Which documentation in the client's chart on the 14th postpartum day indicates a normal involution process?
a. Moderate bright red lochial flow
b. Breasts firm and tender
c. Fundus below the symphysis and not palpable
d. Episiotomy slightly red and puffy
C
The fundus descends 1 cm/day, so by postpartum day 14 it is no longer palpable.
The lochia should be changed by this day to serosa.
Breasts are not part of the involution process.
The episiotomy should not be red or puffy at this stage.
You might also like to view...
Ethical dilemmas are inevitable in the conduct of scientific research
A) True B) False
The nurse is preparing to administer eardrops to a 5-year-old child. Nursing care is appropriate if which technique is used by the nurse?
a. Warm the eardrops in a microwave oven on low. b. Pull the auricle upward and outward. c. Apply eardrops to a cotton ball and insert them in the affected ear. d. Instruct the child to lie with the affected ear on a warm compress.
A nurse completes a thorough database and carries out nursing interventions based on priority diagnoses. Which action will the nurse take next?
a. Assessment b. Planning c. Implementation d. Evaluation
The nurse is caring for a client who is taking sucralfate (Carafate, Sulcrate) for treatment of a duodenal ulcer. Which assessment requires action by the nurse?
a. Sodium level 140 mEq/L b. Absent bowel sounds, hard abdomen c. Urinary output 30 mL/hr d. Calcium level 8.5 mg/dL