Practice Question
A nurse is caring for a client who is 1 hr postpartum and observes a large amount lochia rubra and several small clots on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following actions should the nurse take?
Answer Choices:
Correct Answer:
Document the findings and continue to monitor the client.
Rationale:
🔵 A firm fundus at the umbilicus with moderate lochia rubra and clots can be normal in the first hour postpartum.
🔵 Monitoring is crucial, but there is no indication of active hemorrhage.
🔵 Documenting baseline findings allows comparison for early detection of trends.
🔵 If the uterus is firm and midline, the bleeding is not likely due to uterine atony.
🔵 Further intervention is unnecessary unless lochia increases or uterus becomes boggy.
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This question is from Custom N205 Clinical Skills which contains 25 questions.
More Questions from This Exam
A nurse is teaching a prenatal class. and a learner asks the nurse to explain what happens during a prolapsed umbilical cord. Which of the following statements should the nurse make?
Answer Choices:
A. "An occult prolapsed cord occurs when the umbilical cord is wrapped around the fetal neck."
B. "A compound prolapsed cord occurs when the cord is felt through the cervix inside the intact amniotic sac."
C. "An occult cord prolapse occurs when the umbilical cord is hidden within the vagina."
D. '"An overt prolapsed cord occurs when the umbilical cord comes through the cervix ahead of the presenting part."
A nurse is planning discharge teaching for a postpartum client. Which of the following information should the nurse include for the client experiencing constipation
Answer Choices:
A. Avoid fiber-rich foods, as they can worsen constipation.
B. Stay hydrated throughout the day.
C. Daily enemas are needed to relieve constipation.
D. Laxatives are contraindicated for postpartum clients.
A nurse is assessing a newborn 1 hr after birth. Which of the following respiratory rates is within the expected reference range for a newborn?
Answer Choices:
A. 48/min
B. 22/min
C. 100/min
D. 110fmin
A nurse is planning the discharge of a postpartum client and their newborn. Which of the following statements by the client indicates the teaching about preventing heat loss in a newborn has been effective?
Answer Choices:
A. "If the baby seems cold, I can place them to skin-to-skin."
B. "l should keep a hat on the baby even when indoors."
C. "Blankets can help keep the baby warm while they are sleeping."
D. "Babies need two more layers of clothing than adults do to maintain their temperatures."
A nurse in a provider's office is speaking on the phone with a postpartum client who reports pain around their chest. Which of the following actions should the nurse take first?
Answer Choices:
A. Recommend over-the-counter antacids, as heartburn is common in postpartum clients.
B. Inquire about the client's most recent meal and whether it was spicy. greasy, or larger than usual.
C. Investigate by asking the client about pain location, level, and onset.
D. Assess for a history of anxiety, as it can have somatic manifestations.
Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN Custom Exam(s)
- Answer Choices: 4
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