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18 Cards in this Set
- Front
- Back
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The leading cause of maternal morbidity in the U.S. is
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a. embolism*
b. hemorrhage c. infection d. eclampsia e. cardiomyopathy |
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A nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which of the following signs, if noted, would be an early sign of excessive blood loss?
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a. A temperature of 100.4
b. A blood pressure change from 130/88 to 124/80 mmHg c. An increase in the pulse rate from 88 to 102 beats/min* d. An increase in the respiratory rate from 18-22 breaths per/min |
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A nurse is developing a plan of care for a client recovering from a cesarean delivery. To prevent thrombophlebitis, the nurse plans to encourage the woman to:
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a. Elevate her legs
b. Remain on bed rest c. Ambulate frequently* d. Apply warm moist packs to the legs |
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A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following?
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a. Ask the client to turn on her side
b. Ask the client to urinate and empty her bladder* c. Massage the fundus gently before determining the level of the fundus d. Ask the client to lie flat on her back with the knees and legs flat and straight |
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When performing a postpartum assessment on a client, a nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which nursing action is appropriate?
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a. Notify the physician*
b. Document the findings c. Reassess the client in 2 hours d. Encourage increased oral intake of fluids |
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When implementing the plan of care for a postpartum woman who gave birth just a few hours ago, the nurse vigilantly monitors the client for which complication?
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a. Postpartum psychosis
b. Uterine infection c. Postpartum hemorrhage* d. Hypoglycemia |
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Which of the following would the nurse expect to include in the plan of care for a woman with mastitis who is receiving antibiotic therapy?
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a. Stop breast feeding and apply lanolin
b. Do nothing, it will go away on its own c. Apply warm or cold compress and administer analgesics* d. Remove the nursing bra and expose the breast to fresh air. |
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Causes of postpartum hemorrhage include: select all that apply
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a. Uterine atony*
b. Subinvolution* c. Uterine inversion* d. Low blood pressure |
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1. A client is admitted to the nursing unit with a diagnosis of diabetic ketoacidosis (DKA). Which of the following assessment findings should the nurse expect?
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a. Cool, clammy skin
b. Acetone breath ordor* c. Slurred speech d. Radial pulse 70, bounding |
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Which one of the following is an appropriate client instruction regarding DKA prevention?
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a. Check your blood glucose four times daily and have regular glycosylated hemoglobin tests.
b. If ill, take your insulin and drink clear liquids with carbohydrates. * c. Call 911 for emergency assistance if your blood glucose is over 300mg/dL. d. Use a dipstick to assess for ketones in your urine daily. |
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The client is admitted with metabolic acidosis secondary to diabetic ketoacidosis (DKA). Understanding metabolic acidosis, the nurse should choose which of the following as the priority nursing diagnosis?
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a. Decreased urinary elimination related to reduced output and muscle function.
b. Decreased cardiac output related to fluid and electrolyte imbalance.* c. Ineffective breathing pattern related to hyperventilation. d. Anxiety related to fears of long-term outcomes and discomfort. |
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The client with diabetic acidosis (DKA) is given intravaneous normal saline infusion and regular insulin. In addition to hourly blood glucose monitoring, what assessment data are early signs of clinical improvement?
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a. Respiratory rate of 12-15 and normal Bp in the standing position.
b. Temperature and pulse in normal range. c. Improved level of consciousness and decreasing urine output.* d. Client eats a full meal and respiratory rate is normal. |
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A hospitalized client is found in a coma. The skin is is dry and flushed; kussmaul respirations are noted and the smell of acetone is on the breath. The nurse prepares for the emergency treatment of:
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a. Hyperosmolar Hyperglycemic nonketotic syndrome.
b. Diabetic Ketoacidosis* c. Hypoglycemia d. Dawn phenomena |
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When caring for a client with DKA, which of the following nursing diagnoses take priority?
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a. Knowledge deficit
b. Imbalance nutrition: less than body requirements c. Fluid volume deficit* d. Risk for injury |
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The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L. When monitoring the ECG tracing, the nurse would expect to observe:
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a. Abnormal P waves and depressed T waves.
b. Peaked T waves and widened QRS complexes.* c. Abnormal Q waves and prolonged ST segments. d. Peaked P waves and increased number of T waves. |
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A nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the priority nurse action is to prepare to:
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a. Correct the acidosis
b. Apply a monitor for an electrocardiogram. c. Administer 5% dextrose intravenously. d. Administer regular insulin IV.* |
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A nurse is assisting a client with diabetes mellitus who is recovering from diabetes ketoacidosis (DKA) to develop a plan to prevent recurrence. Which of the the following is most important to include in the plan of care?
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a. Test urine for ketone levels.
b. Eat simple meals per day. c. Monitor blood glucose frequently.* d. Receive appropriate follow-up healthcare. |
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Which of the following signs and symptoms is an early sign in DKA?
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a. Polydipsia*
b. Generalized seizures c. Kussmaul respiration pattern d. Confusion |
