The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance, the day before. The baby 's Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate?

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: 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.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Pad saturation every 30 minutes. This finding indicates excessive postpartum bleeding, which is a critical complication that requires immediate attention. Post-cesarean section, monitoring for hemorrhage is crucial due to the risk of uterine atony or other causes of bleeding. Excessive bleeding can lead to hypovolemic shock and even be life-threatening for the mother. Option A) Fundus at the umbilicus is a normal finding in the immediate postpartum period. The fundus should be firm and midline to promote uterine involution. Nodular breasts (Option B) are also a normal postpartum finding related to milk production. A pulse rate of 60 bpm (Option C) is within the normal range for a postpartum woman and does not raise immediate concerns. Educationally, understanding the significance of postpartum complications and the importance of timely assessment and reporting is crucial for nurses caring for postpartum women. Recognizing abnormal findings and knowing when to escalate care is essential in preventing adverse outcomes for both the mother and the newborn. Regular education and training on postpartum complications and assessment skills are necessary for healthcare providers to deliver safe and effective care to postpartum women.

Correct Answer: D

Rationale: The best response for the nurse to make in this situation is option D: "To have things work out differently than you had planned is disappointing." This response is the most empathetic and validating, acknowledging the client's feelings of disappointment and failure without dismissing or minimizing them. It shows understanding and compassion towards the client's emotional experience, which is crucial in providing effective postpartum care. Option A ("You'll feel better later after you have had a chance to rest and to eat") may come across as dismissive of the client's current feelings and fails to address the underlying emotions of failure and disappointment. Option B ("Don't say that. There are many women who would be ecstatic to have that baby") is invalidating and may make the client feel guilty for having negative emotions. Option C ("I am sure that you will have another baby. I bet that it will be a natural delivery") is not appropriate as it disregards the client's current emotional state and focuses on future pregnancies, which may not be the client's immediate concern. In an educational context, it is important for healthcare providers, especially nurses, to develop strong communication skills to effectively support and empathize with patients experiencing emotional distress. Understanding the significance of validating and acknowledging patients' feelings can lead to better patient outcomes and enhanced therapeutic relationships. By choosing the most appropriate response, nurses can promote a sense of trust, respect, and emotional well-being in their patients during vulnerable moments like the postpartum period.

Correct Answer: D

Rationale: In this scenario, the correct action by the nurse is option D: Assist the woman to the bathroom. This is the appropriate choice because the woman is 1 hour postpartum and needs to urinate, which is a common physiological response after delivery. Assisting her to the bathroom promotes her comfort, mobility, and independence in meeting her basic needs. Option A is incorrect because using a bedpan may not be necessary if the woman is able to ambulate and use the bathroom. Option B is incorrect as it dismisses the woman's need to urinate as a normal postpartum occurrence. Option C is incorrect as it provides inaccurate information; if the woman had a catheter in place, it would have been mentioned in the scenario. Educationally, it is essential for nurses to understand the normal postpartum physiological changes and provide appropriate care and support to women during this critical period. Assisting women with postpartum care helps promote their physical and emotional well-being, aiding in the transition to motherhood.