The nurse receives the following report on a client who delivered 36 hours ago: para 1, rubella immune, A-negative, antibody screen negative, newborn B-positive, Coombs negative, discharge orders are written for both mother and newborn. What should be the priority action by the nurse?
1. Administer rubella vaccine.
2. Ask if she is breast- or bottlefeeding.
3. Determine if RhoGAM has been given.
4. Discuss the discharge education with the client.
Question 2
A newly admitted client at 32 weeks' gestation is experiencing a sudden onset of intense nausea and a frontal headache for the past 2 days. The client's initial blood pressure is 158/98, and she reports scant urination over the past 24 hours. Which intervention should the nurse anticipate implementing?
1. Ordering a low-protein diet for the client
2. Conducting a urine dipstick test to assess for proteinuria
3. Placing a wedge under the client's left hip so that she is in a right lateral tilt position
4. Administering diuretics and facilitating a dietary regimen of strict sodium restriction
The patient and his family meet with the nurse to discuss progress on the patient care plan.
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nurse
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