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NURSADN4 Postpartum Assessment: Questions And Accurate Answers
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NURSADN4 Postpartum Assessment: Questions And Accurate Answers
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NURSADN4 Postpartum Assessment: Questions AndAccurate Answers
What does BUBBLEE stand for? Right Ans - B - Breasts
U - Uterus
B - Bladder
B - Bowels
L - Lochia
E - Episiotomy/Epidural Site
E - Extremities
What should the nurse assess on a breast in postpartum? Right Ans -
Assess areola for cracking, tenderness, masses; proper breast feeding
technique
What should the nurse assess on a uterus/fundus in postpartum? Right Ans
- Assess for firmness and midline of fundus, level with umbilicus
How quickly should the fundus be descending in postpartum? Right Ans -
Descends 1-2cm every 24 hours, should be 1cm above umbilicus after 12
hours
What may cause a distended fundus? Right Ans - Full bladder
What is an important intervention for patients in postpartum? Right Ans -
Voiding every 2 to 3 hours (Bed pan preferred if on pain meds, ambulate
otherwise)
When should an in and out catheter/straight catheter be used? Right Ans -
If the patient is unable to walk or void properly on their own due to an
epidural or pain meds
TERM:
What is Uterine Atony Right Ans - Soft or boggy feeling of the fundus,
severely increasing the risk for hemorrhaging
, What is an appropriate intervention when uterine atony is present? Right
Ans - Oxytocin infusion (contracts uterus to prevent bleeding) and massage
fundus
A client who gave birth vaginally with an epidural anesthesia reports no urge
to urinate after 3 hours after birth. The fundus is above the umbilicus, but
distended 3 cm to the right. What should the nurse do next? Right Ans -
Perform a straight or in and out catheterization
A client who had a vaginal birth 1 hour ago has a boggy fundus that is deviated
to the left and above the umbilicus. What intervention should the nurse
perform first? Right Ans - Assist the client to use a bed pan to void
What are 3 interventions that are appropriate for a client with a soft and
boggy fundus 8 hours after delivery? Right Ans - Firmly massage fundus,
encourage patient to void, administer methergine per orders
What is Methergine? Right Ans - Analgesic & uterotonic; treats sever
bleeding in the uterus AFTER childbirth (Drastically increases BP,
contraindicated with hypertension or preeclampsia)
6 hours after a vaginal delivery the nurse notes the perineal pad is soaked and
there is blood underneath the patient's buttocks. Which action should the
nurse take first? Right Ans - Assess the fundus
What is the purpose of oxytocin when administered after delivery? Right
Ans - Simulate firm contractions of the uterus
What medication is used for treating a client with sever PP bleeding? Right
Ans - Oxytocin
What is an early sign of excessive blood loss during the fourth stage of labor?
Right Ans - Increased HR of 88-102bpm
What should the be assessed on the bladder in postpartum? Right Ans -
Distention, urinary track infections, incontinence
What should be assess for bowel sounds in postpartum? Right Ans - Assess
bowel sounds, ask when was the last bowel movement
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