A nurse on a postpartum unit is caring for a client who delivered vaginally 24 hr ago.
Which of the following should the nurse expect to find when collecting data?
Moderate lochia serosa on perineal pads
Frequent urges to urinate
Uterine fundus 2 finger widths above the umbilicus
colostrum expressed from the breast
The Correct Answer is A
A) Correct - Lochia serosa, a pinkish-brown vaginal discharge, is typically present 24 hours after vaginal delivery. It is the second stage of lochia that follows the bright red lochia rubra.
B) Incorrect- Frequent urges to urinate might be present but are not specific to the 24- hour postpartum period.
C) Incorrect- The uterine fundus should be descending in the days after childbirth, not located 2 finger widths above the umbilicus.
D) Incorrect- Colostrum is the early milk produced by the breasts, but its presence is not a specific finding in the immediate postpartum period.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Incorrect- Having a high-fat snack before bed might exacerbate nausea. It's generally recommended to have a light snack if needed.
B) Incorrect- Eating small, frequent snacks between meals can help manage nausea by preventing an empty stomach.
C) Incorrect- Drinking water with meals might not necessarily help with nausea and might worsen the feeling of fullness.
D) Correct - "Eat a slice of dry toast before getting out of bed" can help alleviate morning sickness in the first trimester. Eating a small, bland snack before rising can prevent an empty stomach, which can contribute to nausea.
Correct Answer is B
Explanation
A) Incorrect- Applying a heat pack to the area might increase inflammation and discomfort. Heat is generally not recommended for healing episiotomies and hemorrhoids.
B) Correct - "I will apply witch hazel pads after urination" is the correct statement. Witch hazel pads have a cooling and soothing effect that can provide relief from discomfort associated with episiotomies and hemorrhoids.
C) Incorrect- Using a numbing spray before cleansing might not be necessary and could interfere with proper cleansing. It's generally recommended to cleanse the area before applying any products.
D) Incorrect- Remaining in a sitz bath for 10 minutes is beneficial for perineal care, but it doesn't specifically address the use of witch hazel pads or understanding of the overall perineal care regimen. Furthermore, prolonged sitz baths, as can interfere with healing and increase the risk of infection.
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