A nurse is caring for a client who is 4 hr postpartum.

The nurse finds a small amount of lochia rubra on the client's perineal pad.

The fundus is midline and firm at the umbilicus.

Which of the following actions should the nurse take?

Assist the client to ambulate.

Increase the rate of IV fluids.

Check for blood under the client's buttock.

Perform fundal massage.

Answer and Explanation

The Correct Answer is C

The nurse should check for blood under the client’s buttocks.
A small amount of lochia rubra on the client’s perineal pad 4 hours postpartum is normal.
The fundus being midline and firm at the umbilicus is also a normal finding.
Choice A is incorrect because assisting the client to ambulate is not necessary at this time.
Choice B is incorrect because there is no need to increase the rate of IV fluids.
Choice D is incorrect because performing a fundal massage is not necessary since the fundus is already firm and midline.

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Correct Answer is B

Explanation

“Placenta.” The placenta is the structure that provides oxygen and nutrients to the growing fetus and removes waste products from the fetus’s blood.
Choice A is incorrect because the umbilical arteries carry deoxygenated blood and waste products from the fetus to the placenta.
Choice C is incorrect because amniotic fluid provides a cushion for the fetus and helps maintain a constant temperature in the uterus but does not provide nutrition.
Choice D is incorrect because the decidua is the lining of the uterus during pregnancy and does not provide nutrition to the fetus.

A. The infant is unable to roll from the back to the abdomen. B. The infant is unable to use a pincer grasp to pick up objects. C. The infant is unable to raise his head when in a prone position. D. The infant is unable to sit without support.

Correct Answer is C

Explanation

By 3 months old, most babies can lift their heads and chest up from a belly-down position.
Choice A is not correct because it is normal for a 3-month-old infant to be unable to roll from back to abdomen.
Choice B is not correct because it is normal for a 3-month-old infant to be unable to use a pincer grasp to pick up objects.
Choice D is not correct because it is normal for a 3-month-old infant to be unable to sit without support.

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A nurse is caring for a client who is 4 hr postpartum. The nurse finds a small amount of lochia rubra on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following actions should the nurse take?

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A nurse is caring for a client who is 4 hr postpartum.

The nurse finds a small amount of lochia rubra on the client's perineal pad.

The fundus is midline and firm at the umbilicus.

Which of the following actions should the nurse take?