A nurse is caring for a client following a cesarean birth. The client tells the nurse that she is hungry. Which of the following actions should the nurse take first?
Offer clear liquids.
Auscultate the client's abdomen.
Check the client's chart for a diet prescription.
Give the client soda crackers.
The Correct Answer is B
Choice B reason:
Auscultating the client's abdomen is the first action the nurse should take, as it can assess the return of bowel function after surgery. The nurse should listen for bowel sounds in all four quadrants, and note their frequency and quality.
Offering clear liquids is an important action, as it can provide hydration and nutrition for the client. However, this is not the first action the nurse should take, as it may cause nausea and vomiting if the client's bowel function has not returned.
Choice C reason:
Checking the client's chart for a diet prescription is an important action, as it can ensure that the client follows the provider's orders and does not consume anything contraindicated. However, this is not the first action the nurse should take, as it does not address the client's hunger or bowel function.
Choice D reason:
Giving the client soda crackers is an important action, as it can provide a bland and easily digestible food for the client. However, this is not the first action the nurse should take, as it may be too solid for the client's stomach if her bowel function has not returned.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Expressions of excitement are typical during the dependent, taking-in phase, which lasts for the first 24 to 48 hr after delivery. The client may relive and review her labor and delivery experience, and may need reassurance and validation from others.
Choice B reason:
Lack of appetite is not an expected finding during the dependent, taking-in phase, as the client may have increased hunger and thirst after delivery. The nurse should encourage adequate nutrition and hydration to promote healing and lactation.
Choice C reason:
Eagerness to learn newborn care skills is more characteristic of the dependent-independent, taking-hold phase, which begins around the third day postpartum. During this phase, the client becomes more confident and interested in caring for herself and her newborn.
ChoiceD reason:
Focus on the family unit and its members is more characteristic of the interdependent, letting-go phase, which occurs after the first week postpartum. During this phase, the client redefines her role within the family and society, and integrates the newborn into her life.
Correct Answer is B
Explanation
Choice A reason:
Dinoprostone stimulates uterine contractions is incorrect, as this is not the primary purpose of the medication. Dinoprostone is a prostaglandin that can induce labor by ripening the cervix and enhancing uterine contractility, but it is not used solely for stimulating contractions.
Choice B reason:
Dinoprostone promotes softening of the cervix is correct, as this is the main purpose of the medication. Dinoprostone is used to prepare the cervix for labor by increasing its softness, dilation, and effacement. This can facilitate the descent of the fetus and shorten the duration of labor.
Choice C reason:
Dinoprostone relaxes uterine contractions is incorrect, as this is the opposite effect of the medication. Dinoprostone can increase uterine tone and frequency, which can help initiate or augment labor. The nurse should monitor the client for signs of uterine hyperstimulation or fetal distress.
Choice D reason:
Dinoprostone assists with ending the pregnancy is incorrect, as this is not the intended use of the medication. Dinoprostone can be used to terminate a pregnancy in some cases, such as fetal demise or missed abortion, but it is not routinely used for this purpose. The nurse should explain to the client that dinoprostone is used to induce labor and not to end a pregnancy.
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