Maternal / Newborn Question #10
Question
The nurse is performing a BUBBLE LE postpartum assessment and palpates a raised area just above the symphysis pubis. Which is the nurse’s priority action?
Answers
- Document the finding.
- Rationale:
- Massage the uterus.
- Rationale:
- Assist the client to void.
- Rationale:
- Alert the health care provider.
- Rationale:
Overview
Explanation
The raised area indicates a full bladder, which may interfere with uterine involution. Having the client to void is an important intervention. Option A is incorrect since it is not the priority action. The nurses intervention is priority and will document intervention and client response afterward. Option B is incorrect since massaging the uterus will not help decrease the raise area. Option D is incorrect as the health care provider does not need notification.
Learning Outcomes
Test Taking Tip