The obstetrician has ordered that a post-op cesarean section client 's patient-controlled analgesia (PCA) be discontinued. Which of the following actions by the nurse is appropriate?

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: 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.

Correct Answer: C

Rationale: The correct answer is C) Assess the urine for cloudiness. This action is appropriate because cloudiness in the urine can indicate a urinary tract infection (UTI) postpartum. UTIs are common during the postpartum period due to factors like bladder distention, catheter use during labor, and hormonal changes. Cloudy urine may suggest the presence of bacteria, white blood cells, or other signs of infection. By assessing the urine for cloudiness, the nurse can gather important information to help confirm the presence of a UTI and guide further diagnostic and treatment interventions. Option A is incorrect because frequent urination alone is not a normal postpartum symptom and could be indicative of a UTI. Option B, obtaining an order for a urine culture, is a valid step in diagnosing a UTI but may not be the most immediate action needed in this scenario. Option D, asking if the woman is prone to UTIs, does not address the immediate need to assess the current symptoms and could delay necessary interventions. In an educational context, it is crucial for nurses to understand the common complications that can arise during the postpartum period, such as UTIs, and to recognize the signs and symptoms that may indicate their presence. Proper assessment and timely intervention are essential in promoting the health and well-being of postpartum women.