In which clinical situation would the nurse most likely anticipate a fetal bradycardia?

Choice A rationale

Puerperal infection, an infection of the reproductive tract after childbirth, is a risk factor for all postpartum women. However, a large newborn size (macrosomia) increases the risk of prolonged labor, increased instrumentation during delivery, and postpartum hemorrhage, which indirectly increases the risk of infection but is not the most direct immediate risk related to the newborn's weight.

Choice B rationale

Retained placental fragments are a risk factor when the placenta does not deliver intact. While a large newborn can sometimes be associated with difficulties during placental delivery, it is not the primary direct risk factor immediately following birth. Uterine atony is a more immediate and direct risk related to uterine overdistension.

Choice C rationale

Thrombophlebitis, the formation of blood clots in the veins, is a postpartum risk factor related to hormonal changes, immobility, and hypercoagulability. While factors like prolonged labor (more common with large babies) can contribute, it is not the most immediate and direct risk in the first few hours postpartum for a woman who delivered a large newborn.

Choice D rationale

A newborn weighing 9 lb 6 oz (4252 g) is considered macrosomic. This large size can lead to overdistension of the uterus during pregnancy and labor. Uterine overdistension impairs the ability of the uterine muscles to contract effectively after delivery, a condition known as uterine atony. Uterine atony is the primary and most immediate risk for postpartum hemorrhage in women who have delivered large newborns. .

The nurse should first address the client’s calf findings followed by their stress about discharge.

Rationale for correct answers

Calf findings must be addressed first due to the risk of deep vein thrombosis (DVT), which is a known complication of cesarean delivery and postpartum immobility. The presence of unilateral calf edema (3 cm greater than the right) and tenderness, combined with an elevated D-dimer, strongly suggests a thrombotic process requiring urgent evaluation. If DVT is confirmed, anticoagulation therapy should be initiated promptly to prevent progression to pulmonary embolism.

Stress about discharge should be the second priority, as emotional concerns can affect adherence to postpartum care instructions. Addressing anxiety about recovery, follow-up visits, and newborn care can improve the client’s overall well-being and readiness for discharge.

Rationale for incorrect Response 1 options

• Breast engorgement: Although uncomfortable, this is a transient issue that can be managed with cold compresses and supportive bras. It does not pose an immediate health risk.
• Constipation: Postpartum bowel irregularities are expected after cesarean delivery; stool softeners and hydration can alleviate symptoms without urgency.
• Surgical incision pain: Rated only 2/10, indicating mild pain that does not require immediate intervention beyond routine analgesia.