A 7-year-old client with a greenstick fracture of the forearm has a cast applied at the emergent care clinic.
Which home care information is most important for the practical nurse (PN) to reinforce with the parents?

The correct answer is Choice D.

Choice A rationale: This choice incorrectly counts four pregnancies. Scientifically, gravida includes all confirmed pregnancies, but only those that actually occurred. The client has had one miscarriage, one fetal demise, and is currently pregnant—totaling three pregnancies. Counting four would imply an additional pregnancy that did not occur. Overestimating gravida can lead to inaccurate obstetric records and misinterpretation of reproductive history, which may affect clinical decision-making and risk assessment.

Choice B rationale: This choice undercounts the total number of pregnancies by only including two. It likely omits either the miscarriage or the current pregnancy. Scientifically, all pregnancies are counted in gravida, regardless of gestational age or outcome. Miscarriages and fetal demises are included. Underreporting gravida can lead to incomplete obstetric history, which may compromise prenatal care and risk evaluation during labor and delivery.

Choice C rationale: This choice significantly underestimates the gravida by counting only one pregnancy. It may reflect a misunderstanding that only the current or viable pregnancies are included. However, from a clinical standpoint, gravida includes all pregnancies, including those that ended in miscarriage or fetal demise. Accurate gravida documentation is essential for assessing maternal risk factors and planning appropriate obstetric care.

Choice D rationale: This is the correct interpretation. The client has had three pregnancies: one miscarriage at 16 weeks, one fetal demise at 31 weeks, and the current pregnancy at 39 weeks. Scientifically, gravida includes all pregnancies regardless of outcome. This total of three pregnancies makes her gravida 3. Accurate documentation of gravida is crucial for understanding reproductive history and guiding prenatal and intrapartum care.

Choice A rationale

A soft, spongy fundus, often described as boggy, indicates uterine atony. This condition means the uterine muscles are not contracting effectively, which is abnormal postpartum and significantly increases the risk of postpartum hemorrhage due to inadequate compression of uterine blood vessels.

Choice B rationale

Unilateral lower leg pain, especially accompanied by warmth, redness, or swelling, is an abnormal finding and can be indicative of a deep vein thrombosis (DVT). Postpartum women are at an increased risk for DVT due to hypercoagulability and venous stasis, making this a critical assessment requiring immediate attention.

Choice C rationale

Saturating two perineal pads per hour is an excessive amount of lochia and suggests postpartum hemorrhage. Normal lochia flow should not saturate more than one pad per hour in the immediate postpartum period, indicating that the uterus is not contracting adequately to control bleeding.

Choice D rationale

A heart rate of 56 beats/minute, also known as puerperal bradycardia, is considered a normal physiological finding for a primigravida client 12 hours postpartum. This transient bradycardia often occurs due to the increased stroke volume and cardiac output that result from the significant decrease in uterine blood flow after delivery.