Nokea
The postpartum mother with a third degree laceration tells the nurse she is afraid to have a bowel movement because of her painful episiotomy. What should the nurse do?
- A. Offer a suppository or enema.
- B. Encourage ambulation.
- C. Offer stool softeners as prescribed.
- D. Offer pain medication before defecating.
Correct Answer: C
Rationale: Stool softeners are available to ease the pain of defecation caused by hemorrhoids and birth trauma. Suppositories or enemas are contraindicated in mothers with third or fourth degree lacerations. Pain medications can often cause constipation. Ambulation may aid in defecation, but will not soften the stool.
You may also like to solve these questions
What is the name of the vaginal discharge that occurs immediately following delivery?
- A. Lochia serosa
- B. Lochia rubra
- C. Lochia palatine
- D. Lochia alba
Correct Answer: B
Rationale: The vaginal discharge that occurs immediately following discharge is known as lochia rubra and is made up mostly of blood. As the placenta heals, the draining turns pink to dark brown in color and is known as lochia serosa. After about 7 days, the discharge turns slight yellow to white and is called lochia alba.
A new mother had spinal anesthesia during a cesarean delivery. She now has a desire to void and can wiggle her toes. What should be the nurse's response when the mother asks to go the bathroom?
- A. Assess her blood pressure.
- B. Obtain a wheelchair.
- C. Palpate her bladder.
- D. Put slippers on her feet.
Correct Answer: D
Rationale: The nurse should check that the mother is wearing slippers to ensure better footing. If the mother has a desire to void and can move her toes, there is no need for her to remain bedridden.
When assessing a mother 12 hours following the delivery of a baby where should the nurse expect to palpate the fundus?
- A. 2 cm below the umbilicus
- B. At the umbilicus
- C. 1 cm below the umbilicus
- D. Halfway between the umbilicus and the symphysis pubis
Correct Answer: B
Rationale: Within 12 hours, the fundus rises to the level of the umbilicus. The fundus should be firm. Immediately following delivery, the fundus will be felt halfway between the umbilicus and the symphysis.
Within the first hour following a vaginal delivery the nurse assesses the mother and finds the fundus is firm and there is a trickle of bright red blood. What should be the nurse's reaction to the assessment?
- A. This is a normal occurrence.
- B. This is abnormal and should be reported.
- C. The patient should be administered a blood thinner.
- D. The patient should be restricted to bed rest.
Correct Answer: A
Rationale: A bright red drainage is normal immediately after delivery. The patient should be monitored at regular intervals. Bed rest is not indicated. A blood thinner would not be given.
Before initially feeding an infant what reflex should the nurse assess?
- A. Moro reflex
- B. Rooting reflex
- C. Babinski reflex
- D. Swallow reflex
Correct Answer: D
Rationale: The nurse should verify that the infant is able to swallow normally before feeding.