A nurse is assessing a client for postpartum infection. Which of the following findings should indicate to the nurse that the client requires further evaluation for endometritis?

Choice A reason:
Checking basal body temperature 1 hour following intercourse is not recommended as a method to determine ovulation. Intercourse and physical activity can increase body temperature, which may lead to inaccurate readings. Basal body temperature should be measured after a period of rest, not after physical activity.

Choice B reason:
The basal body temperature method involves measuring the body's at-rest temperature to identify slight changes that occur around the time of ovulation. It is most accurate when taken every morning before getting out of bed, after at least 3 hours of uninterrupted sleep, and before any physical activity, including eating or drinking. A slight increase in basal body temperature typically occurs after ovulation and remains elevated until the next menstrual period. This method requires consistency and precise timing to be effective.

Choice C reason:
Measuring basal body temperature before going to bed every night is not an effective way to track ovulation. The body's temperature fluctuates throughout the day due to various factors, including activity levels, meals, and external temperatures. Therefore, nighttime measurements would not provide the consistent, resting temperature needed to accurately detect ovulation.

Choice D reason:
While it is true that ovulation typically occurs around the middle of the menstrual cycle, which for many women is between days 13 to 17, limiting temperature checks to these days only may miss the initial rise in temperature that indicates ovulation. Ovulation can vary from cycle to cycle, and it is important to measure basal body temperature daily to detect the pattern over time.

Choice A reason:
Inserting an indwelling urinary catheter can be helpful in measuring urine output and reducing bladder distention, which may impede uterine contractions. However, it is not the immediate next step in managing postpartum hemorrhage.

Choice B reason:
Administering oxytocin by continuous IV infusion is a standard intervention to promote uterine contractions after delivery, which helps to control bleeding. However, before starting an oxytocin infusion, it is important to ensure that there are no retained placental fragments and that the uterus is not already well-contracted.

Choice C reason:
Massaging the client's fundus is the priority action because it can stimulate uterine contractions, which are essential for controlling postpartum bleeding. A firm, contracted uterus helps to compress the blood vessels and prevent excessive bleeding.

Choice D reason:
Tilting the client onto her right side with her legs elevated can help improve venous return and may be part of the management for shock. However, the immediate concern in a postpartum client with excessive bleeding is to manage the bleeding by promoting uterine contractions.