A nurse is caring for a woman after a cesarean birth. Prior to ambulating her for the first time, which action by the nurse takes priority?
A.
Assess sensation in the lower extremities.
B.
Discontinue the patient's intravenous line.
C.
Encourage the patient to cough and deep breathe.
D.
Have the patient sit on the edge of the bed.
ANS: A
After a cesarean birth with spinal or epidural anesthesia, the nurse must assess sensation in the woman's legs. She will not be allowed out of bed until sensation returns. Discontinuing the IV line may or may not be appropriate. Coughing and deep breathing are always important for a postoperative patient, but this action is not related to ambulating for the first time. Sitting on the edge of the bed prior to getting up would only be done if the woman had full sensation in her legs.
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