Which documentation on a woman's chart on postpartum day 14 indicates a normal involution process?

Moderate bright red lochial flow

Fundus below the symphysis and nonpalpable

Episiotomy slightly red and puffy

Breasts firm and tender

Answer and Explanation

The Correct Answer is B

A.   Moderate bright red lochial flow on postpartum day 14 may indicate excessive bleeding and is not indicative of normal involution.
B.   A fundus below the symphysis and nonpalpable suggests a well-contracted uterus, which is indicative of normal involution.
C. An episiotomy that is slightly red and puffy on day 14 may indicate ongoing healing, but it is not a direct measure of uterine involution.
D.   Breasts that are firm and tender on postpartum day 14 may indicate engorgement, but they are not directly related to uterine involution.

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Correct Answer is C

Explanation

A. Placing the baby on the stomach is not recommended due to the risk of sudden infant death syndrome (SIDS).
B. Placing the crib next to the heater may cause overheating, which is a risk factor for SIDS.
C. Removing extra blankets from the baby's crib is important to reduce the risk of SIDS.
D. Padding the mattress in the baby's crib is not recommended as it can pose a suffocation risk.

A. Change the perineal pad of a client who just transferred from labor and delivery. B. Monitor vital signs during admission of a client who has gestational hypertension. C. Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum. D. Observe an area of redness on the breast of a client who is 1 day postpartum.

Correct Answer is C

Explanation

A. Changing the perineal pad of a client who has just been transferred from the labor ward is a task that should not be delegated to an assistive personnel (AP) since it is beyond their scope.
B. Monitoring vital signs during the admission of a client with gestational hypertension requires nursing judgment and assessment skills.
C. Providing a sitz bath to a client with a fourth-degree laceration and is 2 days post- partum can be delegated to an AP. This task does not require the nurse's clinical judgment or assessment skills, and it can be safely performed by the AP following the nurse's instructions.
D. Observing an area of redness on the breast requires nursing assessment and intervention.

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Which documentation on a woman's chart on postpartum day 14 indicates a normal involution process?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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