A nurse just assumed her shift and is preparing to assess a client's uterine fundus in the immediate postpartum period.

When the nurse locates the fundus, she notes that the uterus feels soft and boggy.
Which initial nursing action would be most appropriate?

Assist the patient in emptying her bladder.

Assess the blood pressure and pulse.

Evaluate the lochia.

Notify the physician of an impending hemorrhage.

Answer and Explanation

The Correct Answer is A

Choice A rationale

A soft, boggy uterus in the postpartum period is often caused by bladder distension. A full bladder displaces the uterus upward and to the side, preventing efficient myometrial contraction. This uterine relaxation increases the risk of bleeding. Assisting the patient to void allows the uterus to return to the midline and contract effectively. This is a common and easily reversible cause of uterine atony that should be addressed before considering more invasive medical treatments.

Choice B rationale

Monitoring blood pressure and pulse is necessary to evaluate the patient's hemodynamic status, as a soft uterus can lead to hemorrhage. However, physiological compensation in the early postpartum period can mask signs of blood loss until it is quite severe. While these parameters provide a baseline for the severity of the situation, they do not correct the underlying problem of a boggy uterus. Uterine tone must be restored first to prevent the vital signs from deteriorating.

Choice C rationale

Evaluating the lochia helps determine the amount and characteristics of vaginal discharge, which is an indicator of uterine healing and potential hemorrhage. Increased lochia often accompanies a boggy uterus. While this assessment is part of the overall postpartum evaluation, it does not directly treat the cause of the bogginess. The nurse's priority is to implement an intervention that encourages uterine firmness, such as emptying the bladder or performing massage, rather than just observing the output.

Choice D rationale

Notifying the physician is required if the uterus remains boggy after initial nursing interventions or if bleeding is excessive. However, the nurse should first attempt to resolve the issue through bladder emptying or fundal massage. Reporting a boggy uterus without first checking for bladder distension or attempting to firm the fundus is premature. Effective nursing practice involves performing immediate, independent actions to stabilize the patient before escalating the situation to the physician for further orders.

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Correct Answer is A

Explanation

Choice A rationale

Promoting paternal-infant bonding is critical during the transition to fatherhood. By pointing out that the infant responds specifically to the father's voice, the nurse provides positive reinforcement and validates the father's importance to the newborn. This encourages the development of a paternal identity and fosters a sense of competence. Highlighting these early interactions helps the father realize he already possesses a natural connection with his child, which reduces anxiety about his new role.

Choice B rationale

While rest is important for new parents, telling a father to go home to sleep can inadvertently make him feel excluded from the care of the infant. This action might be interpreted as a suggestion that his presence is not necessary or that he is not capable of helping during the immediate postpartum period. The goal should be to integrate the father into the family unit rather than separating him from the infant and the mother.

Choice C rationale

Correcting a father's technique in a critical manner, such as telling him to tape a diaper differently, can undermine his confidence. During the transition to parenthood, fathers are often sensitive to perceived failures or inadequacy. Instead of focusing on a specific task being done perfectly, the nurse should encourage the effort and offer supportive guidance only when necessary. Excessive criticism can lead to the father withdrawing from caretaking activities to avoid further judgment.

Choice D rationale

Suggesting the infant sleep in the bassinet is a standard safety measure, but it does not actively assist the father in his emotional or psychological transition to parenthood. It focuses on a physical task rather than the relational development between the father and the newborn. To best help a father, the nurse should prioritize interventions that facilitate interaction and bonding, helping him feel more connected to the infant's unique responses and needs during this time.

A. Infertility medications to stimulate ovulation. B. Intrauterine insemination (IUI) to place sperm closer to the egg. C. Intrauterine device (IUD) placement. D. In-vitro fertilization (IVF) if IUI is unsuccessful. E. Gestational surrogacy.

Correct Answer is ["B","D"]

Explanation

Choice A rationale

Infertility medications like clomiphene citrate or letrozole are primarily indicated for female partners who experience anovulation or irregular menstrual cycles. In this specific scenario, the female partner is already documented to have regular ovulation and patent fallopian tubes. Therefore, stimulating the ovaries further does not address the primary identified issue, which is the male partner's low sperm motility, making this an inappropriate and unnecessary intervention for this specific couple.

Choice B rationale

Intrauterine insemination is a highly appropriate first-line treatment for male-factor infertility involving low motility. This procedure bypasses the cervical mucus and places a concentrated, washed sample of motile sperm directly into the uterine cavity near the time of ovulation. By reducing the distance the sperm must travel to reach the egg in the fallopian tube, the chances of fertilization are significantly improved despite the decreased swimming ability of the sperm.

Choice C rationale

An intrauterine device is a form of long-acting reversible contraception designed to prevent pregnancy by either releasing progestin or using copper to create a spermicidal environment. Placing an IUD would be entirely counterproductive for a couple that has been actively trying to conceive for eighteen months. The goal of infertility treatment is to facilitate conception, whereas an IUD is specifically indicated for those seeking to avoid pregnancy for an extended period.

Choice D rationale

In-vitro fertilization is a complex assisted reproductive technology where eggs are harvested and fertilized by sperm in a laboratory setting. If less invasive methods like intrauterine insemination fail to result in pregnancy, IVF becomes the next logical step. It is particularly effective for low sperm motility because techniques like intracytoplasmic sperm injection can be used to manually insert a single healthy sperm directly into the mature egg, ensuring fertilization occurs.

Choice E rationale

Gestational surrogacy involves another woman carrying a pregnancy for the couple and is typically reserved for cases where the female partner has no uterus, a severely compromised uterine environment, or life-threatening contraindications to pregnancy. Since the female partner in this case has regular ovulation and patent tubes, there is no clinical evidence suggesting she cannot carry a pregnancy. Surrogacy is an extreme and unnecessary measure for a couple with treatable male-factor motility issues.

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A nurse just assumed her shift and is preparing to assess a client's uterine fundus in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which initial nursing action would be most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a nurse's routine rounds, a first-time father verbalized that he does not know anything about fatherhood. The nurse can best help a father in his transition to parenthood by:

Correct Answer is A

Explanation

A couple has been trying to conceive for 18 months. Testing reveals the male partner has low sperm motility, and the female partner has patent fallopian tubes with regular ovulation. Which treatment options would be appropriate for this couple? Select all that apply.

Correct Answer is ["B","D"]

Explanation

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At 5 days postpartum, a woman who gave birth to a healthy infant boy is being assessed by the nurse. What type of lochia would the nurse expect to find when assessing this woman?

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A woman at 38 weeks gestation tells the nurse, "I can finally breathe better, but now I feel pressure in my pelvis and I'm running to the bathroom constantly!" The nurse explains this is called lightening. Which physiologic event is occurring?

A nurse just assumed her shift and is preparing to assess a client's uterine fundus in the immediate postpartum period.

When the nurse locates the fundus, she notes that the uterus feels soft and boggy.
Which initial nursing action would be most appropriate?