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vvll vvll
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6 years ago
The nurse is observing a new graduate perform a postpartum assessment. Which action requires intervention by the nurse?
 
  1. Asking the patient to void and donning clean gloves
  2. Listening to bowel sounds, then asking when her last BM occurred
  3. Telling visitors the assessment will be quick, then checking the fundus
  4. Completing the assessment and explaining the results to the patient
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6 years ago
3
Rationale 1: Voiding prior to the assessment helps ensure comfort; clean gloves prevent exposure to body fluids.
Rationale 2: It is appropriate to ask about a body part when assessing that part.
Rationale 3: The patient should be asked whether she wants visitors to remain in the room or leave the room prior to beginning the assessment.
Rationale 4: Informing the patient of the results and of the normalcy of the results helps reassure her.
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