A postoperative cesarean section woman is to receive morphine 4 mg q 3 -4 h subcutaneously for pain. The morphine is available on the unit in premeasured syringes 10 mg/1 mL. Each time the nurse administers the medication, how many milliliters (mL) of morphine will be wasted? Calculate to the nearest tenth.

Correct Answer: B

Rationale: The correct answer is B) 0.6 mL. To calculate the wastage, we first determine the total morphine used in 24 hours, which is 4 mg every 3-4 hours. If we assume the maximum frequency (every 3 hours), the patient would receive 6 doses in 24 hours (24 hours ÷ 3 hours = 8 doses, but the last dose is not fully utilized). Therefore, the total morphine used in 24 hours is 24 mg (4 mg/dose x 6 doses). Given that each syringe contains 10 mg/1 mL, the total volume of morphine needed in 24 hours is 2.4 mL (24 mg ÷ 10 mg/mL = 2.4 mL). However, since the syringes are premeasured and contain 1 mL each, there will be a wastage of 0.4 mL per dose. Therefore, for 6 doses in 24 hours, the total wastage will be 2.4 mL (0.4 mL/dose x 6 doses), which is equivalent to 0.6 mL when rounded to the nearest tenth. Educationally, understanding medication calculations is crucial for safe and effective nursing practice. Nurses must be able to accurately calculate dosages to prevent medication errors and ensure patient safety. This question highlights the importance of precise calculations in medication administration to minimize wastage and optimize patient care.

Correct Answer: C

Rationale: The correct answer is C) The woman's breast milk volume may drop while taking the medicine. This is the correct answer because narcotic analgesics can pass into breast milk and affect the infant. Opioids, like narcotics, can lead to decreased milk production and potentially drowsiness or breathing difficulties in the newborn. It is essential for the nurse to educate the mother about the potential risks associated with taking narcotics while breastfeeding. Option A is incorrect because increasing the strength of the narcotic is not necessary and may increase the risk of adverse effects for both the mother and the baby. Option B is incorrect because while constipation is a potential side effect of narcotic analgesics, it is not the most immediate concern in this scenario. Option D is incorrect because while newborns can experience withdrawal symptoms if the mother is taking narcotics consistently, the primary concern in this situation is the potential impact on breastfeeding due to the medication. Educationally, it is vital for healthcare professionals to understand the implications of prescribing medications to breastfeeding mothers and to provide thorough patient education to ensure the safety and well-being of both the mother and the newborn.

Correct Answer: B

Rationale: In assessing a midline episiotomy on a postpartum client, the nurse should expect to see well-approximated edges (Option B). This indicates proper healing and closure of the incision site. Well-approximated edges suggest that the incision is healing as expected and reduces the risk of infection and other complications. Option A, moderate serosanguinous drainage, may be expected in the immediate postpartum period, but it is not a specific finding related to the assessment of the episiotomy incision site. Option C, an ecchymotic area distal to the episiotomy, suggests bruising, which is not a typical finding in a well-healing incision. Option D, an area of redness adjacent to the incision, could indicate inflammation or infection, which would be concerning and not expected in a healing episiotomy. Educationally, understanding the expected findings in assessing a postpartum episiotomy is crucial for nurses to provide appropriate care, monitor for complications, and intervene promptly if needed to promote optimal healing and recovery for postpartum clients.

Correct Answer: C

Rationale: In developing a standard care plan for postpartum clients with midline episiotomies, including the intervention to teach the client to contract her buttocks before sitting (option C) is crucial. This intervention helps reduce tension and pressure on the episiotomy site, promoting healing and preventing complications such as wound dehiscence and infection. Option A is incorrect as removing stitches on the third postpartum day is premature and can disrupt the healing process. Option B may be necessary for pain management but does not directly address care specific to the episiotomy site. Option D is not recommended as routine irrigation with antibiotic solution can disrupt the natural healing process and increase the risk of developing antibiotic-resistant strains of bacteria. Educationally, this rationale highlights the importance of tailored care plans for specific postpartum complications, emphasizing the significance of interventions that promote healing and prevent complications in line with evidence-based practice.

Correct Answer: B

Rationale: In postpartum care, assessing the fundus correctly is crucial to monitor uterine involution and prevent complications. Option B, where the nurse stabilizes the base of the uterus with the dependent hand, is the correct action. This technique helps accurately locate and evaluate the fundus, ensuring proper contraction and preventing excessive bleeding. Option A is incorrect because measuring fundal height with a paper centimeter tape is not the primary method of fundal assessment. Option C is incorrect as palpating the fundus with the fingertips alone may not provide enough support to accurately assess uterine tone. Option D is incorrect as a sterile vaginal exam is not necessary for fundal assessment and should not precede it in routine postpartum care. Educationally, understanding the correct technique for fundal assessment is essential for nurses caring for postpartum clients. Proper fundal assessment can help identify early signs of postpartum hemorrhage or other complications, allowing for timely intervention and improved patient outcomes.