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A nurse is caring for a client who had a vaginal delivery 2 hr ago. Which of the following actions should the nurse anticipate in the care of this client? (Select all that apply.)

Massage a firm fundus.

Determine whether the fundus is midline.

Document fundal height.

Observe the lochia during palpation of fundus.

Administer methylergonovine maleate if uterus is boggy.

Answer and Explanation

Correct Answer : B,C,D,E

Answer: B, C, D, E

Rationale:

A) Massage a firm fundus: If the fundus is already firm, routine massage is not necessary. Instead, the nurse should monitor the fundus for firmness and position. Massaging is indicated only if the fundus is boggy or atonic to promote uterine contraction.

B) Determine whether the fundus is midline: Checking the position of the fundus is essential to assess for potential complications. A fundus that is not midline could indicate bladder distention, which can interfere with uterine contraction and lead to postpartum hemorrhage.

C) Document fundal height: Documenting the height of the fundus is important for monitoring uterine involution. The fundus should be at the level of the umbilicus 1-2 hours postpartum, and any deviation from expected findings should be noted for ongoing assessment.

D) Observe the lochia during palpation of fundus: Observing lochia during fundal assessment helps identify potential complications such as excessive bleeding or clots. It is crucial for the nurse to monitor lochia in conjunction with fundal assessment to ensure appropriate postpartum recovery.

E) Administer methylergonovine maleate if the uterus is boggy: Methylergonovine is indicated for uterine atony (a boggy uterus) to promote uterine contractions and reduce the risk of postpartum hemorrhage. If the fundus is found to be boggy during assessment, administration of this medication should be anticipated.

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Correct Answer is ["A","C"]

Explanation

A. Indomethacin: Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is commonly used to inhibit uterine contractions and delay preterm labor by suppressing prostaglandin synthesis.

C. Magnesium sulfate: Magnesium sulfate is frequently employed to prevent and treat preterm labor due to its tocolytic properties, which help inhibit uterine contractions and delay the onset of labor.

B. Oxytocin: Oxytocin is typically not used for the treatment of preterm labor. It is primarily administered to induce or augment labor in full-term or near-term pregnant individuals.

D. Methylergonovine: Methylergonovine is not commonly used to treat preterm labor. It is primarily indicated for preventing or controlling postpartum hemorrhage by causing uterine contractions.

E. Prostaglandin E2: Prostaglandin E2 is not typically utilized for the management of preterm labor. It is primarily employed for cervical ripening and induction of labor in full-term or near-term pregnant individuals.

Correct Answer is ["2"]

Explanation

To determine how many amoxicillin tablets the nurse should administer, we can divide the prescribed dosage by the amount of amoxicillin per tablet, rounding to the nearest whole number:

Prescribed dose per administration: 250 mg

Amount of amoxicillin per tablet: 125 mg/tablet

Number of tablets = Prescribed dose / Amount of amoxicillin per tablet (rounded to nearest whole number)

Number of tablets = 250 mg / 125 mg/tablet = 2 tablets

Therefore, the nurse should administer 2 tablets of amoxicillin with each dose.

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A nurse is caring for a client who had a vaginal delivery 2 hr ago. Which of the following actions should the nurse anticipate in the care of this client? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has a diagnosis of preterm labor. The nurse anticipates a prescription by the provider for which of the following medications? (Select all that apply.)

Correct Answer is ["A","C"]

Explanation

A nurse is preparing to administer amoxicillin 250 mg PO every 8 hr. The amount available is amoxicillin 125 mg tablets. How many tablets should the nurse administer with each dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["2"]

Explanation

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