A 14-year-old female is brought to the clinic by her mother, who is concerned that her daughter's shoulders appear uneven.

The adolescent denies pain but reports feeling self-conscious during gym class.

The nurse performs a forward bend test and notes an asymmetry in the rib cage.

The provider diagnoses idiopathic scoliosis.

The adolescent is prescribed a thoracolumbosacral orthosis (TLSO) brace.

Which nursing action is most appropriate in promoting adherence to treatment and psychosocial well-being?

Choice A rationale

At the end of the first trimester, around 12-14 weeks gestation, the uterus is still relatively low in the pelvis. The symphysis pubis serves as a reliable anatomical landmark for locating the fundus of the uterus at this stage. Placing the Doppler just above this bony prominence allows for optimal transmission of sound waves to detect the fetal heart tones.

Choice B rationale

The right upper quadrant contains structures like the liver, gallbladder, and part of the colon. At the end of the first trimester, the uterus is not typically high enough to extend into this region. Therefore, attempting to locate fetal heart tones in this area would be ineffective and unlikely to yield a clear signal, as the fetus is not yet positioned there.

Choice C rationale

Just above the umbilicus is the general location for assessing fetal heart tones later in pregnancy, typically during the second and third trimesters when the uterus has significantly enlarged and risen out of the pelvis. At the end of the first trimester, the uterus is still too small and low for the fetal heart tones to be consistently heard at this location.

Choice D rationale

The left upper quadrant contains the stomach, spleen, and part of the colon. Similar to the right upper quadrant, the uterus is not positioned high enough in the first trimester to extend into this area. Therefore, attempting to locate fetal heart tones in the left upper quadrant would be inappropriate and unlikely to be successful.

Choice A rationale

Massaging the client's fundus is the immediate priority when a postpartum client saturates a perineal pad in 10 minutes, indicating excessive bleeding. Fundal massage stimulates uterine contractions, which compress blood vessels in the myometrium, reducing blood loss and preventing postpartum hemorrhage by promoting uterine involution and preventing atony.

Choice B rationale

Checking the client's blood pressure is an important assessment to monitor for signs of hypovolemia. However, it is not the first action. The immediate priority is to address the source of excessive bleeding and prevent further blood loss, which is achieved through fundal massage. Blood pressure assessment would follow.

Choice C rationale

Observing for pooling of blood under the buttocks is a necessary assessment to quantify blood loss and identify concealed hemorrhage. While important, it is a secondary action to fundal massage. The primary intervention focuses on controlling the bleeding at its source, as delaying can lead to rapid deterioration of the client's condition.

Choice D rationale

Administering oxytocin is a pharmacological intervention used to prevent and treat postpartum hemorrhage by increasing uterine contractility. While highly effective, it is not the *first* action. Manual fundal massage can be initiated immediately, providing a rapid mechanical stimulus to the uterus while awaiting medication preparation and administration.