A nurse is collecting data from the perineal pad of a client who is 3 days postpartum. The nurse last checked the perineal pad 1 hour ago. There is 2 cm of red lochia on the pad.
Which of the following correctly documents the nurse's finding?
Heavy lochia alba.
Heavy lochia rubra.
Moderate lochia serosa.
Scant lochia rubra.
The Correct Answer is D
Choice A rationale
Heavy lochia alba is an incorrect choice as lochia alba typically occurs after 10 days postpartum and is characterized by a whitish or yellowish discharge, not red.
Choice B rationale
Heavy lochia rubra is an incorrect choice because lochia rubra is characterized by bright red bleeding but heavy lochia would involve saturation of the pad within an hour, which is not the case here.
Choice C rationale
Moderate lochia serosa is incorrect because lochia serosa is typically pink or brown and occurs from approximately day 4 to day 10 postpartum, not red.
Choice D rationale
Scant lochia rubra is correct as the client is 3 days postpartum with red lochia measuring 2 cm on the pad, which indicates a small amount of bleeding consistent with scant lochia rubra.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Rhythmic respirations indicate the client is using controlled breathing techniques to manage labor pain, which demonstrates effective coping. This method helps maintain oxygen levels and can reduce the perception of pain through focused breathing.
Choice B rationale
Crying during labor may indicate emotional distress or pain, suggesting the client might be struggling to cope effectively with labor. While it is a natural response, it is not typically associated with controlled coping mechanisms.
Choice C rationale
Lack of concentration can indicate that the client is overwhelmed by pain or anxiety, which may hinder her ability to use coping strategies effectively. It suggests she might be struggling to manage her labor experience.
Choice D rationale
Perspiration is a common physiological response to the exertion and stress of labor, but it does not specifically indicate how well the client is coping with labor pain or stress. It is a normal part of the labor process but not a clear sign of effective coping.
Correct Answer is D
Explanation
Choice A rationale
Heavy lochia alba is an incorrect choice as lochia alba typically occurs after 10 days postpartum and is characterized by a whitish or yellowish discharge, not red.
Choice B rationale
Heavy lochia rubra is an incorrect choice because lochia rubra is characterized by bright red bleeding but heavy lochia would involve saturation of the pad within an hour, which is not the case here.
Choice C rationale
Moderate lochia serosa is incorrect because lochia serosa is typically pink or brown and occurs from approximately day 4 to day 10 postpartum, not red.
Choice D rationale
Scant lochia rubra is correct as the client is 3 days postpartum with red lochia measuring 2 cm on the pad, which indicates a small amount of bleeding consistent with scant lochia rubra.
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