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The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis?
- A. To prevent uterine prolapse.
- B. To prevent uterine movement
- C. To prevent uterine hemorrhage
- D. To prevent uterine inversion
Correct Answer: D
Rationale: Step 1: Palpating the uterus 12 hours after delivery is to assess for proper involution.
Step 2: Placing a hand above the symphysis pubis helps to prevent uterine inversion.
Step 3: Uterine inversion is a rare but serious complication post-delivery.
Step 4: By supporting the uterus, the nurse prevents the risk of inversion.
Summary: A is incorrect as palpation doesn't prevent prolapse. B is incorrect as some uterine movement is normal. C is incorrect as palpation doesn't prevent hemorrhage at this stage.
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The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis?
- A. To prevent uterine prolapse.
- B. To prevent uterine movement
- C. To prevent uterine hemorrhage
- D. To prevent uterine inversion
Correct Answer: D
Rationale: The correct answer is D: To prevent uterine inversion. Placing a hand just above the symphysis pubis during uterine palpation helps prevent uterine inversion by providing support to the lower segment of the uterus. Uterine prolapse (A) is the downward displacement of the uterus, which is not prevented by this action. Uterine movement (B) is a natural occurrence and not a concern during palpation. Uterine hemorrhage (C) is more related to postpartum bleeding management and is not directly impacted by the hand placement.
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: Step-by-step rationale for why choice A is correct:
1. Fundus is firm and at midline: Indicates normal involution of the uterus post-delivery.
2. Lochia is moderate with rubra and small clots: Expected findings in the early postpartum period.
3. Overall assessment findings within normal range: Indicate normal postpartum recovery.
Summary of why other choices are incorrect:
B. Presence of infection would usually be indicated by abnormal signs such as foul-smelling lochia or fever, which are absent in this case.
C. No abnormal findings are present that would necessitate physician notification.
D. Fluid intake is important postpartum, but there are no signs in this scenario indicating a need for increased fluid intake.
The nurse is researching for evidence-based practice related to a mother's response during the postpartum period. Based on research by Rubin and Mercer, which finding will the nurse be able to easily implement to change the culture of the unit?
- A. Satisfaction questionnaires
- B. Alterations in terminology
- C. Decrease nurse/patient ratios
- D. Soliciting paternal expectations
Correct Answer: B
Rationale: The correct answer is B: Alterations in terminology. Rubin and Mercer's research emphasizes the importance of language in shaping postpartum experiences. By changing terminologies used in the unit to be more supportive and empowering, the nurse can easily implement this finding to positively change the culture. Satisfaction questionnaires (A) may not directly address cultural change. Decreasing nurse/patient ratios (C) may require significant resources and restructuring. Soliciting paternal expectations (D) focuses on a different aspect and may not directly impact unit culture.
The nurse is researching for evidence-based practice related to a mother's response during the postpartum period. Based on research by Rubin and Mercer, which finding will the nurse be able to easily implement to change the culture of the unit?
- A. Satisfaction questionnaires
- B. Alterations in terminology
- C. Decrease nurse/patient ratios
- D. Soliciting paternal expectations
Correct Answer: B
Rationale: The correct answer is B: Alterations in terminology. Rubin and Mercer's research focuses on the importance of language and terminology used during the postpartum period. By implementing changes in the unit's terminology to be more supportive and empowering for mothers, the nurse can positively impact the culture of the unit. This can help create a more nurturing and understanding environment for new mothers.
Incorrect choices:
A: Satisfaction questionnaires are not directly related to changing the culture of the unit based on Rubin and Mercer's research.
C: Decreasing nurse/patient ratios may improve patient care but is not specifically mentioned in the research as a way to change the unit's culture.
D: Soliciting paternal expectations is not the focus of Rubin and Mercer's research, which is centered on the mother's response during the postpartum period.
The nurse in a postpartum unit evaluates new parents for risk factors that can indicate problems with bonding/attachment. Which situations does the nurse NOT recognize as a cause for bonding/attachment problems?
- A. The mother experienced eclampsia in the third trimester of pregnancy.
- B. The neonate is being treated for meconium aspiration syndrome.
- C. The mother experienced dystocia in the second phase of labor.
- D. The father of the neonate is in the military and not yet home on leave.
Correct Answer: D
Rationale: The correct answer is D because the father being in the military and not yet home on leave does not directly impact bonding/attachment between the parents and the neonate. Bonding issues are typically related to factors such as maternal health conditions (choice A), neonatal health complications (choice B), or labor complications experienced by the mother (choice C). In contrast, the father's absence due to military service, while potentially challenging emotionally, does not inherently cause bonding/attachment problems as the mother and baby can still form a strong attachment bond. Choices A, B, and C are incorrect as they can directly affect the bonding/attachment process due to physical health issues of the mother and baby during pregnancy and labor.