The nurse is caring for a client.

Which of the following 4 orders or prescriptions should the nurse anticipate?
Select the 4 orders or prescriptions that the nurse should anticipate.

A. Fundus 2 fingerbreadths above the umbilicus: This finding relates to uterine involution rather than urinary elimination. While important for postpartum assessment, it does not indicate restored bladder function.

B. Uterine atony: Uterine atony is a complication that increases the risk of postpartum hemorrhage. It does not provide information about the client’s ability to void and requires separate monitoring and intervention.

C. Fundus firm and to the right of the abdominal midline: A firm but displaced fundus may indicate a full bladder, which can interfere with urination. This finding suggests bladder distention rather than restored urinary elimination.

D. Two voids of 150 mL each over the past 2 hr: Adequate urine output in regular intervals indicates that the bladder is emptying effectively. Measuring volume and frequency confirms the client’s ability to eliminate urine has been restored postpartum.

A. Avoid oral sucrose: Oral sucrose is actually an effective nonpharmacologic pain management strategy for infants. It should not be avoided; small amounts can help reduce procedural pain during circumcision.

B. Provide IV morphine: IV morphine is not routinely indicated for circumcision in healthy term infants due to the risk of respiratory depression and because less invasive pain control methods are effective.

C. Swaddle the infant: Swaddling provides comfort and a sense of security, reducing pain and distress after circumcision. It is a safe, nonpharmacologic intervention that helps calm the infant during recovery.

D. Apply petroleum daily: Petroleum jelly is typically applied to the circumcision site to prevent the diaper from sticking and protect the healing tissue. However, it is usually applied with each diaper change, not just once daily, to ensure proper care and healing.