A postpartum client reports severe headache, visual disturbances, and epigastric pain. Which nursing action is most appropriate?

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Question 1 of 5

A postpartum client reports severe headache, visual disturbances, and epigastric pain. Which nursing action is most appropriate?

Correct Answer: C

Rationale: The most appropriate nursing action in this situation is to assess the client's blood pressure and other vital signs. The client's symptoms of severe headache, visual disturbances, and epigastric pain could be indicative of preeclampsia or eclampsia, which are serious conditions that require immediate medical attention. Checking the blood pressure and other vital signs will help determine if the client's symptoms are related to abnormal blood pressure levels, which is critical in identifying and managing hypertensive disorders in postpartum clients. Once the assessment is completed, appropriate medical interventions can be initiated promptly if necessary.

Question 2 of 5

In collecting sputum specimen, the nurse should instruct Roy to _____.

Correct Answer: A

Rationale: In collecting a sputum specimen, the nurse should instruct Roy to breathe slowly, cough, and then expectorate into the specimen container. This ensures that the sputum sample is collected from the lower respiratory tract where it is most likely to contain pathogens or other relevant substances for analysis. By instructing Roy to breathe slowly, it helps him to take deep breaths and effectively cough to produce a good sputum sample. Additionally, asking him to expectorate directly into the specimen container helps prevent contamination from saliva or other sources, ensuring the accuracy of the specimen collected for testing.

Question 3 of 5

Since she wanted to capture the essence and emotion of the victims she chose to use the qualitative design. Which among the statements below is CORRECT about qualitative design?

Correct Answer: C

Rationale: Qualitative research design focuses on gaining an in-depth understanding of attitudes, beliefs, motivations, and behaviors of individuals or groups. It does not typically involve statistical analysis or estimation of relationships between variables like quantitative designs do. Qualitative research involves collecting data through methods such as interviews, observations, or focus groups to provide rich and detailed insights into the experiences and perspectives of the participants. The emphasis is on understanding the meanings individuals attach to their experiences, rather than generalizing findings to a larger population.

Question 4 of 5

Nurse Nora notices patient's uterine contractions are 70 seconds long and occur every 90 seconds when assessing the frequency of her contractions after she receives oxytocin. what would be the nurse's FIRST action?

Correct Answer: B

Rationale: Patient's uterine contractions lasting 70 seconds and occurring every 90 seconds signify hyperstimulation, which can be a serious complication associated with oxytocin administration. This may result in decreased uterine perfusion, fetal distress, and other adverse effects. The first action should be to discontinue the oxytocin infusion to prevent further complications and allow the uterus to relax. Observations and assessment should continue to monitor the patient's condition and response after discontinuing the infusion. Giving an emergency bolus of oxytocin or increasing the IV infusion rate would exacerbate the hyperstimulation, and turning the client to her left side and breathing deeply would not address the underlying issue of oxytocin-induced hyperstimulation.

Question 5 of 5

Which of the following is the BEST evidence of a family whose family coping index on therapeutic competence is rated as coping well?

Correct Answer: A

Rationale: Showing positive interpersonal relationships is the best evidence of a family coping well when their family coping index on therapeutic competence is rated as coping well. Positive interpersonal relationships indicate that family members are effectively communicating, supporting each other, and resolving conflicts in a healthy manner. This reflects strong family dynamics, emotional resilience, and adaptability which are important aspects of effective coping. While the other options (B, C, D) are beneficial activities or behaviors, positive interpersonal relationships directly demonstrate the family's ability to cope well together, making it the most relevant evidence for a high therapeutic competence rating.

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