A nurse is providing care for an adolescent who was brought to the emergency department (ED) by their guardians due to pain in the left arm that started the previous evening.

The adolescent has a history of sickle cell disease diagnosed at age 4. They have a prescription for oral morphine sulfate and took one dose the previous evening at 1800 and another this morning at 0900.

The adolescent reports no relief from pain, rating it as 9 on a scale of 0 to 10. For each potential provider’s prescription, specify if the prescription is anticipated, nonessential, or contraindicated for the client.

Choice A rationale
Offering the parent the opportunity to hold their stillborn baby can be a crucial part of the grieving process. It allows the parent to acknowledge the reality of the loss and begin to say goodbye.
Choice B rationale
Telling a grieving parent that “this is for the best” can be perceived as dismissive and insensitive. It’s important to validate the parent’s feelings of loss and grief.
Choice C rationale
Sharing personal experiences of loss can shift the focus away from the grieving parent. It’s more helpful to provide empathetic support and allow the parent to share their feelings.
Choice D rationale
While spiritual support can be helpful for some, it’s not appropriate to assume that every parent will want this. It’s better to ask the parent if they would like to speak with a chaplain or other spiritual advisor.

Choice A rationale
Uterine atony refers to a soft and weak uterus after childbirth. It happens when your uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth. This can lead to life-threatening blood loss after delivery. One of the causes of uterine atony is urinary retention. When the bladder is full, it can displace the uterus, preventing it from contracting properly. This can lead to uterine atony and postpartum hemorrhage. Therefore, urinary retention can cause uterine atony and lateral displacement of the fundus.
Choice B rationale
Poor involution of the uterus is a condition where the uterus does not return to its normal size after childbirth. While poor involution can lead to prolonged bleeding, it does not directly cause uterine atony. Uterine atony is specifically a lack of muscle contraction, while poor involution is a failure of the uterus to reduce in size.
Choice C rationale
While infection can lead to many complications during the postpartum period, it is not a direct cause of uterine atony. Infections can cause endometritis, which is inflammation of the uterine lining, but this does not prevent the uterus from contracting.
Choice D rationale
Hemorrhage, or heavy bleeding, is a result of uterine atony, not a cause. When the uterus does not contract properly after childbirth, it can lead to excessive bleeding, or hemorrhage.