A nurse is assessing a 1-hour-old newborn.
Which of the following findings should the nurse report to the provider?

The nurse should first monitor the client’s fundal tone followed by the client’s heart rate.

Rationale for correct answers
Fundal tone is the primary indicator of uterine contractility. A boggy fundus that does not firm with massage indicates uterine atony, the most common cause of postpartum hemorrhage (PPH). Effective uterine contraction compresses uterine blood vessels to reduce bleeding. Monitoring fundal tone allows early identification of hemorrhage risk. Heart rate is a sensitive early sign of hypovolemia; a rising heart rate (tachycardia above 100 beats/min) reflects compensatory response to blood loss before blood pressure drops. Normal adult heart rate ranges from 60 to 100 beats/min; an increase indicates circulatory stress.

Rationale for incorrect answers
Bruising to perineal area (A) is important but secondary; it does not directly assess bleeding severity or uterine status. Pain level (C) is subjective and can be influenced by many factors; it does not reliably indicate hemorrhage. Uterine height (D) measures fundal location but does not assess firmness or tone, which are critical for detecting atony. Temperature (B) changes are not immediate indicators of bleeding. Pain level (C) and uterine height (D) similarly lack specificity for hemorrhage assessment compared to fundal tone and heart rate.

Take home points

• Fundal tone assessment is critical for early detection of uterine atony causing postpartum hemorrhage.
• Tachycardia is an early physiological sign of hypovolemia and should be closely monitored.
• Perineal bruising and pain are secondary findings and less specific to hemorrhage severity.
• Uterine height and temperature changes do not reliably indicate acute hemorrhage status.

Choice A rationale

A BUN level of 25 mg/dL is above the normal range of 10 to 20 mg/dL for pregnant clients. Elevated BUN can indicate impaired renal function, which can be a complication of pregnancy, particularly in conditions like preeclampsia or underlying kidney disease. This finding, especially in a client with a history of anemia, warrants further investigation as it suggests potential kidney compromise affecting waste product excretion.

Choice B rationale

A hemoglobin (Hgb) level of 10.2 mg/dL is slightly below the normal range of 11 to 16 mg/dL for pregnant clients. Given the client's history of anemia, this finding is consistent with their known condition and, while it indicates mild anemia, it might not necessarily represent a new acute prenatal complication requiring immediate report unless there is a significant drop or associated symptoms. Iron supplementation is typically initiated for this level.

Choice C rationale

A fasting blood glucose of 70 mg/dL is within the normal range of 70 to 110 mg/dL. This indicates adequate glucose regulation and does not suggest a prenatal complication such as gestational diabetes. Maintaining a normal fasting blood glucose is a positive indicator for maternal and fetal well-being, especially for a client without a history of diabetes.

Choice D rationale

A hematocrit (Hct) level of 32% is slightly below the normal range of 33 to 47% for pregnant clients. Similar to hemoglobin, a slightly low hematocrit is common in pregnancy due to hemodilution, where plasma volume increases more significantly than red blood cell mass. While it indicates mild physiological anemia, it is often managed with dietary adjustments or iron supplements and does not typically signify an acute prenatal complication requiring immediate report.