A nurse on a postpartum unit is caring for a client who delivered vaginally 24 hr ago.
Which of the following should the nurse expect to find when collecting data?
Moderate lochia serosa on perineal pads
Frequent urges to urinate
Uterine fundus 2 finger widths above the umbilicus
colostrum expressed from the breast
The Correct Answer is A
A) Correct - Lochia serosa, a pinkish-brown vaginal discharge, is typically present 24 hours after vaginal delivery. It is the second stage of lochia that follows the bright red lochia rubra.
B) Incorrect- Frequent urges to urinate might be present but are not specific to the 24- hour postpartum period.
C) Incorrect- The uterine fundus should be descending in the days after childbirth, not located 2 finger widths above the umbilicus.
D) Incorrect- Colostrum is the early milk produced by the breasts, but its presence is not a specific finding in the immediate postpartum period.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) Incorrect- Keeping the cord covered with a diaper is not recommended, as it can trap moisture and delay cord drying.
B) Incorrect- Cleaning the cord with antibacterial soap is not necessary and can actually interfere with the natural drying process.
C) Correct - Notifying the provider about odor coming from the cord is important, as it could indicate infection.
D) Incorrect- Some oozing of blood is normal as the cord stump dries, but bright red bleeding might be a sign of a problem and should be evaluated by a healthcare provider.
Correct Answer is C
Explanation
A) Incorrect- the fundal height corresponds with approximately 16 weeks. At around 16 weeks of gestation, the fundal height is usually located approximately at the midpoint between the symphysis pubis (pubic bone) and the belly button (umbilicus). This measurement corresponds to the anatomical level of the uterus at this stage.
B) Incorrect- the fundal height corresponds with approximately 20 weeks. By 20 weeks of gestation, the fundus has typically reached the level of the umbilicus. The fundal height measurement is around the same level as the belly button.
C) Correct- the fundal height corresponds with approximately 32 weeks. Around 32 weeks of gestation, the fundal height has increased significantly compared to earlier stages of pregnancy. The fundus of the uterus is located above the belly button, and the measurement is typically about 32 centimeters (or roughly 12.6 inches) above the symphysis pubis.
D) Incorrect- the fundal height corresponds with approximately 24 weeks. Around 24 weeks of gestation, the fundal height is usually about 1 to 2 fingerbreadths above the
umbilicus. This represents the ongoing upward growth of the uterus as the pregnancy progresses.
E) Incorrect- the fundal height corresponds with approximately 18 weeks. At around 18 weeks of pregnancy, the fundal height is typically located just above the pubic bone, below the belly button (umbilicus). The fundus of the uterus is still relatively low in the abdomen at this point. The fundal height measurement at 18 weeks is usually around the midpoint between the symphysis pubis (pubic bone) and the belly button.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.