A nurse is preparing a postpartum mother for fundal assessment. Which of the following actions is most appropriate?

Appeared in: BHU NO - 12 April 2024

Explanation

Emptying the bladder is the most critical preparatory step before a fundal assessment to ensure accuracy.
A full bladder displaces the uterus, typically upwards and to the right, leading to incorrect measurement of fundal height and assessment of uterine tone.
This displacement can prevent the uterus from contracting effectively and can mask uterine atony, delaying the detection of potential postpartum hemorrhage.

Option A: While the supine position is required for the assessment, it is not the priority action. Performing the assessment on a patient with a full bladder, even in the correct position, will yield inaccurate results.
Option C: Fundal massage is a therapeutic intervention, not a preparatory step. It is only performed if the assessment reveals that the uterus is boggy or atonic.
Option D: The presence of an attendant is not a clinical requirement for the procedure. It relates to patient comfort and support, not the technical preparation for the assessment.

Clinical Relevance

Nursing practice connection: Use the key finding related to Preparation for postpartum fundal assessment to guide bedside assessment, documentation, and the next nursing action.
Accurate fundal assessment is a critical nursing skill for the early detection of uterine atony, the most common cause of postpartum hemorrhage (PPH).
A displaced uterus due to a full bladder not only leads to an incorrect assessment but also inhibits effective uterine contraction, thereby increasing the risk of PPH.
What if? - If the fundus is palpated high and to the right of the umbilicus, the first nursing action should be to assist the patient to empty her bladder, as this is a classic sign of bladder distention.

How to Approach the Question

Identify the core of the question: it asks for the 'most appropriate' preparatory action for a fundal assessment. This implies a question of priority.
Analyze the options in the context of preparing for a procedure. Distinguish between preparatory steps (A, B), interventions (C), and supportive measures (D).
Consider the factors that could interfere with the accuracy of the assessment. A full bladder is a major physiological factor that alters the anatomical position of the uterus.
Prioritize the actions based on clinical impact. Emptying the bladder must come before positioning the patient to ensure the findings are valid and the assessment is accurate.
Conclude that asking the patient to void is the highest priority preparatory step.

Concept Tested & Keywords

Concept Tested: Preparation for postpartum fundal assessment
Stem keywords: postpartum mother, fundal assessment, preparing
Lead-in keywords: most appropriate
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 1-4

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) pp. 232-234, 198-200

Practise the full BHU NO - 12 April 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.