A nurse is assessing the fundus of a postpartum patient one day after delivery and notes that the fundus is soft and spongy. Which is the first nursing intervention to preform?

Administer Oxytocin IV per MD orders

Notify the healthcare provider

Document the fundal height and consistency

Massage the fundus until it firms

Answer and Explanation

The Correct Answer is D

A. Administer Oxytocin IV per MD orders. This may be done after attempting fundal massage to help firm the uterus, but massage is the first step.
B. Notify the healthcare provider. This would be done if the fundus does not respond to massage or if excessive bleeding continues, but not before attempting to firm the fundus.
C. Document the fundal height and consistency. Documentation is important but should occur after addressing the immediate issue of a soft fundus to prevent hemorrhage.
D. Massage the fundus until it firms. The immediate action should be to massage the uterus to promote contraction and reduce bleeding. A soft, spongy uterus indicates uterine atony, which can lead to hemorrhage.

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Correct Answer is ["A","C","D","F"]

Explanation

A. Provide the caregiver with resources in the community for support: Ensures the caregiver has access to additional help and knowledge about asthma management.
B. Provide the child with a pamphlet on how to use an inhaler: While education for the child is important, at 5 years old, the ability to manage an inhaler independently may not be developmentally appropriate.
C. Refer the caregiver to the asthma educator: Specialized instruction can enhance the caregiver's understanding of asthma management.
D. Ask the caregiver, "what worries you about your child?": Understanding concerns helps tailor education and support to address specific needs.
E. Teach the child how to use the inhaler: Similar to B, teaching the child directly to use the inhaler without supervision may not be feasible at this age.
F. Provide information on child development: Educates the caregiver about realistic expectations regarding the child's ability to manage asthma independently.

A. "The most common manifestation of postpartum depression is harming the infant." B. "It's common for clients who have postpartum depression to exhibit psychotic behavior." C. "Postpartum depression usually begins 48 hours after childbirth." D. "Postpartum depression is more likely to occur in women who have a history of depression."

Correct Answer is D

Explanation

A. "The most common manifestation of postpartum depression is harming the infant." This is incorrect; harming the infant is a severe complication but not the most common manifestation.
B. "It's common for clients who have postpartum depression to exhibit psychotic behavior." Psychotic behavior is a rare but serious complication of postpartum depression.
C. "Postpartum depression usually begins 48 hours after childbirth." Postpartum blues may start within this timeframe, but postpartum depression typically manifests later.
D. "Postpartum depression is more likely to occur in women who have a history of depression." This statement correctly identifies a significant risk factor for postpartum depression.

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A nurse is assessing the fundus of a postpartum patient one day after delivery and notes that the fundus is soft and spongy. Which is the first nursing intervention to preform?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in an acute pediatric unit is assessing a 5-year-old child following an asthma event. The child's caregiver expects the child to use an inhaler without supervision. The nurse can apply which of the following interventions as protective factors for the child? (Select All that Apply.)

Correct Answer is ["A","C","D","F"]

Explanation

A nurse is discussing postpartum depression with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of this condition?

Correct Answer is D

Explanation

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