Nokea
The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance, the day before. The baby 's Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate?
- A. Sometimes babies just don 't deliver the way we expect them to.
- B. With all of your preparations, it must have been disappointing for you to have had a cesarean.
- C. I know you had to have surgery, but you are very lucky that your baby was born healthy.
- D. At least your husband was able to be with you when the baby was born.
Correct Answer: B
Rationale: The nurse should acknowledge the emotional impact of an unplanned cesarean section while validating the mother's feelings.
You may also like to solve these questions
Why does the nurse encourage ambulation in a patient who has experienced a cesarean birth?
- A. Ambulation helps to prevent DVT.
- B. Ambulation causes the person to lose weight in the hospital.
- C. Ambulation helps with breast-feeding.
- D. Ambulation decreases peristalsis.
Correct Answer: B
Rationale: The correct answer is B because ambulation after a cesarean birth helps the patient to lose weight. Walking promotes circulation, aids in healing, and can prevent complications such as blood clots and pneumonia. It also helps to restore strength and energy levels. Choices A, C, and D are incorrect because ambulation primarily benefits the patient's overall well-being and recovery, rather than directly preventing DVT, aiding breastfeeding, or decreasing peristalsis.
Which client is at greatest risk for early PPH?
- A. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress
- B. Woman with severe preeclampsia on magnesium sulfate whose labor is being
- C. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
- D. Primigravida in spontaneous labor with preterm twins
Correct Answer: B
Rationale: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH
The nurse notices the uterus is boggy and the bladder is full. What intervention should the nurse perform next?
- A. Call for help.
- B. Start IV bolus.
- C. Get the person out of bed to walk to restroom.
- D. Massage the fundus and assess the lochia.
Correct Answer: D
Rationale: Massaging the fundus and assessing the lochia is critical to manage uterine atony.
A client has just been transferred to the postpartum unit from labor and delivery. Which of the following nursing care goals is of highest priority?
- A. The client will breastfeed her baby every 2 hours.
- B. The client will consume a normal diet.
- C. The client will have a moderate lochial flow.
- D. The client will ambulate to the bathroom every 2 hours.
Correct Answer: C
Rationale: After delivery, the highest priority is ensuring the client has a normal lochial flow, which is a key indicator of the uterus returning to its non-pregnant state. Breastfeeding, diet, and ambulation are also important but secondary.
A Muslim woman requests something to eat after the delivery of her baby. Which of the following meals would be most appropriate for the nurse to give her?
- A. Ham sandwich.
- B. Bacon and eggs.
- C. Spaghetti with sausage.
- D. Chicken and dumplings.
Correct Answer: D
Rationale: In Islam, pork is prohibited. Chicken is a halal option that adheres to dietary restrictions.