A nurse is assessing the fundus of a client during the immediate postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly?

Correct Answer: B

Rationale: B: The nurse stabilizes the base of the uterus with one hand while massaging the fundus. This is the correct action because it ensures that the fundus is properly supported and allows for accurate assessment of the fundal height. Massaging the fundus also helps to prevent postpartum hemorrhage by promoting contractions of the uterus to reduce bleeding. A: The nurse measures the fundal height using a paper tape. This is an incorrect action because measuring the fundal height with a paper tape is not necessary during the immediate postpartum period. The focus should be on assessing the firmness, position, and height of the fundus to ensure proper involution of the uterus. C: The nurse palpates the fundus with the tips of his or her fingers. This action is incorrect because palpating the fundus with the fingertips may not provide enough support to accurately assess the fundal height. It is important to use the palm of the hand to provide adequate support and pressure while assessing the fundus. D: The nurse precedes the assessment with a sterile vaginal exam. This action is incorrect because a sterile vaginal exam is not necessary for assessing the fundus during the immediate postpartum period. The focus should be on assessing the fundus externally to ensure proper involution and prevent complications such as postpartum hemorrhage.

Correct Answer: A

Rationale: Option A is the correct answer because the symptoms described by the partner (anger, confusion, having conversations with herself) could indicate a serious mental health issue such as postpartum psychosis. Postpartum psychosis is a rare but severe condition that requires immediate medical attention as it can be life-threatening to both the mother and the baby. By advising the partner to take the client to the nearest emergency room for evaluation, the nurse is ensuring that the client receives the necessary urgent care and support. Option B is incorrect because simply bringing the client to the physician's office for medication may not be sufficient to address the severity of the symptoms described. Postpartum psychosis requires more immediate and intensive intervention than just medication. Option C is incorrect because outpatient care is not appropriate for someone experiencing symptoms of postpartum psychosis. This condition requires immediate and intensive treatment, which is typically not provided in an outpatient setting. Option D is incorrect because while intensive behavioral therapy may be a component of treatment for postpartum psychosis, it is not the most appropriate initial response. In this case, immediate medical evaluation in an emergency room setting is necessary to ensure the safety and well-being of the client and her baby.

Correct Answer: C

Rationale: Choice C is correct because the transdermal contraceptive patch should not be applied to the breast. This is because the breast tissue has a different composition and sensitivity compared to other areas where the patch is typically placed, such as the abdomen or buttocks. Applying the patch to the breast may result in decreased effectiveness of the contraceptive, as the absorption of hormones may be altered. Additionally, the breast is a sensitive area and applying the patch there may cause skin irritation or discomfort. Choice A is incorrect because simply documenting the use of the patch does not address the issue of its inappropriate placement on the breast. While documentation is important for the woman's medical record, addressing the incorrect placement of the patch is a more immediate concern. Choice B is incorrect because questioning the woman on her satisfaction with the patch does not address the issue at hand, which is the inappropriate placement of the patch on the breast. While it is important to assess the woman's satisfaction with her contraceptive method, this should not take precedence over addressing the incorrect application of the patch. Choice D is incorrect because removing the patch to complete the breast exam is unnecessary and may not be within the scope of practice for a midwife. The primary concern should be educating the woman on the correct placement of the patch and ensuring that she understands the potential risks associated with applying it to the breast.

Correct Answer: B

Rationale: Choice A is incorrect because a variable baseline heart rate of 140 with V-shaped decelerations to 120 unrelated to contractions is concerning. V-shaped decelerations are usually associated with cord compression, which can lead to fetal distress. Choice C is incorrect because a flat baseline heart rate of 140 with decelerations to 120 that return to baseline after the contraction indicates fetal distress. Decelerations should not drop below the baseline heart rate, and a flat baseline can suggest fetal hypoxia. Choice D is incorrect because a flat baseline heart rate of 140 with no obvious decelerations or accelerations can be indicative of fetal compromise. A lack of variability in the heart rate can be a sign of fetal distress. Choice B is the correct answer because a variable baseline heart rate of 140 with decelerations to 100 that mirror each of the contractions is considered normal. This pattern, known as early decelerations, is typically caused by head compression during contractions and is not associated with fetal distress. It is a reassuring sign of fetal well-being during labor.

Correct Answer: B

Rationale: Option A is incorrect because there is no evidence to support the statement that epidurals do not work well when the pain level is above 5. Pain is subjective, and each individual experiences pain differently. The decision to administer an epidural should be based on the patient's request and assessment of their pain level, not an arbitrary cutoff point. Option C is incorrect because it is never too late for an epidural. While it is true that the baby may be born soon in stage 2 labor, epidurals can still be administered to provide pain relief during delivery. The timing of the epidural should be based on the patient's request and pain level, not assumptions about the progression of labor. Option D is incorrect because the decision to administer an epidural should not be based on the fetal heart rate alone. Fetal heart rate monitoring is important for assessing the well-being of the baby, but it should not determine whether a patient receives pain relief. The decision to administer an epidural should be based on the patient's request and assessment of their pain level. Option B is the correct answer because the nurse should promptly respond to the patient's request for an epidural by contacting the doctor to obtain an order. It is important to advocate for the patient's preferences and provide timely pain relief during labor. Promptly contacting the doctor for an epidural order demonstrates good communication and patient-centered care.