A nurse is caring for a client who is 12 hours postpartum following a vaginal delivery. Which of the following findings should the nurse expect?

Fundus soft, 1 cm to the right of the umbilicus.

Fundus firm, at the level of the umbilicus.

Fundus soft, 2 cm above the umbilicus.

Fundus present, to the left of the umbilicus.

Answer and Explanation

The Correct Answer is B

Choice a reason:
The fundus being soft and to the right of the umbilicus could indicate that the bladder is full and displacing the uterus. This is not an expected finding and would require the nurse to encourage the client to empty her bladder to help the uterus contract and return to its normal position.

Choice b reason:
The expected finding for a client who is 12 hours postpartum is for the fundus to be firm and at the level of the umbilicus. A firm fundus indicates good uterine tone and that the uterus is contracting as it should to return to its pre-pregnancy size. This helps to prevent excessive bleeding and promotes recovery.

Choice c reason:
A fundus that is soft and 2 cm above the umbilicus is not an expected finding at 12 hours postpartum. This could suggest that the uterus is not contracting properly, which could lead to postpartum hemorrhage. The nurse would need to assess further and possibly provide interventions such as fundal massage or medication to encourage uterine contractions.

Choice d reason:
The fundus being present to the left of the umbilicus may indicate that the uterus is not contracting symmetrically or that there is a full bladder displacing the uterus. This finding would prompt the nurse to assess for bladder distention and encourage the client to void to help the uterus contract properly.

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Correct Answer is A

Explanation

Choice A reason:
Cervical dilation is a definitive sign that labor has begun. During labor, the cervix dilates to allow the baby to pass through the birth canal. The process of cervical dilation begins gradually and progresses until it reaches 10 cm, which is considered full dilation. In a primigravida, or a woman who is pregnant for the first time, this process can take longer compared to women who have given birth before.

Choice B reason:
The presence of amniotic fluid in the vaginal vault could indicate that the client's water has broken, which can be a sign of labor. However, it is not a definitive sign of labor on its own, as the membranes can rupture before labor begins (prelabor rupture of membranes). It is also possible for a woman to have a leak of amniotic fluid without being in active labor.

Choice C reason:
Pain above the umbilicus is not typically associated with labor. Labor pains, or contractions, are usually felt as a tightening or cramping sensation that starts in the back and moves to the front of the abdomen. The pain is more commonly located in the lower abdomen and pelvic area.

Choice D reason:
A brownish vaginal discharge, often referred to as "bloody show," can be a sign that labor is approaching, but it does not confirm that labor has begun. The bloody show is caused by the expulsion of the mucus plug that blocks the cervical canal during pregnancy. While it indicates that the cervix is starting to change, it can occur days before labor starts.

A. Blunt force trauma B. Cigarette smoking C. Hypertension D. Cocaine use

Correct Answer is C

Explanation

Choice A reason: Blunt force trauma, such as from a car accident or a fall, can indeed cause placental abruption, but it is not the most common risk factor. Trauma can lead to the placenta detaching from the uterine wall, but such events are less frequent compared to other risk factors.

Choice B reason: Cigarette smoking is associated with a variety of pregnancy complications, including placental abruption. However, while smoking does increase the risk, it is not considered the most common risk factor when compared to hypertension.

Choice C reason: Hypertension is the most common risk factor for placental abruption. High blood pressure can damage the blood vessels in the uterus, leading to the placenta detaching prematurely.

Choice D reason: Cocaine use during pregnancy can lead to placental abruption because it causes the blood vessels to constrict, which can reduce blood flow to the placenta and cause detachment. While it is a significant risk factor, it is less common than hypertension in the general population.

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A nurse is caring for a client who is 12 hours postpartum following a vaginal delivery. Which of the following findings should the nurse expect?

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