Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

A. Ask the patient to empty her bladder:
A boggy uterus that is displaced above and to the right of the umbilicus is often a sign of bladder distention. A full bladder can push the uterus out of its normal position, preventing it from contracting properly and leading to uterine atony. Asking the patient to empty her bladder is the most appropriate initial action, as it can help reposition the uterus and promote uterine contraction, reducing the risk of postpartum hemorrhage.

B. Notify the MD about an impending hemorrhage:
While a boggy, displaced uterus can be a sign of uterine atony and the risk of hemorrhage, the first action should be to address the likely cause—bladder distention. Emptying the bladder may resolve the issue and help the uterus contract. Notifying the healthcare provider may be necessary later if other complications arise, but it’s not the most immediate intervention in this situation.

C. Assess blood pressure and pulse:
Assessing vital signs, including blood pressure and pulse, is important for monitoring the patient’s overall condition, especially if there is suspicion of hemorrhage. However, this is a secondary action after addressing the immediate problem (bladder distention). The priority is to help the uterus contract and reposition it before worrying about potential hemorrhage.

D. Evaluate lochia:
Evaluating lochia is an important step in assessing the patient’s postpartum status, especially to monitor for excessive bleeding. However, the immediate concern in this case is the displaced uterus, which is most likely due to bladder distention. The most effective action would be to address the bladder fullness first. After addressing this, lochia should be assessed to monitor for bleeding.

A) 2 to 3 oz (60 to 90 mL):
To determine the appropriate amount of formula for this infant, first calculate the total fluid requirements for the day. The infant weighs 6 lb (2722 g), and newborns typically need 73 mL of fluid per pound of body weight per day.
6 lb × 73 mL = 438 mL of fluid required daily.
Since the infant is fed every 4 hours, this equates to approximately 6 feedings in a 24-hour period.
438 mL ÷ 6 feedings = 73 mL per feeding.
Converting this to ounces (since 1 oz = 30 mL), the infant would need about 2.5 oz per feeding. Therefore, 2 to 3 oz (60 to 90 mL) per feeding is appropriate to meet the infant's daily fluid needs.

B) 1 to 1.5 oz (30 to 45 mL):
This amount is insufficient for the infant’s daily fluid needs. At 1 to 1.5 oz per feeding, the total intake for the day would be only 180 to 270 mL, which is well below the required 438 mL. This could lead to dehydration and inadequate nourishment.

C) 4 to 5 oz (120 to 150 mL):
This amount is excessive for a 3-day-old infant. Newborns typically consume much smaller amounts at each feeding due to their smaller stomach capacity. Overfeeding could lead to discomfort and potential digestive issues.

D) 3 to 4 oz (90 to 120 mL):
While this range is closer to the required amount, it is still slightly too much for a 3-day-old infant. At this age, the recommended amount is closer to 2.5 oz per feeding, so 3 to 4 oz may be excessive and could contribute to overfeeding, which might be uncomfortable for the infant.