NCLEX-RN
Implementation Questions
Extract:
Question 1 of 5
The nurse is checking the fundus of a postpartum woman and notes that the uterus is soft and spongy. Which nursing action is appropriate initially?
Correct Answer: C
Rationale: If the fundus is boggy (soft), it should be massaged gently until it is firm and the client is observed for increased bleeding or clots. Option 1 is an inappropriate action at this time. The nurse should document the fundal position, consistency, and height; the need to perform fundal massage; and the client's response to the intervention. The primary health care provider will need to be notified if uterine massage is not helpful.
Question 2 of 5
Correct Answer:
Rationale:
Question 3 of 5
Correct Answer:
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Question 4 of 5
Correct Answer:
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Question 5 of 5
Correct Answer:
Rationale: