Question 1.

A nurse on the postpartum unit is caring for a client following a cesarean birth. Which of

the following assessments is the nurse’s priority?

Amount of lochia

- When using the airway, breathing, circulation approach to client care, the nurse

should place the priority in the immediate postpartum period on assessing the

amount of postpartum lochia. The greatest risk to the client is bleeding and

postpartum hemorrhage.

Question 2.

A nurse is caring for a client who is in labor and whose fetus is in the right occiput

posterior position. The client is dilated to 8 cm and reports back pain. Which of the

following actions should the nurse take?

Apply sacral counterpressure

- Sacral counterpressure assists in relieving back labor pain related to fetal

posterior position.

Question 3.

A nurse is demonstrating to a client how to bathe her newborn. In which order should

the nurse perform the following actions?

Wipe the newborn’s eyes from the inner canthus outward. Wash the newborn’s neck by

lifting the newborn’s chin. Cleanse the skin around the newborn’s umbilical cord stump.

Wash the newborn’s legs and feet. Clean the newborn’s diaper area.

- Use a head to toe, clean to dirty approach when washing a newborn.

Question 4.

A nurse is caring for a client and her partner who have experienced a fetal death. Which

of the following actions should the nurse take?

Take photos of the newborn to give to the parents.