A nurse is reinforcing preoperative teaching with a client who is scheduled for a cesarean birth. Which of the following client statements indicates an understanding of the teaching?
"The nurse will take out my urinary catheter 48 hours after surgery."
"The nurse might need to massage my uterus frequently after surgery."
"I can have regular food once I am able to swallow safely."
"I will need to stay flat on my back in bed for the first 24 hours after surgery."
The Correct Answer is B
A. The urinary catheter is usually removed within the first 24 hours after a cesarean birth, not 48 hours. Early removal helps prevent complications and promotes recovery.
B. Uterine massage is performed to prevent postpartum hemorrhage and ensure the uterus is contracting properly. This practice is part of standard postpartum care to promote uterine involution.
C. Postoperative diet progression typically starts with clear liquids and advances as tolerated. Regular food is introduced once the client can swallow safely and shows no signs of nausea or gastrointestinal issues.
D. Staying flat on the back is not required post-cesarean section. Early ambulation is encouraged to prevent complications like deep vein thrombosis and to promote healing.
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Related Questions
Correct Answer is C
Explanation
A. The deltoid muscle is not recommended for newborns; the vastus lateralis is the preferred site for intramuscular injections.
B. A 25-gauge needle is an appropriate size for newborn injections, but needle choice alone is not the priority action for this specific medication administration.
C. Phytonadione (Vitamin K) is typically administered within the first 6 to 12 hours after birth, allowing time for initial stabilization and bonding before injection, while still preventing vitamin K deficiency bleeding.
D. The mother’s Rh factor is unrelated to vitamin K administration; it is only assessed when considering the need for Rho(D) immune globulin.
Correct Answer is C
Explanation
A. A Mongolian spot is a benign, pigmented skin mark common in newborns, particularly those with darker skin. It is not related to rubella exposure during pregnancy.
B. Jaundice in the newborn can be a common finding and is not specifically related to maternal rubella exposure. Jaundice often resolves with time or may require treatment, but it is not a direct consequence of rubella.
C. Deafness is a known congenital defect associated with rubella syndrome. Infants exposed to rubella during pregnancy are at risk for serious outcomes, including hearing impairments.
D. Transient strabismus is a common condition in newborns and is not specifically associated with maternal rubella exposure. It typically resolves as the baby grows.
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