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A nurse is caring for a client who had a vaginal delivery 4 hours ago and reports perineal pain of 6 on a scale of 0 to 10. Which of the following actions should the nurse take?

A.

Apply a corticosteroid cream to the perineal area twice daily.

B.

Increase the client’s fluid intake for 48 hours.

C.

Catheterize the client’s bladder.

D.

Offer an ice pack to the client during the first 24 hours.

Answer and Explanation

The Correct Answer is D

Choice A rationale

 

Applying a corticosteroid cream is not appropriate for acute perineal pain. It is more suitable for chronic inflammation or skin conditions.

 

Choice B rationale

 

Increasing fluid intake is beneficial for overall health, but it does not directly address acute perineal pain.

 

Choice C rationale

 

Catheterizing the bladder is not indicated for perineal pain unless there is a specific issue with urinary retention.

 

Choice D rationale

 

Offering an ice pack helps reduce swelling and numb the area, providing immediate relief for acute perineal pain. It is a standard intervention for postpartum perineal discomfort.

 


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View Related questions

Correct Answer is A

Explanation

Choice A rationale

Warm compresses can help alleviate pain and inflammation associated with mastitis. The heat from the compresses increases blood flow to the affected area, promoting healing and reducing discomfort.

Choice B rationale

Wearing a nursing bra can provide support and reduce discomfort for individuals with mastitis. Avoiding a nursing bra may lead to increased pain and discomfort due to lack of support.

Choice C rationale

Limiting oral fluid intake is not recommended for individuals with mastitis. Adequate hydration is essential for overall health and can help maintain milk production, which is important for breastfeeding mothers.

Choice D rationale

Hydrocortisone ointment is not typically recommended for treating mastitis. The primary treatment for mastitis includes antibiotics, pain relief, and supportive measures such as warm compresses and continued breastfeeding.

Correct Answer is A

Explanation

Choice A rationale

Warming the newborn’s heel for 5 to 10 minutes before the puncture increases blood flow, making it easier to collect a blood sample.

Choice B rationale

The outer aspect of the heel is the recommended site for puncture to avoid injury to the bone and nerves.

Choice C rationale

Leaving the heel open to the air after the puncture is not recommended as it can increase the risk of infection.

Choice D rationale

Applying an antiseptic after collecting the specimen is not necessary and can interfere with the blood sample.

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