The postpartum nurse is caring for a client who gave birth to full-term twins earlier in the day. The nurse should assess for symptoms of:
1. Increased blood pressure.
2. Hypoglycemia.
3. Postpartum hemorrhage.
4. Postpartum infection.
3
Rationale:
1. Increased blood pressure would cause vasoconstriction, and is not identified in this client.
2. Hypoglycemia would not be a usual assessment to make following delivery for the mother. Hypoglycemia would not be a concern just because of delivery of twins.
3. This client is at risk for hemorrhage due to overdistention of the uterus with twins and possible slower uterine involution.
4. Postpartum infection would be assessed through odor of lochia and uterine pain, and would not be expected this soon after delivery.
.
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