Nursing measures for the client who has had an MI include helping the client to avoid activity that results in Valsalva’s maneuver. Valsalva’s maneuver may cause cardiac dysrhythmias, increased venous pressure, increased intrathoracic pressure, and thrombi dislodgment. Which of the following actions would help prevent Valsalva’s maneuver
A. Have the client drink fluids through a straw.
B. Have the client avoid holding her breath during activity.
C. Have the client assume a side-lying position.
D. Have the client clench her teeth while moving in be
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The correct procedure for auscultating the client’s abdomen for bowel sounds would include
A. palpating the abdomen first to determine correct stethoscope placement.
B. encouraging the client to cough to stimulate movement of fluid and air through the abdomen.
C. placing the client on the left side to aid auscultation.
D. listening for 5 minutes in all four quadrants to confirm absence of bowel sounds.
The most significant sign of acute renal failure is
A. elevated body temperature.
B. increased blood pressure.
C. decreased urine output.
D. increased urine specific gravity.
Which of the following situations is more likely to predispose a client to postpartum hemorrhage
A. Birth of a 7 lb (3,175g) infant.
B. Prolonged first stage of labor.
C. Pregnancy-induced hypertension (PIH).
D. Birth of twins.
The mother of a 4-year-old asks about dental care for her child. "I help brush her teeth every day and her teeth look healthy. When should I take her to see a dentist" Which of the following responses would be most appropriate
A. "Because you help brush her teeth, there’s no need to see a dentist right now. "
B. "Ideally she should have seen a dentist already, but it’s still not too late. "
C. "Your child doesn’t need to see the dentist until she starts school. "
D. "A dental checkup is a good idea even if no problems are noticeable. "
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