The nurse is caring for a patient who had a cesarean birth 4 hours ago. Which interventions would the nurse implement at this time? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply
1. Administer analgesics as needed.
2. Encourage the patient to ambulate to the bathroom to void.
3. Encourage leg exercises every 2 hours.
4. Encourage the patient to cough and deep-breathe every 2–4 hours.
5. Encourage the use of breathing, relaxation, and distraction.
1,3,4,5
Rationale 1: Administering analgesics as needed addresses the patient's nursing care needs, which are similar to those of other surgical patients.
Rationale 2: Encouraging her to ambulate to the bathroom to void might be an intervention done on the 1st or 2nd day postpartum, but not in the first 4 hours.
Rationale 3: Encouraging leg exercises every 2 hours addresses the patient's nursing care needs, which are similar to those of other surgical patients.
Rationale 4: Encouraging the patient to cough and deep-breathe every 2–4 hours addresses the patient's nursing care needs, which are similar to those of other surgical patients.
Rationale 5: Encouraging the use of breathing, relaxation, and distraction addresses the patient's nursing care needs, which are similar to those of other surgical patients.
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