During the fourth stage of labor, your client's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. The priority action of the nurse should be to:
A. Turn the client onto her left side.
B. Place the bed in Trendelenburg position.
C. Massage the fundus.
D. Continue to monitor.
Question 2
While caring for a labor client, the nurse determines during a vaginal exam that the baby's head has internally rotated. This information is given to the family.
The labor support person asks the nurse, What other position changes will the baby undertake during labor and birth? How should the nurse describe the rest of the cardinal movements for a baby in a vertex presentation? A. Flexion, extension, restitution, external rotation, and expulsion
B. Expulsion, external rotation, and restitution
C. Restitution, flexion, external rotation, and expulsion
D. Extension, restitution, external rotation, and expulsion
Physical assessment is one component of the nursing database
Client on IV patient-controlled analgesia (PCA).
Electrocardiography. (a) Electrodes are placed on the patient’s chest to record the electrical event
Patient teaching: abdominal assessment
Dorsalis pedis pulse.
Assessment of central venous pressure