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 B

Explanation

Choice A reason:
Type 1 diabetes mellitus is generally not directly associated with maternal smoking. It is an autoimmune condition where the pancreas produces little to no insulin. Risk factors for Type 1 diabetes include family history and possibly environmental factors, but maternal smoking is not a recognized risk factor.

Choice B reason:
Intrauterine growth restriction (IUGR) refers to poor growth of a fetus while in the mother's womb during pregnancy. The causes of IUGR are many, but maternal smoking is a well-documented risk factor. Smoking during pregnancy can reduce oxygen and nutrient delivery to the fetus, leading to low birth weight and other complications.

Choice C reason:
While smoking during pregnancy can increase the risk of various health issues, there is no direct and consistent evidence linking it to hearing loss in newborns. Hearing loss in newborns can be due to genetic factors, infections during pregnancy, or complications at birth.

Choice D reason:
Congenital heart defects are the most common type of birth defect, and their causes can be multifactorial, including genetic and environmental factors. Maternal smoking has been associated with an increased risk of certain congenital heart defects, but the relationship is not as strong as with intrauterine growth restriction.

A. The client is exhibiting early indications of mastitis. B. Additional interventions are not indicated at this time. C. The client should be advised to remove her nursing bra. D. Application of a heating pad to the breasts is indicated.

Correct Answer is B

Explanation

Choice a reason:
Mastitis is an infection of the breast tissue that results in pain, swelling, warmth, and redness. The symptoms of mastitis typically include breast tenderness, redness on the skin, breast pain, and sometimes fever and malaise. While the client's breasts are described as hard and warm, which could be associated with mastitis, the absence of other key symptoms such as fever or flu-like symptoms suggests that mastitis may not be the issue here.

Choice b reason:
Three days postpartum, it is normal for the fundus to be below the umbilicus and for lochia rubra to be present. The hardness and warmth of the breasts could be due to milk coming in, which is also a normal postpartum change. Without additional symptoms of concern, such as fever, severe pain, or signs of infection, it is reasonable to conclude that no additional interventions are required at this time.

Choice c reason:
Removing a nursing bra can provide comfort, especially if it is too tight and contributing to breast engorgement or clogged ducts. However, there is no indication that the client's nursing bra is causing an issue. Nursing bras are designed to support the breasts during breastfeeding and typically do not need to be removed unless they are causing specific problems.

Choice d reason:
Applying a heating pad can help with milk let-down and relieve discomfort from engorgement or clogged ducts. However, since the client is not exhibiting signs of mastitis or severe engorgement, and the warmth of the breasts may be due to normal postpartum changes, the application of a heating pad is not necessarily indicated at this time.

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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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Correct Answer is B

Explanation

Correct Answer is B

Explanation

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