The Labor and Delivery nurse and a nurse new to the Labor and ...

[jenna1]

The Labor and Delivery nurse and a nurse new to the Labor and Delivery unit are admitting a laboring client. The client is making groaning guttural sounds during contractions, and answering questions with one-word answers.
 
  The Labor and Delivery nurse simultaneously is quickly setting up the instruments and sterile field for this delivery while asking the admission questions between contractions. The experienced Labor and Delivery nurse has not yet completed a pelvic exam. The nurse new to Labor and Delivery understands that this is an example of: 1. An expert nurse assessing advanced labor and imminent delivery in the client.
  2. The correct order of steps when admitting laboring clients.
  3. Inconsistencies in an individual nurse's approach to client care.
  4. Advanced nurse practice.

Question 2

The nurse is teaching the parents of a small child strategies to prevent insect bites and stings. Which statement made by the parents indicates a need for further teaching?
 
  1. If my child wears bright colors and floral prints when outdoors, she will blend in with the surroundings, and the stinging insects will not sting her.
   2. My child should avoid heavy colognes, perfumes, and soaps, so that insects are not attracted to them.
   3. We should remove any items with standing water from our yard and surrounding area to prevent mosquito reproduction.
   4. My child can use insect repellent containing DEET of 10 or less.

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Answer to Question 1

1
Rationale:
1. An expert nurse utilizes multiple aspects of a client's behavior (including the length of each response to a question, and sounds the patient produces during contractions) in addition to the more objective findings of the pelvic exam (including dilation of the cervix) in the assessment of a laboring client. The expert nurse has identified that the grunting and guttural sounds during contractions are involuntary pushing, and that the client is very close to delivery.
2. Although most nurses have a routine when admitting a client, the order of the steps will vary according to the situation at hand.
3. Changing the order of the steps of admission is not being inconsistent; changing the order of the steps of admission is responsive to the needs of the client at that point in time.
4. Advanced nurse practice describes educational and certification achievement, and is not used to describe the continuum from novice to expert.

Answer to Question 2

1
Rationale:
1. Bright-colored clothing and floral prints attract the insects. White and light-colored clothing should be worn.
2. Heavy colognes, perfumes, soaps, and detergents resemble flowers and plants, and will attract the stinging insects.
3. Standing water is a breeding ground for mosquitoes. Rid yards of all bird baths, stagnant pools, any standing water that mosquitoes could use for breeding.
4. DEET is an appropriate insect repellent, and can be used in children. A concentration of 10 or less is recommended due to neurotoxic effects at greater concentrations.