While assessing a client who complained of lower abdominal pressure, the nurse notes a firm mass extending above the symphysis pubis. The nurse suspects
A. a urinary tract infection.
B. renal calculi.
C. an enlarged kidney.
D. a distended bladder.
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A 3-month-old infant just had a cleft lip and palate repair. To prevent trauma to the operative site, the nurse should do which of the following
A. Give the baby a pacifier to help soothe him.
B. Lie the baby in the prone position.
C. Place the infant's arms in soft elbow restraints.
D. Avoid touching the suture line, even to clean.
During her first prenatal visit, a client expresses concern about gaining weight. Which of the following would be the nurse's best action
Ask the client how she feels about gaining weight and provide instructions about expected weight gain and diet.
Be alert for a possible eating problem and do a further in-depth assessment.
C. Report the client's concerns to her caregiver.
D. Ask her to come back to the clinic every 2 weeks for a weight check.
A client who is breast-feeding has a temperature of 102°F (38.9℃) and complains that her breasts are engorged. Her breasts are swollen, hard, and red. Which of the following actions would be inappropriate in managing the client's breast engorgement
Applying frozen cabbage leaves to the breasts.
B. Encouraging the client to shower with her back to the water.
C. Encouraging the client to nurse her baby frequently.
D. Applying a breast binder to support the breasts.
Pericardiocentesis is performed on a client with cardiac tamponade. This procedure would be deemed effective if
A. aspirated blood clots rapidly.
B. blood pressure decreases.
C. blood pressure increases.
D. heart sounds become muffled.
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