A nurse is evaluating a postpartum woman’s knowledge about pain management after birth.

The nurse asks the woman what she would do if she has uterine cramping while breastfeeding her baby.

Which response by the woman indicates a need for further teaching?

The correct answer is choice C) Administer oxytocin (Pitocin).Oxytocin is a hormone that stimulates uterine contractions and helps reduce postpartum bleeding by closing off the blood vessels that were attached to the placenta.

The nurse should administer oxytocin as ordered by the provider to help the client’s uterus contract and prevent hemorrhage.

Choice A) Document findings as normal is wrong because moderate bleeding with bright red blood and small clots is not normal for lochia flow 2 days after delivery.Lochia is the vaginal discharge that occurs after birth and consists of blood, tissue, mucus and bacteria.Lochia should be dark or bright red for the first 3 to 4 days, but the flow should be light and there should be no clots.Moderate bleeding with bright red blood and small clots indicates that the client may have retained placental fragments or uterine atony.

Choice B) Massage fundus until it becomes firm is wrong because the fundus is already firm, midline and at the level of the umbilicus, which indicates that the uterus is contracted properly.Massaging the fundus when it is already firm can cause more bleeding and pain.

Choice D) Increase IV fluid rate is wrong because increasing IV fluid rate will not stop the bleeding or address the underlying cause.Increasing IV fluid rate may also cause fluid overload or dilutional coagulopathy.The nurse should monitor the client’s vital signs, urine output and hematocrit levels to assess for signs of hypovolemia or anemia due to blood loss.

The correct answer is D) Decreased white blood cell count.Postpartum endometritis is an infection of the lining of the uterus that causes fever, abdominal pain, uterine tenderness and sometimes discharge.It is usually caused by bacteria from the lower genital or gastrointestinal tract.White blood cell count is a marker of inflammation and infection, so a decreased white blood cell count indicates that the treatment is effective and the infection is resolving.

A) Decreased vaginal bleeding is not a sign of effective treatment for postpartum endometritis.

Vaginal bleeding after delivery is normal and gradually decreases over time.It is not related to the infection of the uterus.

B) Increased abdominal pain is a sign of worsening infection, not effective treatment.Abdominal pain is one of the symptoms of postpartum endometritis and should improve with antibiotic therapy.

C) Increased temperature is also a sign of worsening infection, not effective treatment.Fever is another symptom of postpartum endometritis and should decrease with antibiotic therapy.