A nurse is caring for a male infant who has stools mixed with blood and mucus. The nurse should recognize that which of the following diagnoses is associated with these findings?

Rationale:

A. Displaced to the left is incorrect because a postpartum uterus that is displaced laterally, usually to the right or left, often indicates a full bladder. A displaced uterus cannot contract effectively, increasing the risk of postpartum hemorrhage, so this is an abnormal finding.

B. Above the umbilicus is incorrect because immediately after delivery, the uterus may be at or slightly above the umbilicus, but by 24 hours postpartum, it typically descends about 1 cm per day. A uterus significantly above the umbilicus 4–6 hours after birth is usually still within normal limits, but persistent elevation without involution may indicate uterine atony or retained placenta.

C. Soft and boggy located midway between the symphysis pubis and the umbilicus is incorrect because a boggy uterus (uterine atony) is abnormal. It indicates the uterus is not contracting effectively, which can lead to excessive bleeding and requires immediate intervention such as fundal massage.

D. Firm and midline is correct because a firm, midline uterus at or just below the umbilicus is the expected normal finding in the immediate postpartum period. A firm uterus indicates adequate uterine contraction and reduces the risk of hemorrhage. The nurse should continue to monitor for involution and signs of bleeding.

Rationale:

A. Absent bowel sounds is incorrect because bowel sounds are typically present and hyperactive in newborns with pyloric stenosis due to obstruction. Absent bowel sounds suggest paralytic ileus or peritonitis, which are not characteristic of pyloric stenosis.

B. Increased sodium levels is incorrect because infants with pyloric stenosis often develop hypochloremic metabolic alkalosis due to vomiting of gastric contents, leading to low chloride and sodium, not increased levels.

C. Golf ball-sized mass over the left quadrant is incorrect because the palpable mass associated with pyloric stenosis is typically located in the right upper quadrant of the abdomen. This mass is often described as an "olive-shaped" mass representing the hypertrophied pylorus.

D. Projectile vomiting after feedings is correct because this is the classic clinical manifestation of pyloric stenosis. The vomiting is non-bilious and forceful due to the narrowing of the pyloric sphincter, which prevents gastric emptying. Infants may appear hungry after vomiting and may experience weight loss, dehydration, and signs of malnutrition if the condition is untreated.