A nurse is caring for a client who is 4 hr postpartum.
The nurse finds a small amount of lochia rubra on the client's perineal pad.
The fundus is midline and firm at the umbilicus.
Which of the following actions should the nurse take?
Assist the client to ambulate.
Increase the rate of IV fluids.
Check for blood under the client's buttock.
Perform fundal massage.
The Correct Answer is C
The nurse should check for blood under the client’s buttocks.
A small amount of lochia rubra on the client’s perineal pad 4 hours postpartum is normal.
The fundus being midline and firm at the umbilicus is also a normal finding.
Choice A is incorrect because assisting the client to ambulate is not necessary at this time.
Choice B is incorrect because there is no need to increase the rate of IV fluids.
Choice D is incorrect because performing a fundal massage is not necessary since the fundus is already firm and midline.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A complete fracture is when the bone breaks into two or more separate pieces.
This is in contrast to an incomplete fracture, where the bone is only partially broken.
A spiral fracture is a type of complete fracture that occurs when a long bone is twisted with force.
A greenstick fracture is a type of incomplete fracture that occurs when a bone bends and cracks but does not break completely.
Choice A, Spiral, is incorrect because it refers to a specific type of complete fracture that occurs when a long bone is twisted with force.
Choice B, Incomplete, is incorrect because it refers to a type of fracture where the bone is only partially broken.
Choice D, Greenstick, is incorrect because it refers to a specific type of incomplete fracture that occurs when a bone bends and cracks but does not break completely.
Correct Answer is D
Explanation
The Ortolani test is a screening test that would help rule out a hip problem related to babies who are breech.
It is used to check for developmental dysplasia of the hip (DDH).
Choice A is not an answer because bracing is a treatment for DDH, not a screening test.
Choice B is not an answer because genu valgum is a condition where the knees angle in and touch each other when the legs are straightened, and it is not a screening test for DDH.
Choice C is not an answer because the Adams test is used to screen for scoliosis, not DDH.
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