a day." d. "After 3 days, switch patch to alternate ear." e. "Apply patch 4 hours before effect is desired." f. "Drowsiness is a concern while on this medication."