The day after delivery, a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong: 'All I do is go to the bathroom. ' Which of the following is an appropriate nursing response?

Correct Answer: C

Rationale: In this scenario, the appropriate nursing response is option C: Inform the client that polyuria is normal. Postpartum diuresis, characterized by increased urinary frequency and volume, is a common physiological response to the body getting rid of excess fluid accumulated during pregnancy. It is crucial for nurses to educate postpartum women about this normal process to alleviate anxiety and provide reassurance. Option A (Catheterize the client per doctor's orders) is incorrect because catheterization is an invasive procedure that is not indicated in this situation unless there are specific medical reasons to do so. Option B (Measure the client's next voiding) is not the best response as it does not address the client's concerns or provide information about the normal postpartum experience of increased urinary frequency. Option D (Check the specific gravity of the next voiding) is unnecessary at this point as the client's symptoms can be explained by the normal postpartum diuresis, and specific gravity testing is not typically needed in this context. Educationally, understanding the normal physiological changes that occur postpartum is essential for nurses caring for postpartum women. It enables them to provide appropriate education, support, and reassurance to clients, promoting better outcomes and enhancing the overall postpartum experience.

Correct Answer: D

Rationale: In this scenario, option D is the best response for the nurse to provide to the woman who had a cesarean section and needs to cough but is afraid to. Supporting the incision with a pillow while coughing can help reduce the pain and discomfort associated with coughing post-surgery. This response shows empathy and provides practical guidance to alleviate the woman's fear and discomfort. Option A is incorrect because simply acknowledging the pain without providing a solution does not address the woman's fear of coughing post-surgery. Option B is incorrect as checking lung fields may not directly address the woman's fear of coughing. Option C is incorrect as deep breathing, although beneficial, may not be as effective as coughing in clearing secretions and preventing complications like pneumonia. Educationally, this scenario highlights the importance of providing practical and patient-centered care to individuals post-surgery. Nurses need to not only address physical discomfort but also provide emotional support and guidance to help patients manage their fears and concerns effectively. Encouraging patients to cough while supporting their incision can be a simple yet effective intervention to promote healing and prevent complications.

Correct Answer: B

Rationale: The correct answer is B) "With all of your preparations, it must have been disappointing for you to have had a cesarean." This response demonstrates empathy and acknowledges the woman's feelings of disappointment and possibly loss of control over her birth experience. It validates her emotions and shows understanding of the situation she is facing. Option A) is inappropriate because it dismisses the woman's feelings and experience by implying that unexpected outcomes are normal and should be accepted without acknowledging her emotions. Option C) while acknowledging the baby's health, fails to address the woman's emotional state and could come across as minimizing her feelings about the birth experience. Option D) focuses on the presence of the husband but does not address the woman's feelings about the birth experience or her disappointment in not having the birth she had planned for. In an educational context, it is crucial for healthcare providers to practice empathy and active listening when communicating with patients, especially in sensitive situations like childbirth. Acknowledging and validating a patient's feelings can help build trust and improve the overall quality of care provided.

Correct Answer: A

Rationale: In this scenario, the appropriate action for the nurse to take is option A) Discard the remaining medication in the presence of another nurse. This choice is correct because it ensures proper disposal of the controlled substance, preventing misuse or diversion. Patient-controlled analgesia (PCA) should be discontinued as per the physician's orders to prevent overmedication or potential side effects. Option B) Recommend waiting until her pain level is zero to discontinue the medicine is incorrect as it does not align with best practice. Pain management should be individualized and based on the patient's needs, not solely on achieving a pain level of zero. Option C) Discontinuing the medication only after the analgesia is completely absorbed is incorrect as it does not address the need for immediate discontinuation as per the physician's order. Option D) Returning the unused portion of medication to the narcotics cabinet is incorrect as controlled substances should never be returned to the cabinet once dispensed to a patient, to prevent diversion and ensure accurate tracking of medication administration. Educationally, this question highlights the importance of following physician's orders accurately, proper disposal of controlled substances, and individualized pain management strategies in postpartum care. Nurses need to be vigilant in medication management to ensure patient safety and prevent medication errors.

Correct Answer: B

Rationale: The correct answer is B) Two days is not that bad. Some patients go four days or longer without a movement. This response by the nurse is appropriate because it reassures the client that her situation is not uncommon and does not warrant immediate concern. Postoperative constipation is a common issue due to factors like reduced mobility, anesthesia effects, and opioid pain medications. Option A is incorrect because ordering an enema should not be the first line of action for postoperative constipation, especially without further assessment. Option C is incorrect as antibiotics through IV may contribute to constipation but are not the sole reason, and addressing constipation is more multifaceted. Option D is not the best response as focusing solely on fluids and exercise oversimplifies the issue of postoperative constipation which may require a more comprehensive approach. Educationally, it is crucial for nurses to understand the physiological factors contributing to postoperative constipation and the appropriate management strategies. Nurses should provide holistic care, including assessing bowel patterns, promoting early ambulation, adequate hydration, fiber intake, and considering stool softeners or laxatives as needed. It is important to educate clients on postoperative expectations and empower them to manage common complications effectively.