A postpartum client presents with signs of urinary retention, including suprapubic discomfort and inability to void. Which nursing intervention should be implemented first?

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Question 1 of 5

A postpartum client presents with signs of urinary retention, including suprapubic discomfort and inability to void. Which nursing intervention should be implemented first?

Correct Answer: B

Rationale: Assisting the client to a seated position on the toilet should be implemented first. This position promotes relaxation of the pelvic floor muscles and can help facilitate urinary elimination. It is a non-invasive and least intrusive intervention compared to performing intermittent catheterization or administering diuretic medication. Encouraging the client to drink plenty of fluids is important for promoting overall urinary function, but in this case, the priority is to aid the client in attempting to void first.

Question 2 of 5

A postpartum client presents with persistent, severe perineal pain despite analgesic medication. On assessment, the nurse observes ecchymosis and swelling of the perineum. Which nursing action is most appropriate?

Correct Answer: C

Rationale: The presence of persistent, severe perineal pain along with ecchymosis and swelling of the perineum can indicate a complication such as a hematoma. A hematoma is a collection of blood that can occur in the perineal area postpartum, usually as a result of trauma during delivery. It is essential to notify the healthcare provider immediately to assess the situation, provide appropriate treatment, and prevent further complications. Applying ice packs or administering additional analgesic medication may not address the underlying issue of a possible hematoma, so prompt medical evaluation is crucial in this situation.

Question 3 of 5

According to RA 9482 or the anti- Rabies Act of 2007, which of the following statement s regarding rabies post exposure prophylaxis is APPLICABLE?

Correct Answer: A

Rationale: According to RA 9482 or the Anti-Rabies Act of 2007, one of the key components of rabies prevention is to have dogs regularly vaccinated against rabies. This is a crucial step in reducing the risk of rabies transmission from dogs to humans. By ensuring that dogs are vaccinated, the likelihood of rabies exposure is significantly decreased. Additionally, proper vaccination also helps protect the health and well-being of the dogs themselves. Therefore, ensuring regular vaccination of dogs is an applicable and important statement regarding rabies post-exposure prophylaxis as mandated by the law.

Question 4 of 5

Nurse Rey with the members of the team. from a tertiary hospital is going for their annual outreach program Operation TULI". There were 3000 patients who came in the morning with only 4 doctors, 3 nurses and 1 pharmacist. Due to the volume of patients, Nurse Rey, was asked to participate in per forming circumcision with the rest of the doctors. Nurse Rey can be 1iable of committing

Correct Answer: D

Rationale: Nurse Rey can be liable for committing malpractice. Malpractice refers to professional negligence or failure to provide the standard of care expected in a particular medical situation. In this scenario, Nurse Rey is not qualified or authorized to perform circumcisions, as it falls outside of the scope of practice for a nurse. By participating in performing circumcisions without the necessary qualifications and training, Nurse Rey is potentially putting patients at risk and not providing the appropriate standard of care expected from a healthcare professional. This could be considered as malpractice, for which Nurse Rey may be held liable.

Question 5 of 5

Nurse Nora observes that the Ellie's uterine contractions are irregular in frequency and short in duration. Ellie screams in pain during contractions. Which of the following actions is considered BEST for the nurse to perform?

Correct Answer: B

Rationale: Administering pain relief medication as ordered is the best action for the nurse to take in this situation where the patient is experiencing intense pain during irregular and short uterine contractions. Pain relief medications can help alleviate the discomfort and distress that Ellie is experiencing, providing her with much-needed relief and improving her overall comfort during labor. It is important for the nurse to follow the prescribed orders for pain relief medication to ensure safe and effective pain management for the patient.

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