A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period.
When the nurse locates the fundus, she notes that the uterus feels soft and boggy at midline.
Which of the following nursing interventions would be most appropriate initially?

Choice A rationale

While understanding methods of labor induction is important if the pregnancy progresses to 42 weeks, it is not the priority teaching at 31 weeks gestation. The immediate focus should be on recognizing potential complications that could arise before the scheduled induction.

Choice B rationale

The benefits of breastfeeding are important for all pregnant women but are not the priority teaching for a client at 31 weeks who is not yet in labor. Information about breastfeeding can be provided later in the pregnancy.

Choice C rationale

Teaching the signs of labor is important as the client approaches term, but at 31 weeks, the priority is to educate the client on recognizing potential warning signs that require immediate attention, such as decreased fetal movement.

Choice D rationale

Monitoring fetal movement is a crucial teaching point at 31 weeks gestation. A decrease in fetal movement can be an early indicator of fetal compromise and requires prompt evaluation. Instructing the client on how to perform kick counts and when to report changes is a priority for ensuring fetal well-being before the scheduled induction.

The nurse should first address the client’s calf findings followed by their stress about discharge.

Rationale for correct answers

Calf findings must be addressed first due to the risk of deep vein thrombosis (DVT), which is a known complication of cesarean delivery and postpartum immobility. The presence of unilateral calf edema (3 cm greater than the right) and tenderness, combined with an elevated D-dimer, strongly suggests a thrombotic process requiring urgent evaluation. If DVT is confirmed, anticoagulation therapy should be initiated promptly to prevent progression to pulmonary embolism.

Stress about discharge should be the second priority, as emotional concerns can affect adherence to postpartum care instructions. Addressing anxiety about recovery, follow-up visits, and newborn care can improve the client’s overall well-being and readiness for discharge.

Rationale for incorrect Response 1 options

• Breast engorgement: Although uncomfortable, this is a transient issue that can be managed with cold compresses and supportive bras. It does not pose an immediate health risk.
• Constipation: Postpartum bowel irregularities are expected after cesarean delivery; stool softeners and hydration can alleviate symptoms without urgency.
• Surgical incision pain: Rated only 2/10, indicating mild pain that does not require immediate intervention beyond routine analgesia.