The postpartum nurse is caring for a first-time mother who is ...

[bobbysung]

The postpartum nurse is caring for a first-time mother who is unable to breastfeed her baby. While assessing the patient's breasts the day after birth, which teaching point should the nurse include?
 
  1. The let-down reflex
  2. Lactation suppression
  3. The purpose of fundal massage
  4. The cause of afterpains

Question 2

The nurse is performing a postpartum assessment on a newly delivered patient. When checking the fundus, there is a gush of blood. The patient asks why that is happening. The best response is:
 
  1. We see this from time to time. It's not a big deal.
  2. The gush is an indication that your fundus isn't contracting.
  3. Don't worry. I'll make sure everything is fine.
  4. Blood has pooled in the vagina while you were in bed.

[atrochim]

Answer to Question 1

Correct Answer: 2
Rationale 1: The let-down reflex is an important teaching point for breastfeeding patients.
Rationale 2: It is important to teach non-breastfeeding patients about lactation suppression after delivery but before discharge.
Rationale 3: The purpose of fundal massage should be addressed when assessing the uterus and fundus, not when assessing the breasts.
Rationale 4: Afterpains can be stimulated by breastfeeding, and they are more common in multiparas. Therefore, the nurse will likely not need to teach a non-breastfeeding primipara about afterpains.

Answer to Question 2

Correct Answer: 4
Rationale 1: Although a gush of blood during fundus assessment is fairly common, this response is not therapeutic because it does not answer the patient's question.
Rationale 2: The fundus might be contracting well. The gush is from pooled lochia in the vagina.
Rationale 3: This response is not therapeutic because it focuses on the nurse and has a don't worry aspect that most patients find demeaning.
Rationale 4: Because of the angle of the vagina, lochia pools in the vagina while a woman is lying or semi-sitting in bed, which leads to a gush when fundal massage is undertaken.