Which fundal assessment finding at 12 hours after birth requires ...

[123654777]

Which fundal assessment finding at 12 hours after birth requires further assessment?
 
  a. The fundus is palpable at the level of the umbilicus.
  b. The fundus is palpable two fingerbreadths above the umbilicus.
  c. The fundus is palpable one fingerbreadth below the umbilicus.
  d. The fundus is palpable two fingerbreadths below the umbilicus.

Question 2

Which client would be most likely to have severe afterbirth pains and request a narcotic analgesic?
 
  a. Gravida 5, para 5
  b. Primipara who delivered a 7-lb boy
  c. Client who is bottle feeding her first child
  d. Client who wishes to breastfeed as soon as her baby is out of the neonatal intensive care unit

[lorealeza]

Answer to Question 1

ANS: B
The fundus rises to the umbilicus after birth and remains there for about 24 hours. A fundus that is above the umbilicus may indicate uterine atony or urinary retention. The fundus palpable at the umbilicus is an appropriate assessment finding for 12 hours postpartum. The fundus palpable one fingerbreadth below the umbilicus is an appropriate assessment finding for 12 hours postpartum. The fundus palpable two fingerbreadths below the umbilicus is an unusual finding for 12 hours postpartum, but is still appropriate.

Answer to Question 2

ANS: A
The discomfort of afterpains is more acute for multiparas because repeated stretching of muscle fibers leads to loss of uterine muscle tone. The uterus of a primipara tends to remain contracted. Afterpains are particularly severe during breastfeeding, not bottle feeding. The non-nursing mother may have engorgement problems. She should empty her breasts regularly to stimulate milk production so she will have the milk when the baby is strong enough to nurse.