A nurse is caring for a client who is 2 hr postpartum following a vaginal birth. Which of the following findings indicates the client's bladder is distended?

Fundus palpable to right of midline

Less than 2.5 cm of rubra lochia on perineal pad

Client report of increased thirst

Client report of frequent uterine contractions

Answer and Explanation

The Correct Answer is A

A.   A fundus palpable to the right of midline may indicate a distended bladder pushing the uterus to the side, and it requires intervention to promote bladder emptying.
B.   Less than 2.5 cm of rubra lochia on a perineal pad is a normal finding in the early postpartum period.
C. Increased thirst is not directly indicative of bladder distention.
D.   Frequent uterine contractions are expected in the postpartum period and do not necessarily indicate bladder distention.

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Correct Answer is B

Explanation

A. Carrying the baby in the parent's arms enhances security but does not directly address the prevention of abduction.
B. Verifying the identity of any questionable person by a second staff member is a key measure to prevent infant abduction.
C. Leaving the baby unattended in the client's room is not a safe practice and does not contribute to preventing abduction.
D. Posting photographs of the infant on the Internet can compromise the child's security and is not recommended.

A. "I wish he had more hair. I don't like the way he looks." B. "He's got my husband's nose, that's for sure." C. "I don't need a baby bath demonstration. I know how to do it." D. "Do you think you could keep him in the nursery for the next feeding so I can get some sleep?"

Correct Answer is A

Explanation

A. Expressing dissatisfaction with the baby's appearance may indicate a lack of immediate bonding.
B. Noting physical features shared with the father suggests recognition and connection.
C. Declining a baby bath demonstration doesn't necessarily indicate a lack of attachment.
D. Requesting nursery care for sleep doesn't necessarily indicate a lack of attachment.

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A nurse is caring for a client who is 2 hr postpartum following a vaginal birth. Which of the following findings indicates the client's bladder is distended?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?

Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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A nurse is caring for a client who is 2 hr postpartum following a vaginal birth. Which of the following findings indicates the client's bladder is distended?

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