A nurse receives report about assigned clients at the start of the shift. Which of the following clients should the nurse plan to see first?

Correct Answer: A

Rationale: The client who experienced a cesarean birth 4 hours ago and is reporting pain should be seen first by the nurse. Pain assessment and management are crucial following a cesarean birth to ensure the client's comfort and well-being. Uncontrolled pain can lead to complications and affect the client's recovery process. Addressing the client's pain promptly is a priority to promote their comfort and facilitate their recovery.

Correct Answer: A

Rationale: The Moro reflex is a normal infantile reflex that is typically present at birth and disappears around 4-6 months of age. This reflex is triggered by a sudden loss of support or a loud noise, causing the infant to throw back the head and extend the arms in a gesture as if trying to grab something. In a situation where the newborn's birth was prolonged due to wide shoulders, there is a higher risk of injury to the brachial plexus (nerves that control arm movement) during delivery. Damage to the brachial plexus can result in weakness or paralysis of the affected arm, and this may impact the Moro reflex as it involves the arms' movement. Therefore, the nurse would be particularly observant for any abnormality or lack of response in the Moro reflex as it may indicate potential nerve injury related to the difficult birth.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.