Question

1. Four clients at full term present to the labor and delivery unit at the same time. which client should the nurse assess first?

1. primipara with vaginal show and leaking membranes
2. primipara with burning on urination and urinary frequency
3. multipara scheduled for a non-stress test and biophysical profile
4. multipara with contractions occurring every 3 minutes

1. A woman who delivered a 9-pound baby boy by cesarean section under spinal anesthesia is recovering in the post anesthesia care unit. Her fundus is firm at the umbilicus and a continues to trickle bright red blood with no clots from the vagina in observed by the nurse. Which actions should the nurse implemented.

1. Massage the fundus
2. Assess her blood pressure
3. Apply ice pack to perineum
4. Let the infant breast feed

Answer 1

D.Multipara with contractions occurring very three minutes

The duration of labor for multiparous women is shorter than primiparous mother.The contractions occurring every 3minutes means that the delivery will be occur soon.

B.Assess her blood pressure

During the post anaesthesia period assessment of blood pressure is important. Here the uterus is firm and bright bleeding occurs.Which indicates that the uterus is normal and lochia rubra is present. So blood pressure monitoring is needed because of bleeding and post anaesthesia effect.