A nurse is providing education to a new mother about kangaroo care for her premature infant in the neonatal intensive care unit (NICU). Which statement by the mother demonstrates a good understanding of kangaroo care?

Choice A rationale

Uterine atony, the lack of uterine muscle tone, is the most common cause of immediate postpartum hemorrhage (PPH). The boggy (soft, not firm) and displaced fundus (to the right) strongly suggest the uterus is not contracting effectively, which allows blood vessels at the placental site to bleed freely. Furthermore, a distended bladder due to incomplete or infrequent voiding (last void 4 hours ago) can physically displace the uterus, impairing its ability to contract and leading to atony, heavy bleeding, and clot formation.

Choice B rationale

While a bleeding disorder can cause PPH, it is less likely to be the primary cause when classic signs of uterine atony are present. A bleeding disorder would typically be associated with generalized bleeding from all sites and possibly abnormal coagulation lab values (e.g., prolonged PT/INR, PTT, low platelet count-normal: 150,000-450,000/μ L). The physical assessment findings of a boggy, displaced fundus are more indicative of a mechanical issue with uterine contraction.

Choice C rationale

A 4th-degree laceration extends through the anal sphincter and rectal mucosa, causing pain and a risk for infection or dehiscence. While it contributes to overall blood loss, it typically causes steady, bright red bleeding despite a firm fundus. The fundal displacement and boggy consistency with large clots are the hallmark signs pointing away from the laceration as the primary source of the current heavy bleeding.

Choice D rationale

A hematoma is a collection of blood in the connective tissue, often in the vagina or perineum, characterized by severe pain, pressure, and possibly a tense, firm, bulging mass. While the patient is sore, the main concern here is the heavy vaginal bleeding accompanied by the boggy and displaced fundus. A hematoma generally does not cause the profuse, clot-filled bleeding that results from uterine atony. —.

Choice A rationale

Administering psychotropic medication based solely on mild, transient mood symptoms, particularly without a provider's order or a formal psychiatric diagnosis, is inappropriate nursing practice. The symptoms described are more consistent with the common "baby blues," which are transient, self-limiting mood disturbances linked to hormonal shifts and adjustment; medication is typically reserved for diagnosed, persistent postpartum depression. Normal postpartum hormonal fluctuations (estrogen, progesterone) significantly contribute to this emotional lability, making non-pharmacological support the initial appropriate action.

Choice B rationale

An Edinburgh Postnatal Depression Scale (EPDS) score of 3 is very low (normal range is 0–9; a score of ≥10 or an affirmative answer to question 10 suggests a need for follow-up) and does not meet the criteria for immediate referral for postpartum depression. The symptoms are more likely the self-limiting "baby blues," which affect 50-80.

Choice C rationale

The described symptoms—tearfulness, anxiety, and feelings of inadequacy—along with the low EPDS score (3), are classic signs of "baby blues" (postpartum blues), a normal, transient condition peaking around day 4-5 and resolving by two weeks. The nurse's role is to provide empathetic reassurance, validation, and education about this common physiological and psychological adjustment to the sudden drop in estrogen and progesterone. This offers emotional support, which is the most appropriate initial intervention.

Choice D rationale

While anxiety may suggest fear, the conclusion that the client requires an extra hospital day is a presumptive and potentially inappropriate advocacy without a complete assessment or discussion. Hospital stays are determined by medical stability and established protocols. The primary intervention for the "baby blues" is psychoeducation and support, not necessarily an extension of the hospitalization, as the condition resolves spontaneously at home. —.