The nurse is caring for a woman who is gravida 2, para 1 on her first postpartum day
The assessment reveals: temperature 38° C (100° F), pulse 60 beats/minute, blood pressure 118/80 mm Hg, fundus firm at the level of umbilicus and displaced slightly to right, last void 6 hours earlier, moderate amount of lochia rubra, and perineum slightly edematous with episiotomy edges well approximated. The first nursing action should be to:
a. Notify the nurse-midwife of her temperature.
b. Apply an ice pack to her perineum.
c. Assist her to the bathroom to void.
d. Chart the assessment findings as normal.
ANS: C
Uterine displacement is usually associated with bladder distention. After the nurse takes her to the bathroom to void, the uterus should shift to a midline position. The other findings are normal.
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A hospitalized child has developed a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse plans which interventions when caring for this child? Select all that apply
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The nurse assigned to the pediatric unit of a hospital is caring for a child who cries for his mother when she is not with him. The mother works during the day
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