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The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments isn't covered by REEDA?
- A. Perineal coloration
- B. Suture line appearance
- C. Amount of swelling
- D. Description of pain
Correct Answer: D
Rationale: The correct answer is D, Description of pain. The REEDA acronym stands for Redness, Edema, Ecchymosis, Discharge, and Approximation. These components focus on physical aspects like inflammation, bruising, wound healing, and discharge. Pain assessment is important but not part of the REEDA acronym, which specifically addresses visible signs of perineal healing postpartum. A thorough assessment should include pain evaluation separately. Choices A, B, and C are incorrect because they are covered by the REEDA acronym, focusing on perineal coloration, suture line appearance, and amount of swelling, respectively.
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The nurse on a postpartum unit is focused on providing care that will assist the mother and father in making the transition to parenthood. For which reason does the nurse review the prenatal and labor records?
- A. Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother.
- B. Awareness of prenatal classes that will help identify and focus on learning needs of both parents.
- C. Identification of preexisting maternal conditions that may interfere with parenting transitions.
- D. Knowledge regarding questions and concerns the mother and father may have about neonate issues.
Correct Answer: A
Rationale: The correct answer is A because reviewing the prenatal and labor records allows the nurse to understand the pregnancy and birth experiences of the mother and father, which can significantly impact their transition to parenthood. By knowing the details of these experiences, the nurse can identify factors that may enhance or impede the process of becoming a mother and father. This information helps the nurse tailor their care and support to address specific needs and concerns of the new parents.
Choice B is incorrect because the focus of reviewing prenatal and labor records is not solely on identifying and focusing on learning needs from prenatal classes. Choice C is incorrect because while identifying preexisting maternal conditions is important for overall care, the primary focus in this scenario is on the transition to parenthood. Choice D is incorrect because the knowledge regarding neonate issues is not the main purpose of reviewing prenatal and labor records in this context.
The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments isn't covered by REEDA?
- A. Perineal coloration
- B. Suture line appearance
- C. Amount of swelling
- D. Description of pain
Correct Answer: D
Rationale: The correct answer is D, Description of pain. The REEDA acronym stands for Redness, Edema (swelling), Ecchymosis (bruising), Discharge, and Approximation (suture line). Pain description is not specifically covered by REEDA, as it focuses on the physical aspects of the perineal assessment. Describing pain would fall under a separate assessment category such as pain scale assessment. Choices A, B, and C are incorrect because they are all aspects that are included in the REEDA assessment for the perineum.
The nurse in a postpartum unit frequently teaches patients regarding breast care. Which teaching is most helpful to the breastfeeding patient?
- A. Run warm water over breasts while in the shower.
- B. Wear a supportive bra for 24 hours a day.
- C. Express milk by a breast pump or manually.
- D. Take analgesics for breast pain management.
Correct Answer: C
Rationale: The correct answer is C because expressing milk by a breast pump or manually helps in relieving engorgement, preventing mastitis, and maintaining milk supply. This action also allows for proper milk removal and promotes breastfeeding success.
A: Running warm water over breasts can provide temporary relief but does not address the underlying issue of engorgement or milk expression.
B: Wearing a supportive bra is important, but doing so 24 hours a day can lead to discomfort and potential issues with milk supply and breast health.
D: Taking analgesics may provide pain relief but does not address the root cause of the issue and may mask potential problems.
The nurse is counseling a lesbian couple who have decided to have a child. Which considerations doesn't the nurse present with regard to which partner will become pregnant?
- A. Consider the age and health of each partner.
- B. Evaluate each partner's career goals.
- C. Decide which partner has better insurance.
- D. Determine who will be on the birth certificate.
Correct Answer: D
Rationale: The correct answer is D because determining who will be on the birth certificate is not a relevant consideration when a lesbian couple decides which partner will become pregnant. The birth certificate can typically be amended to include both partners as legal parents regardless of who gives birth.
A: Considering the age and health of each partner is important for assessing pregnancy risks.
B: Evaluating career goals may impact decisions around timing and balancing work and parenthood.
C: Deciding which partner has better insurance is relevant for covering prenatal care and delivery costs.
A nurse is preparing to perform a fundal assessment on a postpartum client who delivered 12 hours ago. What should the nurse do first?
- A. Lower the head of the bed
- B. Locate the level of the fundus
- C. Assist the woman to the bathroom to empty her bladder
- D. Massage the fundus
Correct Answer: C
Rationale: The correct answer is C: Assist the woman to the bathroom to empty her bladder. This is the first step because a full bladder can displace the uterus, making fundal assessment inaccurate. Emptying the bladder allows for proper fundal assessment by ensuring the uterus is in the correct position. Lowering the head of the bed (choice A) is not necessary before fundal assessment. Locating the level of the fundus (choice B) can be done after ensuring the bladder is empty. Massaging the fundus (choice D) should only be done after fundal assessment to check for firmness.