Nokea
The nurse is educating a new postpartum woman about peri-care. Which action by the client indicates understanding?
- A. The woman applied her peri-pad from back to front.
- B. The woman performed peri-care three times a day.
- C. The woman washed her hands before and after performing peri-care.
- D. The woman mixed tap water and hydrogen peroxide in her peri-bottle.
Correct Answer: C
Rationale: The correct answer is C because washing hands before and after performing peri-care is crucial to prevent infection. Beforehand, it reduces the risk of introducing harmful bacteria into the perineal area. Afterward, it prevents potential contamination of hands. This action demonstrates understanding of maintaining proper hygiene during peri-care.
Explanation of other choices:
A: Applying the peri-pad from back to front is incorrect as it can introduce bacteria from the rectal area to the vaginal area, increasing the risk of infection.
B: Performing peri-care three times a day is not necessarily an indication of understanding proper technique and hygiene. Frequency alone does not ensure correct practice.
D: Mixing tap water and hydrogen peroxide in the peri-bottle is not recommended as it can disrupt the natural flora in the perineal area and cause irritation.
You may also like to solve these questions
Which best represents the process of postpartum diuresis in a postpartum client?
- A. A nervous response to vasomotor changes
- B. Elimination of excess fluid through the skin
- C. Underarm perspiration that occurs after ambulation
- D. Loss of fluid from expulsion of the placenta and amniotic fluid
Correct Answer: D
Rationale: The correct answer is D because postpartum diuresis occurs due to the loss of fluid from the expulsion of the placenta and amniotic fluid. This process helps the body eliminate excess fluid retained during pregnancy. A is incorrect as it refers to a nervous response, not a physiological process. B is incorrect as diuresis involves elimination through urine, not the skin. C is incorrect as underarm perspiration is not directly related to postpartum diuresis. In summary, D is the best representation as it directly links the process to the expulsion of placenta and amniotic fluid.
The nurse is educating a new postpartum woman about peri-care. Which action by the client indicates understanding?
- A. The woman applied her peri-pad from back to front.
- B. The woman performed peri-care three times a day.
- C. The woman washed her hands before and after performing peri-care.
- D. The woman mixed tap water and hydrogen peroxide in her peri-bottle.
Correct Answer: C
Rationale: The correct answer is C because washing hands before and after peri-care is crucial to prevent the spread of infection. Before performing peri-care, clean hands reduce the risk of introducing harmful bacteria to the perineal area. After peri-care, hand hygiene prevents potential contamination from the perineum to other body parts or surfaces.
Explanation of why other choices are incorrect:
A: Applying the peri-pad from back to front can introduce bacteria from the rectal area to the urethra, increasing the risk of urinary tract infections.
B: While performing peri-care multiple times a day is important, it is not the best indicator of understanding peri-care principles.
D: Mixing tap water and hydrogen peroxide in the peri-bottle may be harmful and is not a standard practice for peri-care.
Which best represents the process of postpartum diuresis in a postpartum client?
- A. A nervous response to vasomotor changes
- B. Elimination of excess fluid through the skin
- C. Underarm perspiration that occurs after ambulation
- D. Loss of fluid from expulsion of the placenta and amniotic fluid
Correct Answer: D
Rationale: Postpartum diuresis is the increased urine output that occurs after childbirth. The correct answer, D, explains this process accurately as the loss of fluid from expulsion of the placenta and amniotic fluid triggers the body to eliminate excess fluid through increased urination. Choice A is incorrect as it does not directly relate to the process of postpartum diuresis. Choice B is incorrect because excess fluid is primarily eliminated through urine, not the skin. Choice C is incorrect as underarm perspiration is not a significant factor in postpartum diuresis.
The nurse is assessing her patient, who is 1 day postpartum. The nurse notes that the fundus is firm and at midline, the lochia is moderate in amount, and the presence of rubra with two dime-sized clots is on her peri-pad. What should the nurse determine from these assessment findings?
- A. They are normal.
- B. They indicate the presence of infection.
- C. The physician should be notified of the abnormal findings.
- D. The patient should be instructed to increase her fluid intake.
Correct Answer: A
Rationale: The correct answer is A, as the assessment findings described are normal for a patient who is 1 day postpartum. A firm and midline fundus indicates proper uterine involution. Moderate lochia is expected at this stage, and the presence of small clots is normal. The overall picture suggests the normal process of healing after childbirth.
Choice B is incorrect because the assessment findings do not indicate signs of infection such as foul-smelling lochia, fever, or elevated white blood cell count.
Choice C is incorrect as there are no abnormal findings that would warrant immediate notification of the physician.
Choice D is incorrect as there is no indication from the assessment findings that the patient needs to increase her fluid intake; the findings are within the expected range for a patient 1 day postpartum.
A postpartum patient states, " am really in pain."For which sources of pain will the nurse not assess the patient?
- A. Uterine contractions
- B. Perineal trauma
- C. Breast engorgement
- D. General soreness
Correct Answer: D
Rationale: The correct answer is D because general soreness is a vague and nonspecific term that does not provide any specific information on the source or type of pain. In contrast, uterine contractions, perineal trauma, and breast engorgement are common sources of postpartum pain with specific anatomical locations and characteristics. Assessing for general soreness would not lead to identifying potential underlying issues or appropriate interventions. It is important to focus on assessing specific sources of pain to provide targeted care for the postpartum patient.