A nurse is reinforcing discharge instructions for a client.At 4 weeks postpartum, the client should contact the provider for which of the following client findings?
Sore nipple with cracks and fissures.
Scant nonodorous white vaginal discharge.
Uterine cramping during breastfeeding.
Decreased response with sexual activity.
The Correct Answer is A
Choice A rationale
Sore nipples with cracks and fissures can indicate an infection or improper breastfeeding technique, requiring medical attention.
Choice B rationale
Scant nonodorous white vaginal discharge is normal postpartum and does not require contacting the provider.
Choice C rationale
Uterine cramping during breastfeeding is a normal physiological response due to oxytocin release.
Choice D rationale
Decreased response with sexual activity can be normal postpartum and does not necessarily require immediate medical attention.
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Correct Answer is A
Explanation
Choice A rationale
At 1 cm above the umbilicus is the expected position of the uterine fundus 12 hours postpartum. After delivery, the fundus is typically at the level of the umbilicus and then descends approximately 1 cm per day. At 12 hours postpartum, it is normal for the fundus to be slightly above the umbilicus.
Choice B rationale
One fingerbreadth above the symphysis pubis is not the expected position of the fundus 12 hours postpartum. This position is more typical several days postpartum as the uterus continues to involute and return to its pre-pregnancy size.
Choice C rationale
To the right of the umbilicus is not a normal finding and may indicate a full bladder, which can displace the uterus. The nurse should assist the client to void and then reassess the fundal position.
Choice D rationale
Three fingerbreadths above the umbilicus is not expected 12 hours postpartum. This position may indicate uterine atony or subinvolution, which requires further assessment and intervention.
Correct Answer is C
Explanation
Choice C rationale
Checking the fundus helps determine if the uterus is contracting properly, which is essential in managing postpartum bleeding.
Choice A rationale
Measuring vital signs is important but not the first action to control bleeding.
Choice B rationale
Requesting a vaginal examination is necessary but not the immediate action to control bleeding.
Choice D rationale
Feeling for a full bladder is important but not the first action to control bleeding.