A nurse is collecting data from a client who is 20 hr postpartum following a vaginal delivery. Which of the following findings should the nurse expect?
Positive Homans' sign
Full, firm breasts
Firm fundus at midline
Lochia serosa
The Correct Answer is C
A. Homans' sign is a test for deep vein thrombosis and is not a normal postpartum finding.
B. Full, firm breasts typically occur a few days after delivery when milk production begins, not at 20 hours postpartum.
C. A firm fundus at the midline is an expected finding in the immediate postpartum period, indicating that the uterus is contracting and involuting properly.
D. Lochia serosa (pinkish-brown discharge) is a normal finding around 3 to 10 days postpartum, but it is not typically present at 20 hours postpartum.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Ice packs can help reduce swelling and inflammation associated with engorgement by constricting blood vessels and reducing blood flow to the area, which can alleviate pain and discomfort.
B. Avoiding the use of a breast pump may exacerbate engorgement. It is appropriate to use a pump if needed for comfort or to facilitate breastfeeding.
C. While purified lanolin can help soothe sore nipples, it does not address the inflammation and swelling of engorgement.
D. A well-fitting, supportive bra is important, but it should not be too tight. It should provide adequate support without constricting the breasts.
Correct Answer is D,A,B,C
Explanation
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