A nurse is caring for a client who has just delivered her second twin vaginally and notes that there is excessive bleeding from her vagina and that her uterus feels boggy on palpation.

The nurse should suspect which of the following complications?

The correct answer is choice A. Normal involution.

This means that the uterus is returning to its pre-pregnancy size and position after delivery.

The fundus is the upper part of the uterus and it should be firm, midline, and gradually descend into the pelvis.A fundus that is 2 cm below the umbilicus at 4 hours postpartum is within the normal range.

Choice B. Subinvolution is wrong because it refers to a delayed or incomplete involution of the uterus.

This can result in prolonged bleeding, infection, or retained placental fragments.A fundus that is above the umbilicus, boggy, or displaced to one side may indicate subinvolution.

Choice C. Retained placenta is wrong because it means that some or all of the placenta remains in the uterus after delivery.

This can cause heavy bleeding, infection, or uterine atony.A fundus that is high, soft, or tender may indicate retained placenta.

Choice D. Endometritis is wrong because it means that the lining of the uterus is inflamed due to infection.

This can cause fever, foul-smelling lochia, pelvic pain, or uterine tenderness.A fundus that is enlarged, tender, or malodorous may indicate endometritis.

Normal ranges for fundal height after delivery are:

• Immediately after delivery:

The correct answer is choiceA.

The nurse should instruct the client to avoid lifting anything heavier than the newborn for 6 weeks.This is because lifting heavy objects can strain the abdominal muscles and the incision site, and increase the risk of bleeding and infection.

ChoiceBis wrong because the nurse should advise the client to wait at least 4 to 6 weeks before resuming sexual intercourse.This is to allow the incision to heal and prevent infection and discomfort.

ChoiceCis wrong because the nurse should not recommend ibuprofen for pain relief as it can interfere with blood clotting and increase bleeding.The nurse should suggest acetaminophen or a prescribed analgesic instead.

ChoiceDis wrong because the nurse should not tell the client to report any foul-smelling vaginal discharge to the provider.

The client should expect some vaginal discharge (lochia) for several weeks after a cesarean delivery, which may have a mild odor.However, the nurse should instruct the client to report signs of infection such as fever, chills, redness, swelling, or increased pain at the incision site.