A multiparous patient is admitted to the labor and delivery unit with contractions that are regular, are 2 minutes apart, and last 60 seconds. She reports that her labor began about 6 hours ago, and she had bloody show earlier that morning
A vaginal exam reveals a vertex presenting, with the cervix 100% effaced and 8 cm dilated. The patient asks what part of labor she is in. The nurse should inform the patient that she is in the: 1. Early phase.
2. Active phase.
3. Transition phase.
4. Fourth stage.
3
Rationale 1: This is not the early phase because dilatation is less than 8 cm, and contractions are less frequent and of shorter duration.
Rationale 2: This is not the active phase because dilatation is less than 8 cm, and contractions are less frequent and of shorter duration.
Rationale 3: The transition phase begins with 8 cm of dilatation, and is characterized by contractions that are closer and more intense.
Rationale 4: The fourth stage occurs after delivery of the placenta.
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An x-ray of a patient admitted to the emergency room after a motor vehicle accident reveals rib fractures, and the patient has been diagnosed with a small flail chest injury. The nurse should include which intervention in the patient's plan of care?
A) Suction airway secretions B) Immobilize the ribs with an abdominal binder C) Prepare the patient for surgery D) Immediately sedate and intubate the patient
An older adult client is experiencing anxiety. Which anxiolytic drug would the nurse identify as being relatively safe to administer to this client at a normal dose? Select all that apply
A) Buspirone B) Lorazepam C) Oxazepam D) Alprazolam E) Diazepam
The patient is newly diagnosed with diabetes and will be discharged in the next day or so. The nurse is teaching the patient how to draw up and self-administer his insulin. Which nursing theory is the nurse utilizing?
a. Watson's philosophy of transpersonal caring b. Orem's self-care deficit theory c. Rogers' theory d. Henderson's theory
P.M. care includes:
A) providing an opportunity for patients to empty their bladder on the toilet or in a bedpan/urinal B) assisting with oral hygiene C) washing face and hands D) all of the above