The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement indicates that teaching was effective?

A) "Keep umbilical cord dry and above the level of the diaper."
The umbilical cord stump should be kept clean, dry, and exposed to air as much as possible to prevent infection. The diaper should be folded below the stump to ensure that it remains dry and doesn’t rub against it, which can lead to irritation or infection.

B) "Baby will need to breastfeed every hour."
Newborns typically breastfeed every 2 to 3 hours, not necessarily every hour. The exact frequency may vary based on the baby's hunger cues. Overstating the frequency of feedings may cause undue anxiety for parents, as newborns may not feed this frequently.

C) "Be sure to always wrap baby in 2 blankets when going outside."
Overbundling can lead to overheating. Newborns should be dressed in appropriate layers for the weather, with one layer more than an adult would wear. The use of two blankets may not be necessary unless it is extremely cold. The key is ensuring the baby is comfortably warm, not overheated.

D) "Limit the amount of time baby is skin to skin with parents."
Skin-to-skin contact is beneficial for newborns, especially in the early days after birth. It promotes bonding, stabilizes the baby’s body temperature, supports breastfeeding, and helps with the baby’s physiological stability. There is no need to limit skin-to-skin contact unless medically contraindicated.

A. The fundus is palpable two fingerbreadths above the umbilicus:
While it is higher than expected, this finding may occur if the uterus is still contracting and involuting, as it can sometimes be positioned slightly higher. However, this is not necessarily a cause for concern, and further assessment would depend on other factors like bleeding or discomfort. If the fundus is firm and contractions are present, this finding may still be within a normal range.

B. The fundus is palpable at the level of the umbilicus:
At 12 hours postpartum, the fundus should generally be at the level of the umbilicus. This is an expected finding in the immediate postpartum period as the uterus is beginning to involute. No further action is required unless other complications, like excessive bleeding or signs of infection, are present.

C. The fundus is palpable one fingerbreadth below the umbilicus:
This is another typical finding 12 hours after birth. By this time, the uterus should be involuting and should be slightly below the umbilicus. A slight descent of the fundus is normal as the uterus shrinks and contracts. As long as the fundus is firm and there are no other concerning signs, this is a normal finding.

D. The fundus is palpable two fingerbreadths below the umbilicus:
A fundus palpated two fingerbreadths below the umbilicus 12 hours postpartum suggests that involution may not be progressing as expected. It could indicate uterine atony, where the uterus is not contracting effectively, increasing the risk for postpartum hemorrhage. This requires further assessment to rule out complications such as retained placental fragments or excessive bleeding. Immediate action, including uterine massage or other interventions, may be needed.