A community health nurse is in the initial phase of planning a smoking cessation program. Which of the following actions should the nurse take first?

Choice A reason: Assessing the bladder for distention is an important action, but not the first one. The nurse should first check the uterine tone and position, as a boggy or displaced uterus can indicate uterine atony, the most common cause of postpartum hemorrhage.

Choice B reason: Massaging the client's fundus is the first action to take. The nurse should apply firm, circular pressure to the fundus to stimulate uterine contractions and reduce bleeding. The nurse should also monitor the amount and character of lochia.

Choice C reason: Preparing to administer a prescribed oxytocic preparation is a necessary action, but not the first one. The nurse should first attempt to control the bleeding by massaging the fundus and assessing the bladder. If the bleeding persists, the nurse should administer medications such as oxytocin, methylergonovine, or carboprost to enhance uterine contractions.

Choice D reason: Assessing the client's blood pressure is an important action, but not the first one. The nurse should first manage the bleeding by massaging the fundus and preparing to administer medications. The nurse should also monitor the client's vital signs, including blood pressure, pulse, and temperature, for signs of shock or infection

Choice A reason: Echinacea is not typically utilized for its analgesic or anti-inflammatory properties related to musculoskeletal disorders. Arthritis management usually involves supplements like glucosamine, chondroitin, or omega-3 fatty acids. Since echinacea focuses on immune modulation rather than joint health, improvement in arthritis pain would not be the expected clinical indicator of its effectiveness.

Choice B reason: Sleep enhancement is not a known therapeutic effect of echinacea. Clients seeking herbal assistance for insomnia or sleep disturbances would more likely use valerian root, melatonin, or chamomile. Because echinacea does not possess sedative or hypnotic properties, a report of sleeping through the night would be unrelated to this specific treatment.

Choice C reason: Echinacea is widely used for its immunostimulant properties, which can aid in wound healing and the prevention of upper respiratory infections. By enhancing phagocytosis and immune function, it supports the body's ability to repair tissue. Therefore, a healing leg wound serves as a positive clinical finding indicating the therapy is effective.

Choice D reason: This blood pressure reading indicates a wide pulse pressure and does not reflect a therapeutic goal of echinacea. Echinacea does not have antihypertensive properties or significant effects on cardiovascular hemodynamics. Monitoring blood pressure is a standard nursing action, but these specific values would not be used to evaluate the efficacy of an herbal immunostimulant.