Question about the uterus.

[bekindtokittens]

So, I'm preparing for the NCLEX-RN. I'm doing practice questions from the Saunders CD and today I'm running through OB/maternity. I get this question, in a nutshell...

What is your initial action when finding a postpartum patient with a soft, boggy uterus?

The two answers that stand out are--

massage the fundus until firm, or

encourage the mother to void.

In my OB class, the teacher stressed to us to always first encourage the mother to urinate, or check for a distended bladder, before massaging the fundus. But Saunders is telling me that the correct answer is to massage the fundus first, and if that doesn't work, then to encourage the mother to void. On the off chance that I get this question on the NCLEX, I will probably go ahead and answer "massage the fundus", since that is what Saunders is saying.

But I was wondering what you were taught about this?

[Gauze, BSN, RN]

I am using Kaplan to study, and I had this same exact question. According to Kaplan, you are supposed to encourage the mother to void before massaging the fundus.

I hope that helps/doesn't confuse you!

[oguesswhat]

Yes massage the fundus first. Then pee. I remember you want them to void if it's displaced.

[soonertwin87]

I was always told in class and clinicals to massage the fundus first. I would go with Saunders too!

[Meriwhen, ASN, BSN, MSN, RN]

They taught in my OB class that if the uterus is displaced to one side, then that was a distended bladder and to have her void first; otherwise, massage away.

So I'd stick with "massage" for my answer too, unless the word "distended" appeared in the question

[JaneyW]

I am an OB nurse and a teacher. Look at the question as a priority question. What would you do first? You have a boggy uterus that may or may not be caused by a distended bladder. If it isn't a full bladder, it should massage back to being firm--unless of course it is something else entirely. If she is bleeding heavily, do you want her up to the BR without trying to solve the problem? You have her under your hand literally. Why would you not go ahead and massage?

[bekindtokittens]

Thank you all for your responses. I understand the question a lot better now!

[JaneyW]

You're welcome. Be careful not to read more into the questions than is there. If there is no mention of a distended or displaced uterus, don't go there. Good luck!